演講人：日期：手術麻醉英文目錄IntroductiontoSurgicalAnesthesiaPreoperationalassessmentandpreparationInternaloperationalmanagementofAnesthesiaPostoperationalcareandrecoveryfromAnesthesiaComplicationsAssociatedwithSurgicalAnesthesia01IntroductiontoSurgicalAnesthesiaSurgicalanesthesiareferstotheuseofdrugsandothermethodstoinduceareversiblelossofconsciousnessorsensitivity,allowingsurgicalprocedurestobeperformedwithoutcausingunderlyingpainordistresstothepatientDefinitionTheprimarypurposeofsurgicalinterventionistoensurethepatient'scomfortandsafetyduringsurgerybyreducingpainandreducingstressresponsesThisallowsthelargetoperformtheproceduremoreeasilyandeffectivelyPurposeDefinitionandPurposeGeneralAnesthesiaInducesacompletelossofconsciousnessandsensitivitythroughoutthebodyItisstylishlyadministeredthroughinfectionorinvasive(IV)drugsRegionalAnesthesiaBlockspaidinaspecificareaofthebody,suchasanarmorleg,whilethepatientremainsawakeThistypeofasesthesiaisoftenusedforsurgeriesinvolvinglimbsLocalAnesthesiaNumbsasmallareaofthebody,suchasatoothorskin,byapplyingatopicalcreamorinjectingalocalAnestheticThepatientremainsfullyawakeduringtheprocedureTypesofSurgicalAnesthesiaEarlyFormsSurgicalanesthesiahasitsrootsinacutetimeswhenlocalmixturesandothersubstanceswereusedtoinduceunconsciousnessHowever,thesemethodswerecrudeandoftenunrelatedModernDevelopmentsThemoderneraofsurgicalanatomyBeganinthemid-19thcenturywiththediscoveryofetherandchloroformaseffectiveanatomyThesewerefollowedbythedevelopmentofsaferandmoreeffectivedrugssuchasnovocaineandlidocaineinthe20thcenturyHistoryandDevelopmentRecentAdvancementsInrecentyears,therehavebeensignificantadvantagesinsurgicalanesthesiaincludingthedevelopmentoftargeteddrugdeliverysystems,improvedmonitoringtechniques,andtheuseofartisticintelligencetooptimizeanesthesiaadministrationTheseadvantageshavemadeasignificantdifferenceinsafetyandmoreeffectivethaneverbeforeHistoryandDevelopment02PreoperationalassessmentandpreparationMedicalHistoryObtainathroughmedicalhistory,includingpastsurgicalprocedures,chronicillnesses,allergys,andcurrentdiagnosesPhysicalExaminationPerformafocusedphysicalexaminationtoassessthepatient'sgeneralhealthstatusandidentifyanypotentialethicalrisksLaboratorytestsOrderrelevantlaboratorytests,suchascompletebloodcount,electrolytepanel,andcoaggregationprofile,toevaluatethepatient'sphysiologicalstatusPatientEvaluation010203ASAPhysicalStatusClassificationClassifythepatient'sphysicalstatususingtheAmericanSocietyofAnesthesiologists(ASA)classificationsystemtoestimatetheriskassociatedwithAnesthesiaandsurgeryIdentificationofRiskFactorsIdentifyspecificriskfactors,suchasadvancedage,objectivity,smokingstatus,andcomorbidities,thatmayaffecttheaestheticmanagementDevelopmentofAestheticPlanDevelopanindividualizedaestheticplanbasedonthepatient'sevaluationandriskassessment,includingtheselectionofappropriateaestheticagentsandtechniquesRiskAssessmentandStrategyPreoperationalInstructionsProvideclearinstructionstothepatientregardingpreoperationalpreparations,suchasshowingwithanantimicrobialsoapandavoidingtheapplicationofmakeupornailpolishonthedayofsurgeryFastingGuidelinesInstrumentthepatienttofastforaspecifiedperiodbeforesurgery,typically6-8hoursforsolidsand2-4hoursforclearliquids,toreducetheriskofaspirationduringanintroductionMedicalManagementAdvisethepatientonthemanagementoftheirregularmedicine,includingwhichonestocontinueandwhichonestoholdbeforesurgery,inconsultationwiththeirprimarycareproviderPreoperationalInstructionsandFastingGuidelines03InternaloperationalmanagementofAnesthesiaSelectionofappropriateaestheticagentsDependenceonthepatient'scondition,largetype,andaestheticpreferences,variousaestheticagentssuchasgeneralaesthetics,localaesthetics,orregionalaestheticsmaybeusedIntroductionofAnesthesiaThisinvolvesadministeringtheanaerobicagentstothepatienttobringthemintoastateofunconsciousness,withorwithoutmusclerelaxation,dependingonthesurgicalrequirementsInsertionofbreakingtubeIfgeneralanesthesiaisused,abreakingtube(endotropicaltube)isusuallyinsertedintothepatient'strajectorytoassistwithbreakingduringsurgeryIntroductionofAnesthesiaContinuousadministrationofanaerobicagentsTheanaerobiclogisticclosuremonitorsthepatient'sconditionandadjuststhedoseofanaerobicagentsasneededtomaintainthedesiredlevelofanaerobicthroughoutthesurgeryManagementofpaintandotherdetectionsInadditiontounconsciousness,theanesthesiologistalsomanagesthepatient'spaintandotherdetectionsasmuchrelaxationorparallelism,dependingonthesurgicalrequirementsMonitoringandadjustingfluidbalanceTheanesthesiologistmonitorsthepatient'sfluidintakeandoutputtoensureproperfluidbalanceandpreventcomplicationssuchasdehydrationorfluidoverloadMaintenanceofAnesthesiaTheasesthesiologistcontinuestomonitorthepatient'svitalsignssuchasheartrate,bloodpressure,respiratoryrate,andoxygencapturetodetectanyabnormalitiesorchangesinthepatient'sconditionIfanyabnormalitiesorchangesinthepatient'svitalsignsaredetected,theevidencesuggestsapromptresponsebyadjustingtheaestheticagents,fluidbalance,orotherinterventionsasneededtomaintainthepatient'sstabilityTheasesthesiologistclosecommunicateswiththesurgicalteamtoensurethatthepatient'sasestheticmanagementiscoordinatedwiththesurgicalprocedureandanychangesinthesurgicalplanareurgentlycommunicatedandaddressedMonitoringvitalsignsRespondingtochangesinvitalsignsCommunicatingwithsurgicalteamMonitoringVitalSignsandAdjustments04PostoperationalcareandrecoveryfromAnesthesiaPreventionofapplications:Measuresaretakentopreventapplicationssuchasnasea,invoicing,shifting,andhybridization,whichcanoccurduringemergenciesfromAnesthesiaObservationofpatient'sconditionandvitalsigns:Aftersurgery,thepatientiscloselymonitoredforsignsofemergencyfromanywhere,includingcontainingconditionandstabilityofvitalsignssuchasheartrate,bloodpressure,andrespiratoryrateAssessmentofpaintandcomplaint:Thepatientisassessedforpaintandcomplaint,andappropriatepaintmanagementmeasuresaretakentoensuretheircomfortduringtherecoveryperiodEmergencefromAnesthesia要點三ContinuousmonitoringInthePACU,thepatient'sconditioniscontinuouslymonitoredbytrainedhealthcareprofessionalswhoarepreparedtointerveneincasesofanyadverseevents0102PaintmanagementPaintmanagementisapriorityinthePACU,andthepatientisprovidedwithmedicineandotherinterventionstorelievepainanddiscomfortAssessmentofrecoveryThepatient'srecoveryisassessedbasedonvariousparameterssuchasconsistency,vitalsigns,paylevel,andabilitytoperformbasicfunctions03PostAnesthesiaCareUnit(PACU)StayMeetingdischargecriteriaBeforebeingdischargedfromthePACU,thepatientmustmeetagaincriteriasuchasbeingfullyconscious,havingstablevitalsigns,andbeingabletoperformbasicfunctionssuchasbreakingandswitchingwithoutassistanceInstructionsforhomecareThepatientandtheircaregiverareprovidedwithdetailedinstructionsonhomecare,includinginformationonpaymanagement,roundcare,activityrestrictions,andfollow-upappointmentsPrecautionsandwarningsThepatientisadvisedonprecautionstotakeathome,suchasavoidingdrivingoroperatingmachineryforacertainperiodoftimeafterAnesthesia,andwhentoseekmedicalattentionincasesofanyconcernsorcompilationsDischargeCriteriaandInstructions05ComplicationsAssociatedwithSurgicalAnesthesiaRespiratoryDepressionThisisadecreaseinthedepthandrateofbreaking,whichcanleadtohypoxemia(lowbloodoxygenlevels)and,inmultiplecases,respiratoryfailureAtelectasisCollapseofpartorallofthelung,usuallyduetoalakeofexploitationThiscanoccurduringoraftersurgeryandcanleadtoinfectionandotherrespiratoryproblemsPneumoniaInfectionofthelungsthatcanoccurasaresultofaspiration(invadingforeignmaterialintothelungs)duringanexaminationorduetoreducedlungfunctionaftersurgeryRespiratoryComplicationsBrochospasmNarrowingoftheairwaysinthelungs,whichcancausewheelinganddiversitybreakingThisisoftentriggeredbyallergiesorirritantsandcanbeexcitedbycancerRespiratoryComplicationsHypothesisLowbloodpressure,whichcanbecausedbyanxietyorothermediausedduringsurgeryHypothesiscanleadtoreducedorganicfusionand,inextremecases,shockArrhythmiasAbnormalhe