ANESTHESIOLOGYPeng Zhanglong

Department of Anesthesiology Rui Jin Hospital

Shanghai Second Medical University

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Contents

1. The history of anesthesiology 2. The scope of anesthesiology3. Classification of Anesthesia4. Definition of Anesthesia5. Preparing for anesthesia6. Premedication

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The History of Anesthesiology

Anesthetic practices date from ancient times

Modern anesthesiology began in 1842 --- Ether was used as an anesthetic agent in humans.

Modern anesthesiology only became firmly established less than six decades ago

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Modern inhalation anesthetics were developed from 1950s to 1960s

Intravenous anesthesia first began in 1872--- Use of choral hydrate. From then, many other intravenous agents were developed.

Muscle relaxants resulted in evolution of anesthesiology---Curare( 箭毒 )was firstly used in 1942

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The History of Anesthesiology

The History of Anesthesiology

The original of modern local anesthesia was credited to use of cocaine in 1884.

Subarachnoid anesthesia --- 1898. Caudal epidural anesthesia--- 1901. lumbar epidural anesthesia --- 1921

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1. Clinical anesthesia2. Pain management3. First-aid and resuscitation4. Intensive care

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The Scope of Anesthesiology

Definition of Anesthesia Anesthesia is always defined by drug-induced cha

nges in behavior or perception( 感觉 ).

The components of general anesthetic state include unconsciousness, amnesia( 健忘 ), analgesia( 镇痛 ), immobility, and attenuation of autonomic nervous system responses to noxious stimulation.

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Course of Anesthesia

Anesthesia induction Anesthesia maintenance Anesthesia recovery

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Classification of Anesthesia

General anesthesia• Inhalation anesthesia• Intravenous anesthesi

a

• Combined anesthesia• Intravenous • Venous-inhalation• Intrathecal block- general an

esthesia

Local anesthesia• Topical anesthesia• Infiltration anesthesia• Nerve block• Nerve plexus block• Intrathecal block: Subarach

noid block, epidural block and caudal block

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Some special measures during anesthesia

Deliberate hypotension( 控制性低血压 ) Deliberate hypothermia( 控制性低温 ) Acute isovolumic hemodilution( 急性等容量血液稀释 ) Acute hypervolumic hemodilution( 急性高容量血液稀

释 ) Cardiac pulmonary bypass( 心肺转流 )

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Monitoring During Anesthesia

The Cardiovascular System The Respiratory System Liver and kidney function Central nerve system Coagulation function

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Pain Management

Postoperative analgesia Delivery analgesia Acute and chronic pain cure Cancer analgesia

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Preoperative visit Preoperative evaluation: History, physical

examination, laboratory evaluation Preoperative fasting Coexisting disease therapy Equipment preparation Preoperative medication

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Preparing For Anesthesia

Purposes of the preoperative visit

1. Establish rapport with the patient 2. Obtain a history and perform a physical

examinations3. Order a special investigations4. Assess the risks of anesthesia and surgery 5. Institute preoperative management

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History Review of organ system clinical examination Laboratory Evaluation

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Routine Preoperative Anesthetic Evaluation

ASA Physical Status Classification

Class Definition

1 A normal healthy patient.

2 A patient with mild systemic disease and no functional limitation

3 A patient with moderate to severe systemic disease that results in some functional limitation.

4 A patient with severe systemic disease that is a constant threat to life and functionally incapacitating.

5 A moribund patient who is not expected to survive 24 hours with or without surgery.

E If the procedure is an emergency, the physical status is followed by “E”

Mortality Rate(%)

0.1

0.2

1.8

7.8

9.4

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Preoperative Fasting

The time of fasting solid is more than 6 hours, and fluid is more than 2 hours.

The time of fasting breast milk is 4 hours in baby. If necessary, baby should be transfused.

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Coexisting Disease Therapy

Coexisting disease may affect outcome adversely if not under optimum control.

The coexisting disease must be treated properly before any non–urgent surgery .

Coexisting disease and drug treatment may interact with anesthesia and surgery in several ways

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Coexisting Disease Therapy

1. The course of the disease may be modified by anesthesia or surgery.

2. Influence the effects of anesthesia.3. Both disease and drug treatment may

influence choice of anesthetic technique.4. Drug treatment may modify the normal

compensatory physiological responses

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Choice of Anesthesia Factors to choice a anesthetic technique1. Patient condition

2. Surgery category

3. The technical and theoretic level of anesthetist

4. Anesthetics

5. Anesthesia and monitor equipment

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Anesthetic machine

1. Electrical supply

2. All essential equipment is present and correctly assembled

3. Medical gas supply

4. Vaporizers

5. Breathing system: Ventilators

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Equipment and drug Preparation

Ancillary Equipment1. laryngoscopes, intubation aids2. Face masks, airways, tracheal tubes

and connectors3. Suction apparatus

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Equipment and drug Preparation

Equipment and drug Preparation

Monitoring equipment and drug1. NIBP, SpO2, ECG, etc.2. Ephedrine, Atropine, etc3. Anesthetics

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Preoperative Medication

Sedation and hypnosis Analgesia Drying of airway secretions Attenuate vagal reflexes and sympathoadrenal res

ponses

Goals for pharmacologic premedication

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Preoperative Medication

SedativeBenzodiazepines( 苯二氮 ): Diazepam, Lorazepa

m, MidazolamPhenothiazines( 吩噻嗪 ) ： Promethazine HypnoticsBarbiturates( 巴比妥 ): Phenobarbital

Drugs used for pharmacologic premedication

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Preoperative MedicationButyrophenones( 丁酰苯 ) ： Droperidol, Haloperid

ol AnalgesiaOpioid: Morphine, Meperidine, Fentanyl Anticholinergic agentsAtropine, Scopolamine Other special drugsβ-receptor blocker, Calcium channel blocker

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Preoperative Medication

Announcements1. General status

2. Age

3. Disease

4. Others

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谢 谢

thanks