Anaesthesia’s untapped public-health role: Expanding health screening in India

Hidden within routine preparation for surgery is one of India’s largest unrecognised health-screening exercises. Pre-anaesthesia assessment is primarily intended to improve perioperative safety, but it can also bring previously unrecognised health problems to light. National quality standards place it under anaesthesia services, rather than within a public health screening programme. Unlike screening under the National Programme for Prevention and Control of Non-Communicable Diseases, or NP-NCD, it lacks a programme-specific national screening target or reporting system. India does not currently appear to publish a national count of how many patients undergo pre-anaesthesia assessment each year.

On October 16, 1846, the public demonstration of ether anaesthesia at Massachusetts General Hospital changed surgery forever. World Anaesthesia Day commemorates that event. The demonstration also helped establish an image of the speciality that has proved hard to dislodge. The anaesthesiologist gives a drug, the patient becomes unconscious, the surgeon operates and the patient wakes. Much of what anaesthesiology has become in the 180 years since lies outside that frame.

“Before, During and Beyond Surgery” is the focus of World Anaesthesia Day in 2026. It is aligned with the World Federation of Societies of Anaesthesiologists’ 2026-2028 presidential theme, “Anaesthesiology Along the Patient Pathway”. The work of an anaesthesiologist extends far beyond the operating theatre, from assessing patients before surgery to looking after them in recovery, intensive care and pain services. For India, one practical way to carry this theme beyond surgery is to make fuller use of the pre-anaesthesia assessment.

The anaesthesiologist looks beyond the immediate reason for surgery. Pre-anaesthesia assessment includes reviewing the patient’s medical history and medicines, blood pressure, cardiovascular and respiratory status, functional capacity and relevant investigations. These factors can change the risks of anaesthesia and surgery, and affect how the patient is managed. An approaching operation may bring diabetes, anaemia, kidney disease or an unsuspected cardiovascular problem to clinical attention.

A patient may never have sought preventive care before coming to hospital with a hernia, a gallstone, a fracture or a tumour. The task of reaching that person, so often a difficulty for screening programmes, has already been accomplished. The assessment is undertaken to make surgery safer. This may be the first time a patient is found to have high blood pressure, raised blood sugar or another problem that could affect their care around surgery.

Studies from India over more than a decade have repeatedly shown that pre-anaesthesia assessment can uncover medical conditions patients did not know they had. Such assessments are part of routine perioperative care across hospitals in India, but there is no published national count of how many are performed each year.

India carries a formidable burden of chronic disease. The ICMR-INDIAB study estimated 101 million Indians were living with diabetes, another 136 million with prediabetes and around 315 million with hypertension. Knowing about the disease is itself a problem. An analysis of National Family Health Survey (NFHS-5) found that about 45 per cent of Indians aged 15 to 49 with hypertension did not know they had it. Among men with hypertension, roughly two in three were unaware.

India’s response is already enormous. Government figures published on April 21, 2026, recorded 41.5 crore screenings for hypertension and 41.3 crore for diabetes under the NP-NCD. The pre-anaesthesia clinic need not compete with that effort. It can help people who are already in hospital find their way into it.

A patient whose blood pressure is raised before surgery does not necessarily have chronic hypertension. A single abnormal glucose reading is not enough to diagnose diabetes. Even so, such a finding would still warrant attention. NP-NCD’s operational guidelines make provision for precisely this distinction. Suspected cases undergo further clinical assessment and investigation for confirmation, followed by treatment and follow-up when a diagnosis is established. At primary-care level, opportunistic screening includes blood-pressure measurement and blood-sugar estimation, with further clinical assessment and investigation of suspected cases.

At district hospitals, people with suspected or confirmed NCDs may be referred to the District NCD Clinic from other hospital outpatient departments. These clinics offer opportunistic screening to people of all age groups and the programme provides for referral, follow-up and digital records through the National NCD Portal.

The guidelines identify a wide range of settings for NCD screening, outreach and health promotion, including camps, schools, workplaces, community settings and even religious festivals. Yet anaesthesia does not appear in a screening context anywhere. That leaves the pre-anaesthesia clinic as an unaddressed opportunity.

Recognising it explicitly would be a modest correction. Significant NCD abnormalities found during pre-anaesthesia assessment could prompt referral of suspected or newly established cases into the existing programme. A documented handover would give the finding somewhere to go. Otherwise, too much rests on whether a patient remembers, after surgery, that somebody once told him his blood pressure or blood sugar was high.

The public health system already has NCD referral pathways that could serve this purpose, but the appropriate NCD service may not be available within every government hospital where patients undergo pre-anaesthesia assessment.

Government, private and charitable hospitals would need a clearly defined route, based on consent, to a continuing-care service for patients who want it. Screening, referral, diagnosis and follow-up are already supported by the National NCD Portal. The guidelines do not specify how findings from pre-anaesthesia assessment would enter that process.

That does not mean the anaesthesiologist takes over the long-term treatment of hypertension or diabetes. The responsibility remains perioperative care. But what should happen to information uncovered while providing that care? If it is important enough to alter the way a patient is prepared for surgery, it deserves a reliable handover once the operation is over.

The event commemorated every October 16 transformed care during an operation. One hundred and eighty years later, India has an opportunity to extend that benefit. The clinical encounter and the NCD programme already exist, as does much of the referral infrastructure.

The author is a clinical anaesthesiologist, researcher and founder of PreAnaesthesia.com, a patient education initiative.