ANESTHESIOLOGY Peng Zhanglong Department of Anesthesiology Rui Jin Hospital Shanghai Second Medical University

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ANESTHESIOLOGYPeng Zhanglong Department of
Anesthesiology Rui Jin HospitalShanghai Second
Medical University
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Contents

1. The history of anesthesiology
2. The scope of anesthesiology
3. Classification of Anesthesia
4. Definition of Anesthesia
5. Preparing for anesthesia
6. Premedication

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The History of Anesthesiology

• Anesthetic practices date from ancient times
• Modern anesthesiology began in 1842 --- Ether was
  used as an anesthetic agent in humans.
• Modern anesthesiology only became firmly
  established less than six decades ago

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The History of Anesthesiology

• Modern inhalation anesthetics were developed from
  1950s to 1960s
• Intravenous anesthesia first began in 1872--- Use
  of choral hydrate. From then, many other
  intravenous agents were developed.
• Muscle relaxants resulted in evolution of
  anesthesiology---Curare(??)was firstly used in
  1942

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The History of Anesthesiology

• The original of modern local anesthesia was
  credited to use of cocaine in 1884.
• Subarachnoid anesthesia --- 1898. Caudal epidural
  anesthesia--- 1901. lumbar epidural anesthesia
  --- 1921

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The Scope of Anesthesiology

• Clinical anesthesia
• Pain management
• First-aid and resuscitation
• Intensive care

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Definition of Anesthesia

• Anesthesia is always defined by drug-induced
  changes in behavior or perception(??).
• The components of general anesthetic state
  include unconsciousness, amnesia(??),
  analgesia(??), immobility, and attenuation of
  autonomic nervous system responses to noxious
  stimulation.

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Course of Anesthesia

• Anesthesia induction
• Anesthesia maintenance
• Anesthesia recovery

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Classification of Anesthesia

• Local anesthesia
• Topical anesthesia
• Infiltration anesthesia
• Nerve block
• Nerve plexus block
• Intrathecal block Subarachnoid block, epidural
  block and caudal block

• General anesthesia
• Inhalation anesthesia
• Intravenous anesthesia
• Combined anesthesia
• Intravenous
• Venous-inhalation
• Intrathecal block- general anesthesia

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Some special measures during anesthesia

• Deliberate hypotension(??????)
• Deliberate hypothermia(?????)
• Acute isovolumic hemodilution(?????????)
• Acute hypervolumic hemodilution(?????????)
• Cardiac pulmonary bypass(????)

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Monitoring During Anesthesia

• The Cardiovascular System
• The Respiratory System
• Liver and kidney function
• Central nerve system
• Coagulation function

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Pain Management

• Postoperative analgesia
• Delivery analgesia
• Acute and chronic pain cure
• Cancer analgesia

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Preparing For Anesthesia

• Preoperative visit
• Preoperative evaluation History, physical
  examination, laboratory evaluation
• Preoperative fasting
• Coexisting disease therapy
• Equipment preparation
• Preoperative medication

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Purposes of the preoperative visit

1. Establish rapport with the patient
2. Obtain a history and perform a physical
   examinations
3. Order a special investigations
4. Assess the risks of anesthesia and surgery
5. Institute preoperative management

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Routine Preoperative Anesthetic Evaluation

• History
• Review of organ system
• clinical examination
• Laboratory Evaluation

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• ASA Physical Status Classification

Mortality Rate()
0.1
0.2
1.8
7.8
9.4

Class Definition
1 A normal healthy patient.
2 A patient with mild systemic disease and no functional limitation
3 A patient with moderate to severe systemic disease that results in some functional limitation.
4 A patient with severe systemic disease that is a constant threat to life and functionally incapacitating.
5 A moribund patient who is not expected to survive 24 hours with or without surgery.
E If the procedure is an emergency, the physical status is followed by E
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Preoperative Fasting

• The time of fasting solid is more than 6 hours,
  and fluid is more than 2 hours.
• The time of fasting breast milk is 4 hours in
  baby. If necessary, baby should be transfused.

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Coexisting Disease Therapy

• Coexisting disease may affect outcome adversely
  if not under optimum control.
• The coexisting disease must be treated properly
  before any nonurgent surgery .
• Coexisting disease and drug treatment may
  interact with anesthesia and surgery in several
  ways

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Coexisting Disease Therapy

1. The course of the disease may be modified by
   anesthesia or surgery.
2. Influence the effects of anesthesia.
3. Both disease and drug treatment may influence
   choice of anesthetic technique.
4. Drug treatment may modify the normal compensatory
   physiological responses

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Choice of Anesthesia

• Factors to choice a anesthetic technique
• Patient condition
• Surgery category
• The technical and theoretic level of anesthetist
• Anesthetics
• Anesthesia and monitor equipment

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Equipment and drug Preparation

• Anesthetic machine
• Electrical supply
• All essential equipment is present and correctly
  assembled
• Medical gas supply
• Vaporizers
• Breathing system Ventilators

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Equipment and drug Preparation

• Ancillary Equipment
• laryngoscopes, intubation aids
• Face masks, airways, tracheal tubes and
  connectors
• Suction apparatus

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Equipment and drug Preparation

• Monitoring equipment and drug
• NIBP, SpO2, ECG, etc.
• Ephedrine, Atropine, etc
• Anesthetics

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Preoperative Medication
Goals for pharmacologic premedication

• Sedation and hypnosis
• Analgesia
• Drying of airway secretions
• Attenuate vagal reflexes and sympathoadrenal
  responses

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Preoperative Medication
Drugs used for pharmacologic premedication

• Sedative
• Benzodiazepines(???) Diazepam, Lorazepam,
  Midazolam
• Phenothiazines(???)Promethazine
• Hypnotics
• Barbiturates(???) Phenobarbital

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Preoperative Medication

• Butyrophenones(???)Droperidol, Haloperidol
• Analgesia
• Opioid Morphine, Meperidine, Fentanyl
• Anticholinergic agents
• Atropine, Scopolamine
• Other special drugs
• ß-receptor blocker, Calcium channel blocker

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Preoperative Medication

• Announcements
• General status
• Age
• Disease
• Others

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