Pre-Anesthesia Questions

The pre-anesthesia questions you are asked will help prepare you for the anesthesia process and determine the best anesthetic technique for you. You will be specifically asked about your medical history, current medications, prior operations and allergies. Additional questions may include:

Download the Pre-Anesthesia Questions
(PDF document)

Quick Links: Anesthesia/Sedation Anesthesia Care Team Getting Ready for Surgery Pre-Anesthesia Questions Post Anesthesia Care Unit (Recovery Room) Billing Information

1. Have you recently had a cold or the flu?
2. Are you allergic to latex (rubber) products?
3. Have you experienced chest pain?
4. Do you have a heart condition?
5. Do you have hypertension (high blood pressure)?
6. Do you experience shortness of breath?
7. Do you have asthma, bronchitis, or any other breathing problem?
8. Do you (or did you) smoke? Packs/day _______
9. Number of years ______ Date you quit _________
10. Do you consume alcohol? Drinks/week _________
11. Do you take or have you taken recreational drugs?
12. Have you taken cortisone (steroids) in the last six months?
13. Do you have diabetes?
14. Have you had hepatitis, liver disease, jaundice?
15. Do you have a thyroid condition?
16. Do you have or have you had kidney disease?
17. Do you have ulcers or other stomach disorders?
18. Do you have a hiatal hernia?
19. Do you have numbness, weakness, or paralysis of your extremities?
20. Do you have any muscle or nerve disease?
21. Do you or any of your family have sickle cell trait?
22. Have you or any blood relatives had difficulties with anesthesia?
23. Do you have bleeding problems?
24. Do you have loose, chipped, false teeth, or bridgework?
25. Do you wear contact lenses?
26. Have you ever received a blood transfusion?
27. (Women) Are you pregnant? Due date__________________