非住院病人的麻醉OutpatientAnesthesia非住院病人的麻醉OutpatientAnesthesia1BenefitsofAmbulatorySurgeryPatientpreference,especiallychildrenandelderlyLackofdependenceonavailabilityofhospitalbedsGreaterflexibilityinschedulingoperationsLowmorbidityandmortalityLowerincidenceofinfectionBenefitsofAmbulatorySurgery2LowerincidenceofrespiratorycomplicationsHighervolumeofpatients(greaterefficiency)ShortersurgicalwaitinglistsLoweroverallproceduralcostsLesspreoperativetestingandpostoperativemedicationBenefitsofAmbulatorySurgeryLowerincidenceofrespiratory3PatientSelectionDurationofsurgeryLessthan90minutesPatientcharacteristicsMalignanthyperthermiasusceptibilityObserveforatleast4hourspostoperativelyExtremesofageAgealoneshouldnotbeconsideredadeterrentintheselectionPatientSelectionDurationofs4ContraindicationstoOutpatientSurgerySerious,potentiallylife-threateningdiseasesthatarenotoptimallymanaged(ASAⅢ～Ⅳ):brittlediabetes,unstableangina,symptomaticasthmaMorbidobesitycomplicatedbyhemodynamicorrespiratoryproblemsDrugtherapy:monoamineoxidaseinhibitors;acutesubstanceabuseContraindicationstoOutpatien5ContraindicationstoOutpatientSurgeryEx-prematureinfantslessthan60weekspostconceptualageLackofaresponsibleadultathometocareforthepatientontheeveningaftersurgeryContraindicationstoOutpatien6非住院病人的麻醉課件7PreoperativePreparationAimedatreducingtherisksinherentinambulatorysurgery,improvingpatientoutcome,andmakingthesurgicalexperiencepleasantforthepatientandfamilyPreoperativePreparationAimed8PreoperativePreparationPrepatationshouldminimizepatientanxietythrough

pharmacologicandnon-pharmacologic

meansandshouldreducepotentialpostoperativeproblemsbyuseofappropriatepremedicationPreoperativePreparationPrepat9NonpharmacologicPreparationNonpharmacologicPreparation10PharmacologicprepatationAnixolysisandsedationAnalgesicsPreventionofnauseaandvomitingPreventionofaspirationpneumonitisPharmacologicprepatationAnixo11Nothing-by-mouthGuidelinesNothing-by-mouthGuidelines12AnetheticTechniquesQuality,safety,efficiency,andthecostofdrugsandequipmentareimportantconsiderationsinchoosingananesthetictechniqueforoutpatientsurgeryAnetheticTechniquesQuality,s13AnetheticTechniquesTheabilitytodeliverasafeandcost-effectivegeneralanestheticwithminimalsideeffectsandrapidrecoveryiscriticalinabusyoutpatientsurgeryunitGeneralanesthesiaremainsthemostwidelyusedanesthetictechniqueformanagingambulatorysurgeryAnetheticTechniquesTheabilit14SpecificconsideratinsinGeneralAnesthesiaAirwaymanagementIntravenousanestheticdrugsInhaledanestheticdrugsAnalgesicsMusclerelaxantsReversalofdrugeffectsSpecificconsideratinsinGene15RegionalanesthesiaMonitoredanesthesiacare(MAC)Regionalanesthesia16DischargeCriteriaVitalsignsAmbulationNauseaandvomitingPainSurgicalbleedingDischargeCriteriaVitalsigns17麻醉后監(jiān)測治療室PostanestheticCareUnit(PACU)麻醉后監(jiān)測治療室PostanestheticCareUn18主要任務收治對象當日全麻病人術后未蘇醒者非全身麻醉后病人情況尚未穩(wěn)定者麻醉后神經功能未恢復者目的監(jiān)護和治療病人在麻醉恢復過程中所出現的生理功能紊亂與ICU的區(qū)別麻醉蘇醒期的監(jiān)護和治療，短時間、一般性的麻醉恢復主要任務收治對象19PACU處理的常見問題呼吸道梗阻通氣不足低氧血癥低血壓高血壓心律失常惡心、嘔吐低溫神志觀察PACU處理的常見問題呼吸道梗阻20離開恢復室的標準呼吸循環(huán)神志椎管內麻醉平面穩(wěn)定離開恢復室的標準呼吸21PACU的設置和管理設置足夠的照明足夠的空間足夠的裝備必備的藥物管理PACU的設置和管理設置22呼吸道梗阻上呼吸道梗阻舌后墜上呼吸道分泌物聚積咽或喉梗阻喉頭水腫下呼吸道梗阻呼吸道分泌物、嘔吐物、血液和膿液等阻塞下呼吸道支氣管痙攣呼吸道梗阻上呼吸道梗阻23麻醉蘇醒期終止給予麻醉藥物至病人清醒的時間，可分為下面四個時相感覺和運動功能逐步恢復出現自主呼吸，并能逐漸自行調控呼吸道反射恢復清醒麻醉蘇醒期終止給予麻醉藥物至病人清醒的時間，可分為下面四個時24非住院病人的麻醉課件25SveralintravenousanestheticsforuseduringambulatoryanesthesiaSveralintravenousanesthetics26非住院病人的麻醉課件27非住院病人的麻醉課件28非住院病人的麻醉課件29Intermidiaterecoveryafterpropofol,desflurane(±N2O),orpropofol-desfluraneanesthesiaIntermidiaterecoveryafterpr30Postoperativenauseaafterpropofol,deflurane,orprofofol-defluraneanesthesiaPostoperativenauseaafterpro31RiskFactorsforPostoperativeNauseaandVomitingPredisposingfactorsIncreasedgastricvolumeAnesthetictechniqueSurgical/diagnosticprocedurePostoperativefactorsRiskFactorsforPostoperative32非住院病人的麻醉課件33非住院病人的麻醉OutpatientAnesthesia非住院病人的麻醉OutpatientAnesthesia34BenefitsofAmbulatorySurgeryPatientpreference,especiallychildrenandelderlyLackofdependenceonavailabilityofhospitalbedsGreaterflexibilityinschedulingoperationsLowmorbidityandmortalityLowerincidenceofinfectionBenefitsofAmbulatorySurgery35LowerincidenceofrespiratorycomplicationsHighervolumeofpatients(greaterefficiency)ShortersurgicalwaitinglistsLoweroverallproceduralcostsLesspreoperativetestingandpostoperativemedicationBenefitsofAmbulatorySurgeryLowerincidenceofrespiratory36PatientSelectionDurationofsurgeryLessthan90minutesPatientcharacteristicsMalignanthyperthermiasusceptibilityObserveforatleast4hourspostoperativelyExtremesofageAgealoneshouldnotbeconsideredadeterrentintheselectionPatientSelectionDurationofs37ContraindicationstoOutpatientSurgerySerious,potentiallylife-threateningdiseasesthatarenotoptimallymanaged(ASAⅢ～Ⅳ):brittlediabetes,unstableangina,symptomaticasthmaMorbidobesitycomplicatedbyhemodynamicorrespiratoryproblemsDrugtherapy:monoamineoxidaseinhibitors;acutesubstanceabuseContraindicationstoOutpatien38ContraindicationstoOutpatientSurgeryEx-prematureinfantslessthan60weekspostconceptualageLackofaresponsibleadultathometocareforthepatientontheeveningaftersurgeryContraindicationstoOutpatien39非住院病人的麻醉課件40PreoperativePreparationAimedatreducingtherisksinherentinambulatorysurgery,improvingpatientoutcome,andmakingthesurgicalexperiencepleasantforthepatientandfamilyPreoperativePreparationAimed41PreoperativePreparationPrepatationshouldminimizepatientanxietythrough

pharmacologicandnon-pharmacologic

meansandshouldreducepotentialpostoperativeproblemsbyuseofappropriatepremedicationPreoperativePreparationPrepat42NonpharmacologicPreparationNonpharmacologicPreparation43PharmacologicprepatationAnixolysisandsedationAnalgesicsPreventionofnauseaandvomitingPreventionofaspirationpneumonitisPharmacologicprepatationAnixo44Nothing-by-mouthGuidelinesNothing-by-mouthGuidelines45AnetheticTechniquesQuality,safety,efficiency,andthecostofdrugsandequipmentareimportantconsiderationsinchoosingananesthetictechniqueforoutpatientsurgeryAnetheticTechniquesQuality,s46AnetheticTechniquesTheabilitytodeliverasafeandcost-effectivegeneralanestheticwithminimalsideeffectsandrapidrecoveryiscriticalinabusyoutpatientsurgeryunitGeneralanesthesiaremainsthemostwidelyusedanesthetictechniqueformanagingambulatorysurgeryAnetheticTechniquesTheabilit47SpecificconsideratinsinGeneralAnesthesiaAirwaymanagementIntravenousanestheticdrugsInhaledanestheticdrugsAnalgesicsMusclerelaxantsReversalofdrugeffectsSpecificconsideratinsinGene48RegionalanesthesiaMonitoredanesthesiacare(MAC)Regionalanesthesia49DischargeCriteriaVitalsignsAmbulationNauseaandvomitingPainSurgicalbleedingDischargeCriteriaVitalsigns50麻醉后監(jiān)測治療室PostanestheticCareUnit(PACU)麻醉后監(jiān)測治療室PostanestheticCareUn51主要任務收治對象當日全麻病人術后未蘇醒者非全身麻醉后病人情況尚未穩(wěn)定者麻醉后神經功能未恢復者目的監(jiān)護和治療病人在麻醉恢復過程中所出現的生理功能紊亂與ICU的區(qū)別麻醉蘇醒期的監(jiān)護和治療，短時間、一般性的麻醉恢復主要任務收治對象52PACU處理的常見問題呼吸道梗阻通氣不足低氧血癥低血壓高血壓心律失常惡心、嘔吐低溫神志觀察PACU處理的常見問題呼吸道梗阻53離開恢復室的標準呼吸循環(huán)神志椎管內麻醉平面穩(wěn)定離開恢復室的標準呼吸54PACU的設