The airway comes first
Mouth opening, Mallampati view, thyromental distance, neck movement, dentition, and any history of a difficult intubation. No single test predicts a difficult airway well; a combination shifts your probability, and a previous difficult intubation is worth all of them put together. Ask directly whether anyone has ever had trouble with a breathing tube.
Exercise tolerance is the cardiac test
A patient who climbs two flights of stairs without stopping has told you more about their cardiorespiratory reserve than most investigations will. Metabolic equivalents above four predict a low perioperative cardiac risk. Where the history is unclear or the surgery is major, formal testing earns its place.
The drug history has three parts
What they take, what they must not stop, and what must stop. Beta blockers and statins continue. Anticoagulants and antiplatelets are timed against the bleeding risk and any planned neuraxial block. Ask about herbal preparations and recreational drugs, both of which change what you will need.
Fasting, and the myth of the strict fast
Six hours for solids, six for formula milk, four for breast milk, two for clear fluids. Prolonged fasting does not empty a stomach further; it just dehydrates the patient. Encouraging clear fluids up to two hours before improves comfort and haemodynamics.
The plan is a conversation
Anaesthetic technique, analgesic plan, expected recovery, and the risks that matter to this patient. Sore throat and nausea are common and worth mentioning. Awareness, dental damage, nerve injury and anaphylaxis are rare and worth naming honestly rather than burying.
Watch it done
Arterial line placement
Radial arterial cannulation, palpation and ultrasound, and the transducer set-up.
Source: OPENPediatrics · Watch on YouTube