Anesthesia 5th year, 1st lecture (Dr. Aamir)

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The lecture has been given on Sep. 28th, 2010 by Dr. Aamir.
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  • 1. Preoperative Evaluation and choice of Anesthetic Technique Preoperative evaluation and preparation for anesthesia begins when the anesthesiologist reviews the patient’s medical record and visits the patient the day before elective surgery
  • 2. Important aspects of the preoperative evaluation include: <ul><li>History </li></ul><ul><li>Review of current drug therapy </li></ul><ul><li>Physical examination </li></ul><ul><li>Interpretation of laboratory data </li></ul><ul><li>Consent </li></ul><ul><li>Planned management of anesthesia </li></ul><ul><li>Methods available for relief of post operative pain </li></ul><ul><li>Fasting </li></ul><ul><li>Assignment the physical status classification </li></ul><ul><li>Premedication </li></ul>
  • 3. History <ul><li>Previous adverse responses related to anesthesia </li></ul><ul><li>Allergic reactions </li></ul><ul><li>Prolonged skeletal muscle paralysis </li></ul><ul><li>Delayed awakening </li></ul><ul><li>Nausea and vomiting </li></ul><ul><li>Hoarseness </li></ul><ul><li>Myalgia </li></ul><ul><li>Hemorrhage </li></ul><ul><li>Jaundice </li></ul><ul><li>Post spinal headache </li></ul><ul><li>Adverse responses in relatives </li></ul>
  • 4. <ul><li>Central nervous system </li></ul><ul><li>Cerebrovascular insufficiency </li></ul><ul><li>Seizures </li></ul><ul><li>Cardiovascular system </li></ul><ul><li>Exercise tolerance </li></ul><ul><li>Angina pectoris </li></ul><ul><li>Prior myocardial infarction </li></ul><ul><li>Hypertension </li></ul><ul><li>Rheumatic fever </li></ul><ul><li>Claudication </li></ul><ul><li>dysrhythmias </li></ul>
  • 5. <ul><li>Lungs </li></ul><ul><li>Exercise tolerance </li></ul><ul><li>Dyspnea and orthopnea </li></ul><ul><li>Cough and sputum production </li></ul><ul><li>Bronchial asthma </li></ul><ul><li>Cigarette consumption </li></ul><ul><li>Pneumonia </li></ul><ul><li>Recent upper respiratory tract infection </li></ul>
  • 6. <ul><li>Liver </li></ul><ul><li>Ethanol consumption </li></ul><ul><li>Hepatitis </li></ul><ul><li>Kidneys </li></ul><ul><li>Nocturia </li></ul><ul><li>Pyuria </li></ul><ul><li>Skeletal and muscular systems </li></ul><ul><li>Arthritis </li></ul><ul><li>Osteoporosis </li></ul><ul><li>Weakness </li></ul>
  • 7. <ul><li>Endocrine system </li></ul><ul><li>Diabetes mellitus </li></ul><ul><li>Thyroid gland dysfunction </li></ul><ul><li>Adrenal gland dysfunction </li></ul><ul><li>Coagulation </li></ul><ul><li>Bleeding tendency </li></ul><ul><li>Easy bruising </li></ul><ul><li>Hereditary coagulopathies </li></ul>
  • 8. <ul><li>Reproductive system </li></ul><ul><li>Menstrual history </li></ul><ul><li>Sexually transmitted diseases </li></ul><ul><li>Dentition </li></ul><ul><li>Dentures </li></ul><ul><li>Caps </li></ul>
  • 9. Drug usage and potential interactions with drugs administered in the Perioperative period <ul><li>Alcohol abuse </li></ul><ul><li>Antibiotics </li></ul><ul><li>Antihypertensive </li></ul><ul><li>tolerance to anesthetic drugs </li></ul><ul><li>Prolongation of muscle relaxants </li></ul><ul><li>Impaired sympathetic nervous system responses </li></ul>
  • 10. <ul><li>Aspirin </li></ul><ul><li>Benzodiazepines </li></ul><ul><li>Beta antagonists </li></ul><ul><li>Bleeding tendency </li></ul><ul><li>Tolerance to anesthetic drugs </li></ul><ul><li>Bradycardia </li></ul><ul><li>Bronchospasm </li></ul><ul><li>Impaired sympathetic nervous system responses </li></ul><ul><li>Myocardial depression </li></ul>
  • 11. <ul><li>Calcium channel blockers </li></ul><ul><li>Digitalis </li></ul><ul><li>Diuretics </li></ul><ul><li>Monoamine oxidase inhibitors </li></ul><ul><li>Tricyclic antidepressants </li></ul><ul><li>Hypotension </li></ul><ul><li>Cardiac dysrhythmias or conduction disturbances </li></ul><ul><li>Hypokalemia, Hypovolemia </li></ul><ul><li>Exaggerated response to sympathomimetic drugs with acute treatment </li></ul><ul><li>Exaggerated response to sympathomimetic drugs with acute treatment </li></ul>
  • 12. Physical examination <ul><li>Central nervous system </li></ul><ul><ul><li>Level of consciousness </li></ul></ul><ul><li>2. Evidence of peripheral sensory or skeletal muscle dysfunction </li></ul>
  • 13. <ul><li>Cardiovascular system </li></ul><ul><li>Auscultation of the heart (heart rate, rhythm, murmur) </li></ul><ul><li>Blood pressure (supine and standing ) </li></ul><ul><li>Peripheral pulses (arterial cannulation site) </li></ul><ul><li>Veins (access site) </li></ul><ul><li>Peripheral edema </li></ul>
  • 14. <ul><li>Lungs </li></ul><ul><li>Auscultation of the lungs (rales, wheezes) </li></ul><ul><li>Pattern of breathing </li></ul><ul><li>Anatomy of thorax (emphysema) </li></ul>
  • 15. <ul><li>Upper airway </li></ul><ul><li>Cervical spine mobility </li></ul><ul><li>Temporomandibular mobility </li></ul><ul><li>Prominent central incisors </li></ul><ul><li>Diseased or artificial teeth </li></ul><ul><li>Ability to visualize uvula </li></ul><ul><li>Thyromental distance </li></ul>
  • 16. <ul><li>Coagulation Bruising Petechiae </li></ul><ul><li>Thank you </li></ul>
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