Anesthesia Principles Lecture Notes PDF

This lecture will emphasize on : Aim of evaluation Why the anesthesia is risky? How to evaluate the patient before surgery ? Important questions for cardiovascular system Important questions for Respiratory system Inspection of airway Inspection of airway A...

This lecture will emphasize on : Aim of evaluation Why the anesthesia is risky? How to evaluate the patient before surgery ? Important questions for cardiovascular system Important questions for Respiratory system Inspection of airway Inspection of airway Aim of evaluation : Anesthesia and surgery are physiologically stressful, invasive interventions which may exacerbate or uncover underlying disease processes Some of the most feared complications include catastrophic events such as myocardial infarction, difficulty oxygenating or ventilating, and cerebral vascular accident. A proper pre-operative assessment allows the perioperative providers (anesthesiologist and surgeon) the ability to reduce risk for the patient. Why the anesthesia is risky? Airway : There can be difficulty obtaining an airway to adequately oxygenate and ventilate 1  Induction :(“start of anesthesia”): patient may become hypotensive from the induction agents or hypertensive with laryngoscopy and intubation Administration of blood/blood products Maintenance: Different degrees of stimulation, blood loss. Emergence (i.e. “waking up”): Hypothermia , hypoglycemia. Bronchospasm. Allergic reactions to medications, injury during laryngoscopy, neuropathy from positioning. How to evaluate the patient before surgery ? History of Present illness Fasting or not ? Past medical history: IDH ,HT, DM , Thyroid problem , Drug History : aspirin , Plavix , levothyroxine , hypertension and diabetes drugs. PSH : what operation the patient had in the past Vital signs : blood pressure , Pulse Rate , SPo2 (oxygen saturation). 2  Problems with Anesthesia : Malignant hyperthermia Post-operative nausea and vomiting Difficulty with intubation – letter from anesthesiologist. Allergies : Antibiotics, latex allergy. Smoking : How many pack/day ex-smoker for how long ? Did the patient quite smoking and for how long ? Physical examination (directed) Airway examination. Lungs. Neurological examination. Laboratory: CBC (HB , Platelet), Renal function, S. electrolyte , virology. Imaging : Chest X-Ray : chest infection , cardiomegaly. Cardiac Check : ECG , ECHO. 3 Important questions for cardiovascular system : Smoking. hypertension Age. chest discomfort , pain , pressure, tightness Shortness of breath ( SOB ). Past cardiac procedures Important questions for Respiratory system : Smoking Asthma patient : SOB recent exacerbations 4  Medication : on inhaler , steroids , multiple drugs , Hospitalization : need for oxygen , critical care unit admission ,endotracheal intubation. Inspection of airway : Hints about difficult intubation or mask : 1.Short neck 2.Small mouth openig. 3.Beard and teeth loss 4.Bad Neck extension 5.Mallampati score By : 𝑀𝑂𝐻𝐴𝑀𝐴𝐷 𝐴𝐿-𝐴𝐵𝐵𝐴𝑆𝐼. 5