[Verse 1]
Pull the chart before the patient takes a breath,
Read the history like you're mapping out a quest —
Surgeries, allergies, the medications penned,
Functional capacity from DASI or METs assessed
Can they climb two flights without stopping at the top?
Four METs or better means the workup doesn't stop there
ASA one through six, we stratify the risk,
Examine every system, don't let details slip the disc
[Chorus]
RCRI counts the cardiac flags — diabetes, failure, creatinine high,
Gupta and NSQIP MICA calculate MACE before the knife,
Apfel scores the nausea, STOP-BANG screens the airway tight,
History, exam, then risk indices — sequence it precise
Don't order bloods for ritual — order them with purpose and rationale,
Preop is the prologue to the anesthetic tale
[Verse 2]
ECG for known or suspected cardiac disease,
ACC slash AHA algorithm, follow the cascade please —
Stress testing only if results will change the plan,
Echo when you're hunting for the murmur contraband
PFTs when lung resection's on the surgical docket,
Pulmonary hypertension hiding — better fish it from the pocket
Routine testing is a vestigial act, an artifact of habit old,
Evidence-based selection is the standard we uphold
[Chorus]
RCRI counts the cardiac flags — diabetes, failure, creatinine high,
Gupta and NSQIP MICA calculate MACE before the knife,
Apfel scores the nausea, STOP-BANG screens the airway tight,
History, exam, then risk indices — sequence it precise
Don't order bloods for ritual — order them with purpose and rationale,
Preop is the prologue to the anesthetic tale
[Bridge]
Consent is not a signature, it's a conversation slow —
Disclose the risks proportional to what the patient ought to know,
Capacity means reasoning, not just saying yes or no,
In emergencies implied consent lets the anesthesiologist go
Advance directives, DNR — do they stand inside the OR?
Discuss it with the surgeon, with the patient at the door
Suspend or honor — document the rationale in full,
Autonomy is sacrosanct, never something you can dull
Premedicate with intention — anxiolytics, aspiration guard,
Ranitidine or sodium citrate if the stomach history's scarred
[Verse 3]
Prehabilitation — a proleptic word, anticipating strain,
Optimizing patients weeks before the operative campaign —
Smoking cessation six to eight weeks trims the pulmonary toll,
Anemia treated preop saves the transfusion toll
Nutritional status, albumin low, a healing wound impaired,
Iron, folate, B-twelve — replenish what's been spared
The preop clinic catches what the rushed consult might miss,
Frailty scores revealing who needs more than just this
[Outro]
History and exam, the fundament of every case,
Risk indices as lenses bringing hazard into place,
Informed consent the contract, premedication the grace,
Optimize before the drape — preparation is the base
Preop is the prologue to the anesthetic tale