非住院病人的麻醉.pptVIP

非住院病人的麻醉

BenefitsofAmbulatorySurgeryPatientpreference,especiallychildrenandelderlyLackofdependenceonavailabilityofhospitalbedsGreaterflexibilityinschedulingoperationsLowmorbidityandmortalityLowerincidenceofinfection

BenefitsofAmbulatorySurgery

PatientSelection

ContraindicationstoOutpatientSurgerySerious,potentiallylife-threateningdiseasesthatarenotoptimallymanaged(ASAⅢ～Ⅳ):brittlediabetes,unstableangina,symptomaticasthmaMorbidobesitycomplicatedbyhemodynamicorrespiratoryproblemsDrugtherapy:monoamineoxidaseinhibitors;acutesubstanceabuse

ContraindicationstoOutpatientSurgeryEx-prematureinfantslessthan60weekspostconceptualageLackofaresponsibleadultathometocareforthepatientontheeveningaftersurgery

PreoperativePreparationAimedatreducingtherisksinherentinambulatorysurgery,improvingpatientoutcome,andmakingthesurgicalexperiencepleasantforthepatientandfamily

PreoperativePreparationPrepatationshouldminimizepatientanxietythroughpharmacologicandnon-pharmacologicmeansandshouldreducepotentialpostoperativeproblemsbyuseofappropriatepremedication

NonpharmacologicPreparation

PharmacologicprepatationAnixolysisandsedationAnalgesicsPreventionofnauseaandvomitingPreventionofaspirationpneumonitis

Nothing-by-mouthGuidelines

AnetheticTechniquesQuality,safety,efficiency,andthecostofdrugsandequipmentareimportantconsiderationsinchoosingananesthetictechniqueforoutpatientsurgery

AnetheticTechniques

SpecificconsideratinsinGeneralAnesthesiaAirwaymanagementIntravenousanestheticdrugsInhaledanestheticdrugsAnalgesicsMusclerelaxantsReversalofdrugeffects

RegionalanesthesiaMonitoredanesthesiacare(MAC)

DischargeCriteriaVitalsignsAmbulationNauseaandvomitingPainSurgicalbleeding

麻醉后监测治疗室PostanestheticCareUnit(PACU)

主要任务收治对象当日全麻病人术后未清醒者非全身麻醉后病人情况还未稳定者麻醉后神经功能未恢复者目旳监护和治疗病人在麻醉恢复过程中所出现旳生理功能紊乱与ICU旳区别麻醉清醒期旳监护和治疗，短时间、一般性旳麻醉恢复

PACU处理旳常