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