Preoperative Anesthesia and Premedication

PREOPERATIVE ANESTHESIA and PREMEDICATION dr. Ratna E. Hutapea Sp. An

Routine preoperative anesthetic evaluation I.

History 1. Current problem 2. Other known problems 3. Medication history • Allergies • Drug intolerances • Present theraphy  Prescription  Nonprescription • Non therapeutic  Alcohol  Tobacco • Illicit 4. Previous anesthetics, surgery, and obstetric deliveries 5. Family history

6. Review of organ system General (Including activity level) Respiratory Cardiovascular Renal Gastrointestinal Hematologic Neurologic Endocrine Psychiatric Orthopedic Dermatologic 7. Last oral intake

Routine preoperative anesthetic evaluation III. Laboratory Evaluation

II. Physical Examination 1. Vital signs 2. Airway 3. Heart 4. Lungs 5. Extremities 6. Neurologic examination

Routine preoperative laboratory evaluation of asymtomatic, apparently healthy patients. Hematocrit or hemoglobin concentration : • All menstruating woman • All patients over 60 years of age • All patients who are likely to experience significant blood lose and may require tranfusion. Serum glucose and creatinin ( or blood urea nitrogen ) Concentration : all patients over 60 years of age Electrocardiogram : all patients over 40 years of age Chest radiograph: all patients over 60 years of age

The Anesthetic plan Premedication Type of anesthesia General Airway management Induction Maintenance Muscle relaxation Local or regional anesthesia Technique Agents Monitored anesthesia care Supplemental oxygen Sedation

Intraoperative management Monitoring Positioning Fluid management Special techniques Postoperative management Pain control Intensive care Postoperative ventilation Hemodynamic monitoring

ASA Physical 1. A normal healthy patient 2. A patient with mild systemic disease and no function limitations 3. A patient with moderate to severe systemic disease that results in some functional limitation 4. A patient with severe systemic disease that is a constant threat to life and functionally incapacitating 5. A moribund patient whi is not expected to survive 24 hours with or without surgery 6. A brainded patient whose organs are being harvested E. If the procedure is an emergency, the physical status is followed by “E”

American Society of Anesthesiologists classification and perioperative mortality rates Class

Mortality Rate

1

0,06-0,08 %

2

0,27-0,4%

3

1,8-4,3%

4

7,8-23%

5

9,4-51%

• • • • • • • • • • • • •

Common Problems Amenable to Treatment before Anesthesia and Operation Anxiety Amnesia Pain Salivation and airway secretions Vagal reflexes Hypertensive reponses Seizure Aspiration of gastric contents Nausea and vomiting Infection Reactions to intravenous contrast media Latex allergy Continuation of preoperative theraphy

Commondly used premedications

Informed Consent Etis otonomi pasien adalah suatu hak yang harus dihargai oleh setiap praktisi ilmu kedokteran. Hak pasien untuk memilih tanpa dipengaruhi oleh orang lain. Praktisi juga terikat oleh kewajiban untuk memberikan informasi seutuhnya kepada pasien.

Masukan Oral Refleks laring mengalami penurunan saat anestesia. Regurgitasi isi lambung dan kotoran yg terdapat dalam jalan napas merupakan risiko utama. Untuk meminimalkan risiko tersebut, pasien dijadwalkan puasa sebelum induksi anestesia. Dewasa : 6-8 jam Anak kecil : 4-6 jam Bayi : 3-4 jam Makanan berlemak boleh 5 jam sebelum induksi anestesia Minuman bening,air putih,teh manis sampai 3 jam sebelum induksi Minum obat dengan air putih dalam jumlah terbatas boleh 1 jam sebelum induksi