Anda di halaman 1dari 27

PRE ANESTHESIA MANAGEMENT

AND PREMEDICATION

Dr. Santosh Khadka


Assistant Prof
NAIHS
2073/11/26

1
What we are covering?
Definition
Aim
History taking
Examination: general/ systemic/airway
Investigations: routine / esp.
ASA Grading (Risks analysis )
Modification in pre-existing medical Rx
Optimization & Planning
Premedication
2
Definition :
The process of clinical assessment that
precedes the delivery of anesthesia care for
surgery or non surgical procedures.

PAC consists of the consideration of


information from multiple sources: include
the Pts. Interview, Medical records, Physical
examination & finding from medical tests and
evaluation.
3
Aim
To obtain brief medical and surgical history

To perform examination and needed Invs.

To reduce anxiety and educate the pts.


about anesthesia .

To make a rapport with pt.

4
To identify the risk of anesthesia and surgery
(ASA grading )& optimization of risk factor

To obtain informed written consent

To plan anesthetic technique

5
History
Demographic details

Regarding surgery

Co morbidities

Routine medication
Allergy
Personnel habits 6
Previous anesthesia exposure.

Family history

Airway & spine

Last oral intake / NPO time

7
Examination
General & Physical- vital signs, JALCCOD

Systemic CVS ,RESP,NERVOUS & others

Airway MPG,TOOTH, TMJ,THYROMENTAL


DISTANCES, NECK MOVEMENT, TRACHEAL
POSITION
Esp. Spine , Regional areas & veins

8
Respiratory system-
Chest movement &deformities,
Rate
Auscultation
Special examination: Breath holding time,
Match stick test, PFT
( COPD, LUNG ABCESS, INTERSTITIAL
PERENCHYMAL LUNG DISEASE, EFFUSION)

9
Cardiovascular System:
Heart rate& rhythm, BP, Neck veins
Auscultation
( HTN, Valvular Heart Disease, IHD, Failure, AF
& Blocks, Interventions)

CNS-
Epilepsy, ICP, Motor &Sensory Disorders

10
Endocrine :
DM- Types, duration& sign of Neuropathy,
PRIDICT DIFFICULT AIRWAYS
Thyroid- hypo or hyper

Adrenal-

Parathyroid-

Pituitary-
11
Hepatobiliary

Gastrointestinal

Renal

Musculoskeletal

Hematology & Immune system

12
Airway Examination
History- Past anesthetic exposure
Examination Pts. Features:
Faces, Necks, Mouth opening,
Teeth, Tongue
Thyromental distances
TMJ
Mallampati grading

13
Mallampati grading: On 1985 . Pt. keep on
same level of examiner neutral position with
max. mouth opening with protruding tongue
out side: faucial pillar, soft palate, uvula.

14
Investigations
Screening routine investigations:

To identification & discovery of disease or


disorders

To verification or assessment of already


known disease

15
Normally ASA I Pts. Below 40 yrs- CBC,
URINE R/E .

ASA II Or Above 40 yrs CBC, Blood


Biochemistry, ECG, CXR & other needed INVs

Special INVs- ECHO, PFT, TMT, TFT, ABG,


special Images

16
Preoperative status
Risk analysis :
ASA grading
P1- A normal healthy Pt.

P2- A pt. with mild systemic disease

P3- A Pt. with moderate to severe systemic


disease having functional limitation
17
P4- A Pt. with severe systemic disease having
functionally incapacitate that constant threat
to life.

P5- A moribund Pt. who is not expected to


survive with or without operation.

P6- Brain dead Pts. (organ donation)


Prefix E- emergency.
18
Modification in pre existing medical
therapy
To be continued or stopped

New medication when required

Anti hypertensive drugs, Insulin, OHG, Anti


platelets , Anticoagulants, anti depressants,
Anti epileptics , Steroids, Antibiotics

19
Optimization & Planning
After optimization of Pt. before operation
will minimizing morbidities & mortalities
And improves peri & post operative care.

Anesthesia counseling: Possible details about


anesthesia & obtaining written informed
consent.

20
Anesthesia Plan
NPO Hours before surgery
Adult - Child / Solid liquid food
Types of anesthesia:
G/A Induction, Airway,
Maintenance, Muscle relaxant
REGIONAL- Techniques, agents,
MAC- Monitoring, sedation

21
Intraoperative Mx-
Monitoring, positioning, fluid mx, special
techniques

Post operative Mx-


Pain control, Intensive care, Mechanical
ventilation

22
PREMEDICATION
To reduce anxiety

To produce hemodynamic stability

To induce sedation & decrease metabolic rate

To provide analgesia

To provide retro-grade amnesia


23
To decrease the chances of aspiration
(Decrease acidity& Vol. of gastric content)
To control secretion-oral& resp

To prevent PONV

To control infection

To reduce the doses of anesthetic drugs.


24
Commonly use drugs

Benzodiazepam- Diazepam, Midazolam,


Alprazolam, lorazepam

Alfa 2 agonist- Clonidine, Dexmedetomidine

Opioids- Morphine, Pethidine, fentanyl

25
Anti emetics- Metochlopramide,
Domperidone, Ondensetron, Granisetron

Anti sialagouge/ Anti cholinergic- Atropine,


Glycopyrrolate

Anti biotic

26
THANK YOU
27