《非住院病人的麻醉》最新ppt

1、非住院病人的麻醉Benefits of Ambulatory SurgeryPatient preference, especially children and elderlyLack of dependence on availability of hospital bedsGreater flexibility in scheduling operationsLow morbidity and mortalityLower incidence of infectionBenefits of Ambulatory SurgeryLower incidence of respiratory

2、complicationsHigher volume of patients (greater efficiency)Shorter surgical waiting listsLower overall procedural costsLess preoperative testing and postoperative medicationPatient SelectionDuration of surgeryLess than 90 minutesPatient characteristicsMalignant hyperthermia susceptibilityObserve for

3、 at least 4 hours postoperativelyExtremes of ageAge alone should not be considered a deterrent in the selectionContraindications to Outpatient SurgerySerious, potentially life-threatening diseases that are not optimally managed (ASA):brittle diabetes, unstable angina, symptomatic asthma Morbid obesi

4、ty complicated by hemodynamic or respiratory problemsDrug therapy: monoamine oxidase inhibitors; acute substance abuseContraindications to Outpatient SurgeryEx-premature infants less than 60 weeks postconceptual ageLack of a responsible adult at home to care for the patient on the evening after surg

5、eryPreoperative PreparationAimed at reducing the risks inherent in ambulatory surgery, improving patient outcome, and making the surgical experience pleasant for the patient and familyPreoperative PreparationPrepatation should minimize patient anxiety through pharmacologic and non-pharmacologic mean

6、s and should reduce potential postoperative problems by use of appropriate premedicationNonpharmacologic PreparationPharmacologic prepatationAnixolysis and sedationAnalgesicsPrevention of nausea and vomitingPrevention of aspiration pneumonitisNothing-by-mouth GuidelinesAnethetic TechniquesQuality, s

7、afety, efficiency, and the cost of drugs and equipment are important considerations in choosing an anesthetic technique for outpatient surgeryAnethetic TechniquesThe ability to deliver a safe and cost-effective general anesthetic with minimal side effects and rapid recovery is critical in a busy out

8、patient surgery unitGeneral anesthesia remains the most widely used anesthetic technique for managing ambulatory surgerySpecific consideratins in General AnesthesiaAirway managementIntravenous anesthetic drugsInhaled anesthetic drugsAnalgesicsMuscle relaxantsReversal of drug effectsRegional anesthes

9、iaMonitored anesthesia care(MAC)Discharge CriteriaVital signsAmbulationNausea and vomitingPainSurgical bleeding麻醉后監(jiān)測(cè)治療室Postanesthetic Care Unit (PACU)主要任務(wù)收治對(duì)象當(dāng)日全麻病人術(shù)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(jīng)功能未恢復(fù)者目的監(jiān)護(hù)和治療病人在麻醉恢復(fù)過程中所出現(xiàn)的生理功能紊亂與ICU的區(qū)別麻醉蘇醒期的監(jiān)護(hù)和治療，短時(shí)間、一般性的麻醉恢復(fù)PACU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、嘔吐低溫神志觀察離

10、開恢復(fù)室的標(biāo)準(zhǔn)呼吸循環(huán)神志椎管內(nèi)麻醉平面穩(wěn)定PACU的設(shè)置和管理設(shè)置足夠的照明足夠的空間足夠的裝備必備的藥物管理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麻醉蘇醒期終止給予麻醉藥物至病人清醒的時(shí)間，可分為下面四個(gè)時(shí)相感覺和運(yùn)動(dòng)功能逐步恢復(fù)出現(xiàn)自主呼吸，并能逐漸自行調(diào)控呼吸道反射恢復(fù)清醒Sveral intravenous anesthetics for use during ambulatory anesthesiaIntermidiate recovery after propofol, desflurane( N2O), or propofol-desflurane anesthesiaPostoperative nausea after propofol, deflurane, or profofol-deflurane anesthesia