This chapter reviews the role and importance of preoperative assessment and evaluation. Preoperative assessments are designed to prepare patients to undergo anesthesia and surgery while incurring as little risk as possible. The preoperative assessment gives the opportunity to collect patient information (through patient and/or family interviews centered on medical and anesthesia histories and medication lists, identify and stratify the risk in the hope of mitigating it by optimization of the patient’s conditions. Assessing the patient’s medical and surgical risks in the context of evidence-based guidelines is used to implement rational decision making when ordering appropriate additional workup (such as lab work or cardiac or pulmonary testing). Education regarding what to expect and how to prepare for anesthesia and surgery may also reduce the patient’s and family’s anxiety.

Premedication is often used to alleviate many complications or anxieties related to anesthesia and surgery. Common premedications aim to alleviate preoperative anxiety, preoperative or postoperative pain, or postoperative nausea or vomiting (PONV). This chapter reviews the most commonly used premedications, their mechanism of action, physiological effects, metabolism, and concerns with different metabolic states and coinciding medical conditions.