Anesthesia outside the operating roomPresentation Transcript
Anesthesia Outside of the Operating Room Yujuan Li The Second Affiliated Hospital of Sun-yet Sen University [email_address]
Nonoperating room anesthesia (NORA)
Anesthesia at remote location
Office-based anesthesia (OBA)
Number of NORA activities has increased rapidly( CT, MRI, neuroradiologic procedure or electroconvulsive therapy)
More Complex of the procedure, and situation and patients
Who does the sedation?
Mortality and Morbidity
Special problem of NORA
Limited working place, limited access to the patient,
Electrical interference with monitors and phones, lighting and temperature inadequacy,
Use outdated ,old equipment
Less familiar with the management of patients
Lack of skilled personnel, drugs and supples
ASA guidelines for NORA patients
AAP guidelines for NORA pediatric patients
General anesthesia : tracheal intubation or LMA
best prevention of motion
invasive, time and resource consuming,
less invasive ,cost and time saving
high rate of failure, high airway and respiratory depression
Conscious sedation versus monitored anesthesia care
Conscious sedation : a medically controlled state of depressed consciousness that allows protective reflexes to be maintained and retains the patient's ability to maintain a patent airway and to respond appropriately to physical and verbal stimulation.
MAC: an anesthesiologist provide specific anesthesia services to particular patients with local or no anesthesia who undergoing a planned procedure.
Levels of sedation
Drugs for paediatric sedation
II. Contrast media
Symptoms: skin reactions, airway obstruction, angioedema, and cardiovascular collapse.
Treatment: corticosteroids, H1 and H2 blockers. Oxygen, epinephrine, β2-agonists, and intubation , IV fluids
III. Anesthesia for CT
Use standard monitoring
Less anesthetic time
Higher levels of radiation exposure
IV. Anesthesia for MRI
A. Physical environment
High magnetic field
Need specialized compatible equipment
Metallic implants or implanted devices
Patients with implanted pacemakers, ICDs, or pulmonary artery catheters may not have MRI scans .
Relative contraindications: intracranial mass or aneurysm , recent myocardial infarction, angina, congestive heart failure, untreated glaucoma, major bone fractures, thrombophlebitis, pregnancy, and retinal detachment.
No Sedative premedication , Anticholinergic drugs and Ondansetron by individual.
Standard monitors (ECG, SPO 2 , BP)
Induced with methohexital and succinylcholine or Mivacurium ventilated with 100% oxygen via mask and Ambu bag. labetalol or esmolol when necessary
Place rolled gauze pads
5. Electroencephalogram (EEG) monitor duration
6. Patients ventilated with O 2
7. Some special attention : gastroesophageal reflux, severe cardiac dysfunction , intracranial mass lesions , pregnancy
8.Terminate seizure with propofol or enzodiazepines within 3 minutes