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Evaluating the Patient Before Anesthesia
PENG ShulingSecond Affiliated HospitalSun Yat-sen University
1846 年 10 月 16日乙醚第一次用于临床麻醉
What is anesthesia?
Anesthesiology definitionThe 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
1. Preoperative evaluation and
premedication
2. Anesthesia induction
3. Anesthesia maintenance
4. Anesthesia termination
5. Recovery period
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 )
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 delaying surgical procedures.
• Acute upper respiratory tract infection ( common cold ).
• Existing medical disease which is not under optimum control.
• Recent ingestion of food or liquid.
Active cardiac conditions
Clinical risk factors