Professional Documents
Culture Documents
FOR
SURGEONS
ORAWAN PONGRAWEEWAN,
DEPARTMENT OF ANESTHESIOLOGY,
SIRIRAJ HOSPITAL
Friday 16 October 1846
Dr. William Thomas Green Morton
a dentist from Harford, Connecticut
Type of Anesthesia
z Monitored Anesthetic Care (MAC)
: conscious sedation - minimally depress
level of consciousness
: deep sedation – controlled state of
depressed consciousness
z Regional Anesthesia (RA)
: central neural blockade
: peripheral nerve blockade
z General Anesthesia (GA)
General Anesthesia
z Balanced anesthesia
z Unconsciousness
z Muscle relaxation
z Analgesia
z Blunting of reflex
z Inhalation anesthesia
z Total intravenous anesthesia (TIVA)
Anesthetic drugs
z Induction agents
(pentothal,propofol,etomidate,BZP)
z Inhalation agents
(halothane,isoflurane,sevoflurane,desflurane)
z Muscle relaxants
(succinylcholine,pancuronium,vecuronium,atracurium,
cisatracurium,rocuronium)
z Opioids
(morphine,pethidine,fentanyl,remifentanyl)
z Reversal agents
z Local anesthetics
(lidocaine,bupivacaine,levobupivacaine,ropivacain)
PERIOPERATIVE CARE
Preoperative evaluation
PREOPERATIVE and preparation
NPO,Smoking,DM,HT,
IHD,Invetigations
POSTOPERATIVE
Preoperative Evaluation and
Preparation
GOALS
z To obtain information to determine the
test and consultation
z To choose the care plan guide by patient
choices and risk factors
z To educate the patient about anesthesia
z To make periopertative care more efficient
z To obtain inform consent
Questions
z Isthe patient in optimal health?
z Can, or should, the patient's physical or
mental condition be improved before
surgery?
z Does the patient have any health
problems or use any medications that
could unexpectedly influence perioperative
events?
ASA PS classification
1 A normal healthy patient
2 A patient with mild systemic disease
3 A patient with severe systemic disease
4 A patient with severe systemic disease that is
a constant threat to life
5 A moribund patient who is not expected to
survive without the operation
6 A declared brain-dead patient whose organs
are being removed for donor purposes
E for Emergency
Mortality
z Beta-blockers
• 65% reduction in perioperative myocardial ischemia
• 56% reduction in myocardial infarction
• 67% reduction in cardiac death