Members:

• Camitan, Arthur Jr.

• Galero, Julie Jane
• Gazmin, Rhodri
• Gonzales, Cris
• Jacob, Jeankie
• Latoja, Clarise Maris
• Rocafort, Joyce
• Villaneuva, Paolo
 ASC.1
ANESTHESIA
SERVICES
 MARY BOTSFORD &
ISABELLA HERB
- First Americans to become
specialists in anesthesia
 SYDNEY ORMOND
GOLDAN
- Equality between surgeons
and anesthesiologits
JCAHO standards:
preanesthetic evaluation, immediate
preinduction re-evaluation, safety
of the patient during the
anesthetic period, release of the
patient from any PACU,
recording of all pertinent events
during anesthesia, recording of
postanesthesia visits, guidelines
defining the role of anesthesia
services in hospital infection
control, and guidelines for safe
use of general anesthetic agents
 ASC.2
A qualified individual is
responsible for
managing the
anesthesia services
Anesthesia must be
administered only by:
• A qualified anaesthesiologist
• A doctor of medicine or
osteopathy (other than an
anesthesiologist)
• A dentist, oral surgeon, or podiatrist
who is qualified to administer
anesthesia under State law
• A certified registered nurse anesthetist
(CRNA)
• unless exempted in accordance with
this section under the supervision of
the operating practitioner or of an
anesthesiologist who is immediately
available if needed
• An anesthesiologist's assistant,
who is under the supervision
of an anesthesiologist who is
immediately available if
needed.
 ASC.3
POLICIES &
GUIDELINES
Policies & procedures guide the
care of patients undergoing
moderate and deep sedation
• Preoperative instructions and patient
preparation.
• An appropriate history and physical
exam by a physician prior to sedation.
• Preprocedure studies as outlined in the
American Society for Gastrointestinal
Endoscopy Position Statement on
Laboratory Testing Before Ambulatory
Elective Endoscopic Procedures.
• Procedural sedation shall be
administered by or under the
direction of a qualified physician.
• General anesthesia shall be
administered by the appropriate
anesthesiology personnel.
• The physician is responsible for
directing discharge criteria.
• Patients must be provided with
written postoperative and
follow-up instructions.
• Medical records must be
accurate, confidential and
current.
Joint Commission standards
require that :

"the patient is reevaluated

immediately before moderate
or deep sedation use and
before anesthesia induction".
PATIENT HAS CONFIRMED
IDENTITY, SITE AND
PROCEDURE:
The anesthesiologist will check the:
• patient's name
• date of birth
• medical record number
• type or location of scheduled surgery for
any inconsistencies.
• the type of procedure planned
CONSENT FORM IS
SIGNED BY PATIENT
The coordinator should
confirm that consent for
surgery has been given and
that a consent form has
been signed by the patient.
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:

• Heart or lung disease

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

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 :

• an abnormally shaped windpipe

• prominent upper incisor teeth
• an abnormally small mouth opening
• a short or inflexible neck
• a throat infection, large or swollen tonsils
• 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
ASSESSMENT
• Premedication

• The goal of premedication is to

have the patient arrive in the
operating room in a calm,
relaxed frame of mind. Most
patients do not want to have any
recollection of entering the
operating room.
Induction
the anesthesiologist will start
transitioning you from the normal
awake state to the sleepy state of
anesthesia. It is usually done by
either injecting medication
through an IV or by inhaling
gases through a mask.
• The role of the anesthesia provider
is to remember what to check :
• D-rugs
• A-irway equipment,
• M-onitor
• M-achine
• I-V
• S-uction
SIGN IN prior to
anesthesia
Patient has confirmed:
• • Identity on case sheet
• • Check IOP
• • Sac Patency
• Any evidence of infection in
eye/wound/infection on body
• • Confirm- Paid / Free
• • Side – RT/ LT
• • Procedure – Check as per case sheet
• • Consent / informed consent
• • Paid Receipt No.
• Side on case sheet – Check pupil
• dilated cataract / RD
• Anesthesia safety check
• • BP, ECG, Urine RE, Blood,Sugar
Fitness, IHD, loose teeth,congenital
problems,(goldenhar), vascular
disease,chest infection. Medical fitness
• Betadine 5% eye drop – 1 drop after
peribulbar block
• Pulse oxymeter for risky cases
Does patient have:
• • Known Allergy
• • Difficult aspiration risk
• • Blood loss – NA
• • Xylocain test
• ASC 5.2 – The anesthesia used and
anesthesia technique are written in
the patient record
• Anesthesia record - A written
account of drugs administered,
procedures undertaken, and
cardiovascular responses observed
during the course of surgical or
obstetrical anesthesia.
• ASC 5.3 –Each patient’s
physiological status during
anesthesia administration is
continuously monitored and
written in the patient’s record.
• UK the Association of Anaesthetists
(AAGBI) - For minor surgery, this
generally includes monitoring of heart
rate, oxygen saturation, blood pressure,
and inspired and expired concentrations
for oxygen, carbon dioxide, and
inhalational anesthetic agents. For more
invasive surgery, monitoring may also
include temperature, urine output, blood
pressure, central venous pressure,
pulmonary artery pressure and pulmonary
artery occlusion pressure, cardiac output,
cerebral activity, and neuromuscular
function.
• It reflects a detailed and continuous
account of drugs, fluids, and blood
products administered and
procedures undertaken, and also
includes the observation of
cardiovascular responses, estimated
blood loss, urine output and data
from physiologic monitors during the
course of an anesthetic.
• Anesthesia Information Management
System (AIMS), especially since 2007.
An AIMS is any information system
that is used as an automated electronic
anesthesia record keeper (i.e.,
connection to patient physiologic
monitors and/or the anesthetic machine)
and which also may allow the collection
and analysis of anesthesia-related
perioperative patient data gathered from
monitors and/or the anesthesia machine.
• ASC 6 - Each patient’s
postanesthesia status is
monitored and documented
and the patient is
discharged from the recovery
area by a qualified individual
or by using established
criteria.
Things to be assessed before
discharge:
First priorities upon admission to
the PACU
• Assessment of the patient's
airway patency (openness of the
airway),
• vital signs
• level of consciousness
The following is a list of other
assessment categories:
• surgical site (intact dressings
with no signs of overt bleeding)
• patency (proper opening) of
drainage tubes/drains
• body temperature
(hypothermia/hyperthermia)
• patency/rate of intravenous (IV)
fluids
• circulation/sensation in
extremities after vascular or
orthopedic surgery
• level of sensation after regional
anesthesia
• pain status
• nausea/vomiting
The patient is discharged from
the PACU when he or she
meets established criteria for
discharge, as determined by a
scale.
• One example is the Aldrete
scale
• Aldrete scale - it scores the
patient's mobility, respiratory
status, circulation, consciousness,
and pulse oximetry. Depending
on the type of surgery and the
patient's condition, the patient
may be admitted to either a
general surgical floor or the
intensive care unit.
ASC. 7 Each patient’s
surgical care is
planned and
documented based on
the results of the
assessment
ASC. 7.1 –The 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 –The surgery
performed is written in
the patient record.
ASC. 7.3 –Each Patient’s
physiological status is
continuously monitored
during and immediately
after surgery and written
in the patient’s record.
ASC. 7.4 –Patient care
after surgery is
planned and
documented.
THANK YOU!!!
