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)

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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!