Vous êtes sur la page 1sur 51

|  

à  
  
à    

à 

à 
  
à   

à    |
à  
à 
 
ASC.1
ANESTHESIA
SERVICES
|ARY BOTSFORD &
ISABELLA HERB
- First Americans to become
specialists in anesthesia
SYDNEY OR|OND GOLDAN
- Equality between surgeons
and anesthesiologits
á  
 

   
  
 

  
  
   

 
     

 



   

  


   
    
 
  
  
 
 
  
  
 
   
ASC.2
A qualified individual is
responsible for
managing the
anesthesia services
   
 

à    
à  
  

  

  
à  

 
  

!  

  
" !
à 
 


 
   #$
à   %    
 !
   
 
 
 



 
   !    
  
à   &
!
 

  !
   
 '
ASC.3
POLICIES & GUIDELINES
Policies & procedures guide
the care of patients
undergoing moderate and
deep sedation
à 

 
   


'
à 

 
  
% 

 '
à 

 
    

" 
(
 
)  "  
*

+ , 


)  )  
 
'
à 
 
  
 


 

  '
à ( 
   
 
 

 
  
 '
à +  
  


 
 

'
à   
 
!!
  
 
 ! 
'
à - 

 

   


'
áoint Commission standards
require that :

"the patient is reevaluated


immediately before
moderate or deep sedation
use and before anesthesia
induction".
PATIENT HAS CONFIR|ED
IDENTITY, SITE AND
PROCEDURE:
The anesthesiologist will check
the:
à patient's name
à date of birth
à medical record number
à type or location of scheduled
surgery for any inconsistencies.
à the type of procedure planned
CONSENT FOR| IS SIGNED
BY PATIENT
4 

 

 



  
  

   
 '
PATIENT HISTORY AND RECORDS

This review allows the


anesthesiologist to evaluate the
patient for risk factors that may
increase the patient's sensitivity
to the sedatives or other
medications given before and
during the operation
Risk factors may include:

à Heart or lung disease


à Liver or kidney disease
à Present prescription medications
à Herbal preparations and other alternative
medicines
à Allergies, particularly allergies to medications
à Alcohol or substance abuse
à Smoking
à Previous adverse reactions to sedatives or
anesthetics
à Age
PATIENT INTERVIEW
Your general health and fitness.
à Any serious illnesses you have had in
the past.
à Any problems with previous
anesthesia.
à Whether you know of any family
members who have had problems with
anesthesia.
à Any pains in your chest.
à Any shortness of breath or
cough.
à Any heartburn / acidity /
reflux.
à Any pains you have which
would make lying in one
position uncomfortable.
à Any medicines you are taking,
including herbal remedies and
supplements you many have been
prescribed.
à Any allergies you have
à Any loose teeth, caps, crowns
à Whether you smoker /
drink alcohol or chew tobacco
à If you are taking any pills
medicines, herbal remedies or
supplements
PHYSICAL EXA|INATION

The physical examination will focus on


three primary areas of concern:

the heart and circulatory system -ECG


the respiratory system- Chest x-ray
The patient's airway- patient's teeth,
nasal passages, mouth, andthroat to
check for any signs of disease or
structural abnormalities.
Certain physical features such as :

à an abnormally shaped windpipe


à prominent upper incisor teeth
à an abnormally small mouth opening
à a short or inflexible neck
à a throat infection, large or swollen
tonsils
à a protruding or receding chin can all
A commonly used
classification scheme rates
patients on a four-point
scale, with Class I being the
least likely to have airway
problems under anesthesia
and Class IV the most
likely.
INDUCTION
ASSESS|ENT
à Premedication

à The goal of premedication is


to have the patient arrive in
the operating room in a calm,
relaxed frame of mind. |ost
patients do not want to have
any recollection of entering
the operating room.
¬_ 
¬   !



 

!.   
    '/
   
0 
 
/1

 
.'
à The role of the anesthesia
provider is to remember what to
check :
à D-rugs
à A-irway equipment,
à |-onitor
à |-achine
à I-V
à S-uction
¢_ _
 
 
Patient has confirmed:
à Identity on case sheet
à Check IOP
à Sac Patency
à Any evidence of infection in
eye/wound/infection on body
à Confirm- Paid / Free
à Side ² RT/ LT
à Procedure ² Check as per case sheet
à Consent / informed consent
à Paid Receipt No.
à Side on case sheet ² Check pupil
à dilated cataract / RD
à Anesthesia safety check
à BP, ECG, Urine RE, Blood,Sugar
Fitness, IHD, loose teeth,congenital
problems,(goldenhar), vascular
disease,chest infection. |edical
fitness
à Betadine 5% eye drop ² 1 drop after
peribulbar block
à Pulse oxymeter for risky cases
Does patient have:
à Known Allergy
à Difficult aspiration risk
à Blood loss ² NA
à Xylocain test
à 2¢  6 4     
    
!
 
   


à   

  !
 
 
  


 
 
.  



   


  
  
 

 
   '
à ASC 5.3 ²Each patient·s
physiological status during
anesthesia administration is
continuously monitored and
written in the patient·s record.
à 2   
(,/  3




 
 
 


 % 
 


  
  % 
 


% 
 %  
   '3


 



  


   


 
 







 







 

 
 

'
à /
    

   

  
 

 

.  
  




    
 
     

 
 
 

   '
à   /
-  
" /-"    4556'
/-"
 
  
 
  

.

' '    

 7
   
  !!
   
  
 


  



 7
    '
à ! " # $ % 
&
% 
      

   
 


  % 

'      
    (  

  
'   
 
4
'       
' 
) %   %


 *
à  
  % 
+
, %
 -%

 
 ,.
à   '

à     


4 ,
'       
 
 ' 
à '  -
  
'
, 
 '
   
 
'.
à %
 -%%  %

'. 

'  /

à  %  
-%  /%   .
à %
/  


-0. 
à  
/
 


1        
 %  ' 
à     
 
 
 '
 
  
à %
  
à
 / 
'
4 % 
 '  
 * ,
  
       
'   
  
 
à 2
1%   

à   #    
% 
+    % 
    



 
 %
1  3 %

' 

%  '  
 
% 
+ 
 
 % 

        
'
 '   


  
 
ASC. 7 Ea a 

 a  a   aa

a 

 a  
ASC. 7.1 ²The risks,
benefits and
alternatives are
discussed with the
patient and his or her
family or those who
make decisions for
their patient
ASC.7.2 ²The surgery
performed is written
in the patient record.
ASC. 7.3 ²Each
Patient·s physiological
status is continuously
monitored during and
immediately after
surgery and written in
the patient·s record.
ASC. 7.4 ²Patient care
after surgery is
planned and
documented.
THANK YOU!!!