非住院病人麻醉.ppt

非住院病人的麻醉 Outpatient Anesthesia Benefits of Ambulatory Surgery Patient preference, especially children and elderly Lack of dependence on availability of hospital beds Greater flexibility in scheduling operations Low morbidity and mortality Lower incidence of infection Benefits of Ambulatory Surgery Lower incidence of respiratory complications Higher volume of patients (greater efficiency) Shorter surgical waiting lists Lower overall procedural costs Less preoperative testing and postoperative medication Patient Selection Duration of surgery Less than 90 minutes Patient characteristics Malignant hyperthermia susceptibility Observe for at least 4 hours postoperatively Extremes of age Age alone should not be considered a deterrent in the selection Contraindications to Outpatient Surgery Serious, potentially life-threatening diseases that are not optimally managed (ASAⅢ～Ⅳ):brittle diabetes, unstable angina, symptomatic asthma Morbid obesity complicated by hemodynamic or respiratory problems Drug therapy: monoamine oxidase inhibitors; acute substance abuse Contraindications to Outpatient Surgery Ex-premature infants less than 60 weeks postconceptual age Lack 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 sedation Analgesics Prevention of nausea and vomiting Prevention 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