《非住院病人的麻醉》PPT课件.ppt

非住院病人的麻醉,Outpatient Anesthesia,Benefits of Ambulatory Surgery,Patient preference,especially children and elderlyLack of dependence on availability of hospital bedsGreater flexibility in scheduling operationsLow morbidity and mortalityLower incidence of infection,Lower incidence of respiratory complicationsHigher volume of patients(greater efficiency)Shorter surgical waiting listsLower overall procedural costsLess preoperative testing and postoperative medication,Benefits of Ambulatory Surgery,Patient Selection,Duration of surgeryLess than 90 minutesPatient characteristicsMalignant hyperthermia susceptibilityObserve for at least 4 hours postoperativelyExtremes of ageAge alone should not be considered a deterrent in the selection,Contraindications to Outpatient Surgery,Serious,potentially life-threatening diseases that are not optimally managed(ASA):brittle diabetes,unstable angina,symptomatic asthma Morbid obesity complicated by hemodynamic or respiratory problemsDrug therapy:monoamine oxidase inhibitors;acute substance abuse,Contraindications to Outpatient Surgery,Ex-premature infants less than 60 weeks postconceptual ageLack of a responsible adult at home to care for the patient on the evening after surgery,Preoperative Preparation,Aimed at reducing the risks inherent in ambulatory surgery,improving patient outcome,and making the surgical experience pleasant for the patient and family,Preoperative Preparation,Prepatation should minimize patient anxiety through pharmacologic and non-pharmacologic means and should reduce potential postoperative problems by use of appropriate premedication,Nonpharmacologic Preparation,Pharmacologic prepatation,Anixolysis and sedationAnalgesicsPrevention of nausea and vomitingPrevention of aspiration pneumonitis,Nothing-by-mouth Guidelines,Anethetic Techniques,Quality,safety,efficiency,and the cost of drugs and equipment are important considerations in choosing an anesthetic technique for outpatient surgery,Anethetic Techniques,The ability to deliver a safe and cost-effective general anesthetic with minimal side effects and rapid recovery is critical in a busy outpatient surgery unitGeneral anesthesia remains the most widely used anesthetic technique for managing ambulatory surgery,Specific consideratins in General Anesthesia,Airway managementIntravenous anesthetic drugsInhaled anesthetic drugsAnalgesicsMuscle relaxantsReversal of drug effects,Regional anesthesiaMonitored anesthesia care(MAC),Discharge Criteria,Vital signsAmbulationNausea and vomitingPainSurgical bleeding,麻醉后监测治疗室,Postanesthetic Care Unit(PACU),主要任务,收治对象当日全麻病人术后未苏醒者非全身麻醉后病人情况尚未稳定者麻醉后神经功能未恢复者目的监护和治疗病人在麻醉恢复过程中所出现的生理功能紊乱与ICU的区别麻醉苏醒期的监护和治疗，短时间、一般性的麻醉恢复,PACU处理的常见问题,呼吸道梗阻通气不足低氧血症低血压高血压心律失常恶心、呕吐低温神志观察,离开恢复室的标准,呼吸循环神志椎管内麻醉平面稳定,PACU的设置和管理,设置足够的照明足够的空间足够的装备必备的药物管理,呼吸道梗阻,上呼吸道梗阻舌后坠上呼吸道分泌物聚积咽或喉梗阻喉头水肿下呼吸道梗阻呼吸道分泌物、呕吐物、血液和脓液等阻塞下呼吸道支气管痉挛,麻醉苏醒期,终止给予麻醉药物至病人清醒的时间，可分为下面四个时相感觉和运动功能逐步恢复出现自主呼吸，并能逐渐自行调控呼吸道反射恢复清醒,Sveral intravenous anesthetics for use during ambulatory anesthesia,Intermidiate recovery after propofol,desflurane(N2O),or propofol-desflurane anesthesia,Postoperative nausea after propofol,deflurane,or profofol-deflurane anesthesia,Risk Factors for Postoperative Nausea and Vomiting,Predisposing factorsIncreased gastric volumeAnesthetic techniqueSurgical/diagnostic procedurePostoperative factors,