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1 evaluating the patient before the anesthesia(2009.2.23 27)
 

1 evaluating the patient before the anesthesia(2009.2.23 27)

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    1 evaluating the patient before the anesthesia(2009.2.23 27) 1 evaluating the patient before the anesthesia(2009.2.23 27) Presentation Transcript

    • Evaluating the Patient Before Anesthesia PENG Shuling Second Affiliated Hospital Sun Yat-sen University
    • 1846 年 10 月 16 日乙醚第一次用于临床麻醉
    • What is anesthesia?
    • Anesthesiology definition The management of procedures for rendering a patient insensible to pain and emotional stress during surgical, obstetrical, and certain medical procedures . The support of life functions under the stress of anesthesia and surgical manipulations.
    • Anesthesiology
      • Clinical anesthesia
      • Pain management
      • First-aid and resuscitation
      • Intensive care
    • Anesthesiology Classification
      • General anesthesia: A. Inhalation anesthesia B. Intravenous anesthesia ( intramuscular )
      • Regional anesthesia: spinal (subarachnoid) block epidural block (caudal block) nerve (brachial) plexus block local infiltration
    • Others
      • Deliberate hypotension
      • Deliberate hypothermia
      • Acute normovolemic hemodilution
    • Anesthesia procedures
      • Preoperative evaluation and
      • premedication
      • 2. Anesthesia induction
      • 3. Anesthesia maintenance
      • 4. Anesthesia termination
      • 5. Recovery period
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      • Why should we perform a preoperative evaluation?
      Patient evaluated in PreOp Clinic
    • Basic effects of anesthesia on the body
      • Depression on ascending reticular activating system
      • Depression on medullar ( Res. and Cardiovas. center )
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    • The purposes and procedures of the preoperative visit(evaluation)
      • Establish rapport with the patient.
      • Obtain a history and perform a physical examination.
      • Assess the risks of anesthesia and surgery. To reduce perioperative morbidity and mortality.
      • Institute preoperative management. Order investigations and prescribe premedication.
      • Obtaining informed consent .
    • History.
      • Present surgical illness, presumptive diagnosis, initial treatment, and responses.
      • Coexisting medical illnesses.
      • Medications.
      • Allergies and drug reactions.
      • Anesthetic and surgical history.
      • Social history and habits.
      • Smoking , drugs and alcohol.
    • The physical examination
      • Vital signs : Height and weight , blood pressure , resting pulse , respirations .
      • Head and neck.
      • Heart & lungs.
      • Abdomen.
      • Back and extremities.
      • Neurologic examination.
    • Special investigations
      • Urinalysis
      • Hemoglobin, platelet and coagulation.
      • Serum electrolytes and urea
      • Chest X- ray and/or echocardiography
      • Electrocardiography
      • Respiratory function test
      • Blood gas analysis
    • Review of systems.
      • A recent history of an upper respiratory infection. Asthma and COPD.
      • Cardiovascular system.
      • Hepatic and renal status.
      • Endocrine status.
      • Neurologic status.
    • ASA Classification ( physical status index )
      • Normal,healthy Ⅰ
      • Mild systemic disease Ⅱ
      • Severe systemic disease that limits activity but is not incapacitating Ⅲ
      • Incapacitating systemic disease that is constant threat to life Ⅳ
      • Moribund; not expected to survive 24 hours with or without operation Ⅴ
    • Talk with the patient and family
      • Anesthetic plan and Alternatives.
      • Plan for postoperative pain control.
      • Special IV or other manipulation.
      • Risks associated with anesthesia-related procedures.
      • Blood transfusion.
    • Drugs used for remedication
      • sedatives and analgesics
      • Anticholinergics
      • Antiemetic agents
      • Medicine for preexisting medical conditions
      • Sedation, hypnosis and amnesia , analgesia,
      • reducing salivation and bronchial secreton,
      • blocking vagal reflex
    • ASA guidelines for NPO status preoperatively
      • Fasting for 6 hours preoperatively
      • No clear liquid drinking for 2 hours preoperatively
      • No milk for children 4 hours preoperatively
      • No meat 8 hours preoperatively
    • Two broad questions
      • Is the patient in optimum condition for anesthesia?
      • Is the patient in hi-risk in anticipated surgery or anesthesia?
    • Common causes for d elaying surgical procedures.
      • Acute upper respiratory tract infection ( common cold ).
      • Existing medical disease which is not under optimum control.
      • Recent ingestion of food or liquid.
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    • Active cardiac conditions
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    • Clinical risk factors
    • 谢谢!