The document outlines the objectives and components of an anesthesia and CPR course for medical students. It covers pre-anesthesia assessment, orientation to anesthesia equipment, post-operative care, ICU rounds, and the role of anesthesiologists in the pre-operative period. Key topics include pre-anesthesia evaluation, anesthesia principles, medical history taking, risk stratification, airway evaluation, preoperative testing, informed consent, and documenting the preoperative visit.

1. COURSE OUTLINESTHE FORMAT OF THE COURSEKNOWLEDE AND SKILLS THAT CAN BE GAINED.COURSE PROGRAMECOURE OBJECTIVESREQUIRE MATERIALS:TEXT BOOKS Anesthesia Rotation bookASSESSMENT

2. POLICY OF MISSED WORK (ATTENDENCE REQUIREMENT)FINAL EXAMCONTACT INFORMATION DEPARTMENT 71597 Dr walid tel 71816 Dr osama bleep 2158QUESTIONS

3. Clinical Objectives for Medical Students in (044) Anesthesia and CPR CourseAt the end of the course the student will be able to understand and practice: 1- Pre-anesthesia assessment and evaluationAble to take history from patientAble to open PAC System to get information and investigation.Interpretation of preoperative data relevant to anesthetic plan.Consultations

4. 2- Orientation with anesthesia equipment in O.R.Anesthesia machineAnesthesia circuitsLaryngoscopes – tubes – LMA – AirwaysEpidural set Spinal setMonitors - Anesthesia Record Anesthetics Drugs : I.V. drugs Inhalational & Muscle RelaxantsResuscitation Drugs During AnesthesiaCrystalloids & Colloids Fluids

5. 3- Post-operative Care Unit OrientationsCase Scenarios: Interactive Case Discussion

6. 4- Surgical ICU Rounds & Discussions aboutManagement of critically I’ll patientMonitoring of critically I’ll patientVentilatorsCommon Cases in ICU Head injury management Sepsis management

7. Role Of Anesthesiologist In pre-Opertiveperiod

9. AnesthesiaThe word is derived from the Greek words an, which means “without” and aithesia which means “feeling”The use of medical anesthesia was first reported in 1846The development of anesthesia has made today’s modern surgical techniques possible

10. Basic Principles of Anesthesia“Triad of General Anesthesia”need for unconsciousnessneed for analgesianeed for muscle relaxation and loss of reflexes

11. Anesthetic assessment andpreparation for surgery

12. Purposes of the Preoperative EvaluationObtain medical historyReview current physical statusOrder additional tests / consultationAnswer questions

13. Overview.The preanesthetic evaluation has specific objectives including:- Establishing a doctor-patient relationship, - Becoming familiar with the surgical illness and coexisting medical conditions,

14. Developing a management strategy for perioperative anesthetic care, - Obtaining informed consent for the anesthetic plan. The overall goals of the preoperative assessment are to reduce perioperative morbidity and mortality and to allay patient anxiety.

15. Stages of the Peri-Operative PeriodPre-OperativeFrom time of decision to have surgery until admitted into the OR theatre.

16. Stages of the Peri-Operative PeriodIntra-OperativeTime from entering the OR theatre to entering the Recovering Room or Post Anesthetic Care Unit (PACU)

17. Stages of the Peri-Operative PeriodPost-OperativeTime from leaving the RR or PACU until time of follow-up evaluation (often as out-patient)

18. Purposes of thePreoperative Evaluation Reassure patient / allay anxietyOrder preoperative medicationsObtain informed consentDocument the recordDevelop anesthetic care plan

19. Medical HistoryReview the chartReview previous recordsInterview the patient

20. The Chart ReviewDemographic DataHeight / weightVital signsDiagnosis

21. The Chart ReviewHistory and Physical ExamNote any abnormalitiesDon’t assume that all problems are listed

22. The Chart ReviewMedicationsRoutine medications at homeMeds ordered in hospitalLab / x-ray resultsConsultations

23. Old Hospital RecordsAvailable in same institutionPrevious diagnosisPrevious treatment

24. Old Hospital RecordsReview prior anesthesia recordInduction dosesAirway difficultyWork-up

25. Benefits from surgery ←-> Risk of complications

26. Age ObesitySmokingGeneral health statusChronic obstructive pulmonary disease (COPD)AsthmaPatient related risk factors(pulmonary)

27. SmokingImportant risk factorSmoking history of 40 pack years or more->↑risk of pulmonary complicationsstopped smoking < 2 months : stopped for > 2 months4:1(57% : 14.5%) quit smoking > 6 months : never smoked = 1:1 (11.9% : 11%)

29. Risk StratificationRevised Cardiac Risk Index High risk surgery (vascular, thoracic)Ischemic heart diseaseCongestive heart failureCerebrovascular diseaseInsulin therapy for diabetesCreatinine >2.0mg/dL

30. Active Cardiac ConditionsUnstable coronary syndromesUnstable or severe anginaRecent MIDecompensated HFSignificant arrhythmiasSevere valvular disease

31. Minor Cardiac PredictorsAdvanced age (>70)Abnormal ECGLV hypertrophyLBBBST-T abnormalitiesRhythm other than sinusUncontrolled systemic hypertension

33. Surgical Risk StratificationHigh Risk Vascular (aortic and major vascular)Intermediate RiskIntraperitonealand intrathoracic, carotid, head and neck, orthopedic, prostateLow RiskEndoscopic, superficial procedures, cataract, breast, ambulatory surgery

34. Risk StratificationASA physical statusASA 1 – Healthy patient without organic biochemical or psychiatric disease.ASA 2- A Patient with mild systemic disease. No significant impact on daily activity. Unlikely impact on anesthesia and surgery.ASA 3- Significant or severe systemic disease that limits normal activity. Significant impact on daily activity. Likely impact on anesthesia and surgery.

35. Risk StratificationASA 4- Severe disease that is a constant threat to life or requires intensive therapy. Serious limitation of daily activity.ASA 5- Moribund patient who is equally likely to die in the next 24 hours with or without surgery.ASA 6- Brain-dead organ donor“E” – added to the classifications indicates emergency surgery.

36. Step #1:Is the surgery emergent?yesIs the surgery emergent?Operating room*no(Next Step)Consider beta-blockade, pain controland other peri-operative management

37. Step 2: Determine Presence of Active Cardiac ConditionsIf none are present, proceed with surgeryPresence of one of these delays surgery for evaluationMany patients need a cardiac cath

38. Step 2Unstable coronary syndromesDecompensated heart failureSignificant arrhythmiasSevere valvular disease

39. Step #2: Active Cardiac ConditionsEvaluate and treat per current guidelinesyesActive Cardiac conditionsnoConsider Operating Room(Next Step)

40. Step 3: Surgery Low Risk?Low risk surgery includes:Endoscopic proceduresSuperficial proceduresCataract surgeryBreast surgeryAmbulatory surgeryCardiac risk <1%Testing does not change management

41. Step #3: Surgery Low Risk?yesOperating roomLow risk surgeryNo(Next Step)

42. Airway EvaluationTake very seriously history of prior difficultyHead and neck movement (extension)Alignment of oral, pharyngeal, laryngeal axesCervical spine arthritis or trauma, burn, radiation, tumor, infection, scleroderma, short and thick neck

44. Airway EvaluationJaw MovementBoth inter-incisor gap and anterior subluxation<3.5cm inter-incisor gap concerningInability to sublux lower incisors beyond upper incisorsReceding mandibleProtruding Maxillary Incisors (buck teeth)

45. Airway EvaluationOropharyngeal visualizationMallampati ScoreSitting position, protrude tongue, don’t say “AHH”

46. Preoperative TestingRoutine preoperative testing should not be ordered.Preoperative testing should be performed on a selective basis for purposes of guiding or optimizing perioperative management.

47. Preoperative Testing5Procedure based.Low riskBaseline creatinine if procedure involves contrast dye.Intermediate riskBase line creatinine if contrast dye or >55yr of age.High riskCBC, lytes & S, creatinine as above.PFTs for lung reduction surgery.

48. Preoperative TestingDisease-based indicationsAlcohol abuseCBC, ECG, lytes, LFTs, PTAnemiaCBCBleeding disorderCBC, LFTs, PT, PTTCardiovascularCBC, creatinine, CXR, ECG, lytes

49. Preoperative TestingDisease-based indicationsCerebrovascular diseaseCreatinine, glucose, ECGDiabetesCreatinine, electrolytes, glucose, ECGHepatic diseaseCBC, creatinine, lytes, LFTs, PTMalignancyCBC, CXR

50. Preoperative TestingDisease-based indicationsPregnancy (controversial)Serum B-hCG- 7 days, Upreg 3 daysPulmonary diseaseCBC, ECG, CXRRenal diseaseCBC, Cr, lytes, ECGRACBC, ECG, CXR, C-spine (atlantoaxialsubluxation)AP C-spine, AP odontoid view and lateral flexion and extention.

51. Preoperative TestingDisease-based Sleep apnea CBC, ECGSmoking >40 pack yearCBC, ECG, CXRSystemic LupusCr, ECG, CXR

52. Preoperative TestingTherapy-based indicationsRadiation therapyCBC, ECG, CXRWarfarinPTDigoxinLytes, ECG, Dig levelDiureticsCr, lytes, ECGSteroidsGlucose, ECG

53. Obtaining a ConsultAsk specific questions which you want answeredTalk directly to the consultant

54. Informed ConsentFrequently questioned in malpractice casesRisks / benefitsAlternativesAnswer all questionsDo not deceive the patient

55. Risks of AnesthesiaDetermine what the patient wants to know - Do not frighten patientsStart with minor risksProceed to serious risks

56. Risk associated with anesthesiaand surgeryThe question that patients askis ‘Doctor, what are the risks of having an anaesthetic?’These can be divided into two main groups.

57. MinorThese are not life threatening and can occur even when anaesthesia has apparently been uneventful. They include:• failed IV access;• cut lip, damage to teeth, caps, crowns;• sore throat;• headache;• postoperative nausea and vomiting;• retention of urine.

58. MajorThese may be life-threatening events. They include:• aspiration of gastric contents;• hypoxic brain injury;• myocardial infarction;• cerebrovascular accident;• nerve injury;• chest infection Death

59. Document the VisitComplete the evaluation formEnter progress notesHave patient sign consentWrite appropriate orders

60. Preanesthesia Clinic

61. Questions?