1、Evaluating the Patient Before Anesthesia,PENG Shuling Second Affiliated Hospital Sun Yat-sen University,1846年10月16日乙醚第一次用于臨床麻醉,What is anesthesia?,Anesthesiology definition,The management of procedures for rendering a patient insensible to pain and emotional stress during surgical, obstetrical, and

2、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

3、 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,Preoperative evaluation and premedi

4、cation 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

5、( 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 preoperativ

6、e 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 hi

7、story and habits. Smoking, drugs and alcohol.,The physical examination,Vital signs: Height and weight, blood pressure, resting pulse, respirations. Head and neck. Heart not expected to survive 24 hours with or without operation ,Talk with the patient and family,Anesthetic plan and Alternatives. Plan

8、 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 amnesi

9、a , 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