PREOPERATIVE & PREMEDICATION

Kepaniteraan Klinik Ilmu Nestesi

FK UNTAR
Periode 8 Januari-10 Februari 2018
 PURPOSE OF PREMEDICATION
• Identify those few patient whose outcomes likely will be improved by implementation
of specific medical treatment.
• Identify patients whose condition is so poor that the proposed surgery might only has
ten death without improving the quality of life.
• Identify patients with specific characteristics that likely will influence the proposed
anestetic plan
• Provide the patient with an estimate of anesthetic risk
• Opportunity for the anesthesiologist to describe the proposed anesthetic plan in the
context of the overall surgical and postoperative plan and informed consent for the
proposed anesthetic plan from the surgical patient.
AMERICAN SOCIETY OF ANESTHESIOLOGIST’ (ASA)
PHYSICAL STATUS CLASSIFICATION OF PATIENTS.
class Definition
1 Normal healthy patient
2 Patient with mild systemic disease ( no functional limitation)
3 Patient with severe disease ( some functional limitation)
4 Patient with severe systemic disease that is a constant threat to life( functionally
incapacitated)
5 Moribund patient who is not expected to survive without the operation
6 Brain dead patient whose organs are being removed for fonor purposes.
E If the procedure is an emergency, the physical status is followed by “E”
 ELEMENT OF PREOPERATIVE HISTORY
• Cardiovascular issues
• Determining whether the patient condition can and must be improved prior to the
scheduled procedure, and whether the patient meets criteria for futher cardiac
evaluation prior to the scheduled surgery.
• Pulmonary issues
• Identify patient 60 y.o or older, those with chronic obstructive lung disease those
with heart failure requiring preoperative and postoperative interventions to avoid
complications.
• Efforts at prevention of pulmonary complications should focus on cessation of
cigarette smoking prior to surgery and on lung expation techniques after surgery in
patients at risk.
• Endocrine and Metabolic issues
• In patient with abnormally elevated HbA1c referral to a diabetology service for
education abour the disease and adjustment of diet and medications to improve
metabolic control may be beneficial.
• Elective surgery should be delayed in patients presenting with marked hyperglycemia
• Coagulation Issue
• Must be addresssed during the preoperative evaluation are: how to manage patients
who are takign warfarin on a long term basis, how to manage patients who are taking
CPG and related agents, how to safely provide regional anesthesia to patient who
either are receiving anticoagulation theraphy or who will receive amticoagulation
perioperatively.
• Patient at high risk for thrombosis, warfarin should be replaced by IV heparin/ IM
heparinoids
• Gastrointestional issues
• Aspiration of gastric contents has been recognozed as potentially disastrous
pulmonary complication of surgical anesthesia.
• Treat patients with consistenst symptoms with medication and techniques ( tracheal
intubation) as it they were at increased risk for aspiration.
 ELEMENT OF PREOPERATIVE PHYSICAL
EXAMNINATION
• Vital signs
• Examination of airway, heart, lungs, and musculoskeletal system
• Relevant anatomy should be examined for regional anesthesia/ nerve block
• Infection near the site of anatomic abnormalities may contraindicate the planned
procedure
• Neurological examination
 PREOPERATIVE LABORATORY TESTING
• Baseline Hb or Ht measurementis desirable in any patient about to undergi a procedure
that may result in extensive blood loss and require transfusion.
• Routine testing for HIV antibody is not indicated
 PURPOSE OF PREMEDICATION
• Reduction of patient anxiety
• Sedative
• Reduce airway secretions
• Analgesic