Preanesthesiaassessment

Preanesthesia assessment,术前评估,,理想麻醉要求,什么是理想麻醉？,理想麻醉要求,安全无痛精神安定适当肌松,麻醉方式有哪些？,PAME,PAME,PAME：Preanesthetic Medical Evaluation Apply to all patients undergoing sedation or any type of anesthesia for a procedure.To assure patients are appropriately prepared for procedures completed under sedation or any type of anesthesia.,PAME,An anesthesia care plan is based upon:Reviewing the medical record.Interviewing and examining the patient to:Discuss the medical history, previous anesthetic experiences and drug therapy.Obtaining and/or reviewing tests and consultations necessary for appropriate anesthesia care.Determining the appropriate prescription of preoperative medications as necessary to the conduct of anesthesia.,The anesthesia provider shall verify that the above has been properly performed and documented in the patients electronic medical record.,When does PAME occur?,PAME,Patients who are healthy, on minimal medications, with minimal medical problems, can have this occur on the day of the planned procedure, immediately prior to the procedure by the anesthesia provider responsible for the patient.All other patients need preoperative evaluation before the day of the procedure.,What does PAME include?,PAME,Height (cm), weight (kg), and vital signsReview of systemsAnnotated active problem listReview of medications and allergiesFocused physical exam of airway, heart and lungsFamily historyOrdering of any needed testsRoutine laboratory and radiographic tests such as chest x-ray, CBC, Type and Screen or Crossmatch are required only if specifically indicated.,How long is PAME “good?”,PAME,It depends on requirements of different medical institutionsWhenever possible, the Medical Examination should be scheduled at least 3-5 clinic days prior to surgery. This is to allow time for often necessary testing, consultation and follow-up visits.,PAME,These evaluations are valid until something changes in the patients situation: New medications or change in dosages New medical problem Change in existing medical problem hospitalization Recent operation,ASA,麻醉前评估 - ASA分级,麻醉前评估 - ASA分级,NPO,NPO,NPO Guidelines apply to all patients, adult and pediatric, undergoing sedation or any type of anesthesia for procedures.Adult NPO Guidelines (2-6-8 Rule)Pediatric NPO Guidelines (2-4-6-8 Rule),NPO - Adult NPO Guidelines (2-6-8 Rule),8 hours beforeyour scheduled procedure:Stop eating solid food.Continue drinking liquids.Do not use tobacco products or e-cigarettes.Do not take vitamins or supplements.6 hours before:Stop drinking any non-clear liquids (such as milk or orange juice).You may continue drinking clear liquids such as water, clear fruit juice (such as apple or white grape;noorange juice), carbonated beverages, clear tea or black coffee (nomilk or creamer; sweeteners are allowed).If you are on tube feedings, stop tube feedings.2 hours before:Stop drinking anything.May take a sip of water with medications as instructed.,NPO - Pediatric NPO Guidelines (2-4-6-8 Rule),8 hours beforeyour scheduled procedure:Stop giving your child any solid food.Encourage your child to drink liquids.6 hours before:Stop giving your child any non-clear liquids such as formula or milk.You may continue to give breast milk.Encourage your child to continue to drink clear liquids such as water, clear fruit juice such as apple or white grape (noorange juice), or carbonated beverages.If you are on tube feedings, stop