CONSISTS OF PREOPERATIVE, INTRAOPERATIVE, AND

POSTOPERATIVE MANAGEMENT.

ANAESTHTIC MANAGEMENT
DR. DUAA BABTTAT
PREOPERATIVE MANAGEMENT

A PREOPERATIVE VISIT: IS VERY IMPORTANT.

ALL DATA MUST BE WRITTEN IN THE PREOPERATIVE NOTE.
PATIENT- DOCTOR
RELATIONSHIP
DOCTOR PATIENT RELATIONSHIP

 The patient can discuss with the anesthesiologist the possible

causes of anxiety regarding the anesthetic and surgical
management.
 The anesthesiologist can explain in simple terms the method of
anesthesia, the proposed scope of surgery, the informed
consent and the postoperative pain relief.
THE PREOPERATIVE HISTORY

1. Current Medical problem and other known problems

2. Spacial habits (Smoking, Alcohol, Addiction)
3. Medicatin History (Drug Allergy, Interaction)
4. History of pervious Anaesthesia, Surgery and obstetric deliveries
5. Family history
6. Review of Organ System
7. Last oral intake
LAST ORAL INTAKE

 Heavy Meal 8 hours

 Light Meal 6 hours
 Clear Fluid 2 hrs
 COMMON MEDICATIONS AND ANAESTHETIC IMPLICATIONS

 1. Aspirin: Bleeding tendency, platelet dysfunction

 2. Alcohol abuse: Resistance to anaesthetic drugs
 3. Antibiotics: Potentiation of muscle relaxants
 4. Antihypertensives: Impaired sympathetic nervous system activity,
hypertensive crisis
 5. Beta blockers: Bradycardia, bronchospasm
 6. Benzodiazepines: Potentiation of muscle relaxants, resistance to
anaesthetic drugs
 7. Calcium channel blockers: Interaction with muscle relaxants,
hypotension
 8. MAO inhibitors: Increased response to sympathomimetic drugs
 9. Lithium: Potentiation of muscle relaxants, impaired thyroid
function
10. Digitalis: Dysrhythmias
 11. Diuretics: Hypotension, hypovolaemia, hypokalaemia
 12. Anticoagulant therapy: Excessive bleeding.
PHYSICAL EXAMINATION

 1- Vital signs.
2- Airway.
 3- Heart and lung.
 4- Nervous system.
 5- Other systems that appear to be affected by the history
 If there is any trauma, search for other traumas.
 If there is any congenital anomaly, search for other congenital
anomalies.
 If there is any autoimmune disease, search for other
autoimmune diseases.
 In all patients, search for medical problems.
II. INVESTIGATION AND LABORATORY EVALUATION
INVESTIGATION AND LABORATORY EVALUATION

 Routine laboratory tests in patients who are apparently healthy by

clinical history and examination are invariably of little use and a waste of
resources.
 Before ordering extensive investigations, the anesthesiologist should
consider how the results of these investigations will affect the patient’s
care and management.
 Any disease detected by history or physical examination must be
evaluated by more investigations.
1- COMPLETE BLOOD PICTURE (CBC), HEMATOCRIT, OR HB
CONCENTRATION

 All patients > 60 years of age.

 All menstruating females.
 If significant blood loss is expected and/or blood transfusion.
 All Asian patients (for sickle cell anemia).
 Patients with a clinical condition such as history of blood loss,
previous anemia, blood diseases, malnutrition, liver diseases, or
renal diseases.
2- SERUM GLUCOSE, SERUM CREATININE, UREA, AND
ELECTROLYTES

 All patients > 60 years of age.

 Patients with history of diabetes, renal, hepatic, nutritional
diseases, diarrhea, vomiting, or patients receiving medications as
steroids, diuretics, or nephrotoxic drugs.
3- LIVER FUNCTION TESTS

 Patients with hepatic or nutritional diseases.

 Patients with history of chronic alcoholism.
4- COAGULATION SCREEN:

 Patients with history of coagulation disorders, drug abuse,

chronic alcoholism, liver or renal diseases.
 Patients with a suspicious history of bleeding after a wound,
previous surgery or with a history of easy bruising.
 Patient receiving anticoagulants as warfarin, heparin, aspirin…
etc.
5- CHEST X-RAYS:

 All patients> 60 years of age.

 Patients with history of cardiac, thyroid, respiratory diseases or
cancer (for secondaries). N.B.: Smoking and resolved upper
respiratory infection are not indications for a preoperative
chest x-ray.
6- ELECTROCARDIOGRAPH (ECG):

 All patients> 50 years of age (some authors recommend> 40

years of age).
 Patients with history of cardiovascular diseases, hypertension,
or pulmonary diseases.
III. RISK ASSESSMEN
I. GENERAL SCORING SYSTEM

 ASA Physical Status Classification

 POSSUM: Physiological and Operative Severity Score for the
enUmeration of Mortality and Morbidity
ASA
2. SPECIFIC SYSTEM ASSESSMENT

 1- Cardiovascular assessment e.g., Goldman’s index of cardiac

risk in non-cardiac procedure.
2- Respiratory assessment.
 3- Neurological assessment.
 4- Renal and liver disease assessment.
IV. INFORMED CONSENT
 Informed consent means to ensure that the competent patient
(or guardian) has sufficient information about the procedure
(both anesthetic and surgical) and its risks in a lay plain terms
and language to make a reasonable and prudent decision
whether to consent or not without pressure.
V. PREMEDICATIONS:
DEFINITIONS:

 is administration of drugs in the preoperative period before

induction of anesthesia by:
 1-5 minutes for IV drugs,
 30-60 minutes for IM Drugs
 60-90 minutes for oral drugs,
INCLUDE:

 Benzodiazepines
 Anticholinergics
 Antiemetics
 Prophylaxis against Aspiration
 Antihistaminics <H1 blockers)
 Opioids
INTRAOPERATIVE MANAGEMENT
INTRAOPERATIVE ANAESTHTIC RECORDS

1. Patient Monitoring
2. Patient position
3. Choice of Anesthetic Agents
4. Induction of general anesthesia
5. Maintenance of Anaesthesia
6. Intraoperative IV fluids
7. Intraoperative complications and management
8. Emergence and recovery
 FACTORS FOR SELECTION OF ANAESTHETIC TECHNIQUE

 1. Safety of the patient

 2. Coexisting systemic disorders
 3. Site of operation
 4. Elective or emergency procedure
 5. Age of the patient
 6. Preference of the patient, if any
 7. Ability of the anaesthetist concerned
 8. Convenience of the surgeon.
POSTOPERATIVE MANAGEMENT
COMMON CAUSES OF POSTPONEMENT OF OPERATION

 1. Acute respiratory infection

 2. Coexisting systemic illness not under optimal control
 3. Lack of adequate resuscitation
 4. Full stomach
 5. Nonavailability of written consent
 6. Failure to obstain recent investigation reports.
 The patient’s recovery from anesthesia.
 Any apparent anesthesia-related complications and pain status and their
management.
 The patient’s immediate postoperative condition.
 The disposition i.e., (discharge to An outpatient area, Inpatient ward.,
Intensive care unit (ICU), Home)
Inpatients should be seen again at least once by the anesthesiologist
within 48 hours after discharge from PACU
PRIORITIES OF ORGAN PROTECTION

 Airway protection: (at first maintenance of ventilation, then

protection against aspiration).
 Brain protection.
 Myocardial protection.
 Respiratory protection.
 Renal and liver protection.
 Other organ protections e.g., eyes.
THANK YOU