非住院病人的麻醉.ppt

非住院病人的麻醉,OutpatientAnesthesia,BenefitsofAmbulatorySurgery,Patientpreference,especiallychildrenandelderlyLackofdependenceonavailabilityofhospitalbedsGreaterflexibilityinschedulingoperationsLowmorbidityandmortalityLowerincidenceofinfection,LowerincidenceofrespiratorycomplicationsHighervolumeofpatients(greaterefficiency)ShortersurgicalwaitinglistsLoweroverallproceduralcostsLesspreoperativetestingandpostoperativemedication,BenefitsofAmbulatorySurgery,PatientSelection,DurationofsurgeryLessthan90minutesPatientcharacteristicsMalignanthyperthermiasusceptibilityObserveforatleast4hourspostoperativelyExtremesofageAgealoneshouldnotbeconsideredadeterrentintheselection,ContraindicationstoOutpatientSurgery,Serious,potentiallylife-threateningdiseasesthatarenotoptimallymanaged(ASA):brittlediabetes,unstableangina,symptomaticasthmaMorbidobesitycomplicatedbyhemodynamicorrespiratoryproblemsDrugtherapy:monoamineoxidaseinhibitors;acutesubstanceabuse,ContraindicationstoOutpatientSurgery,Ex-prematureinfantslessthan60weekspostconceptualageLackofaresponsibleadultathometocareforthepatientontheeveningaftersurgery,PreoperativePreparation,Aimedatreducingtherisksinherentinambulatorysurgery,improvingpatientoutcome,andmakingthesurgicalexperiencepleasantforthepatientandfamily,PreoperativePreparation,Prepatationshouldminimizepatientanxietythroughpharmacologicandnon-pharmacologicmeansandshouldreducepotentialpostoperativeproblemsbyuseofappropriatepremedication,NonpharmacologicPreparation,Pharmacologicprepatation,AnixolysisandsedationAnalgesicsPreventionofnauseaandvomitingPreventionofaspirationpneumonitis,Nothing-by-mouthGuidelines,AnetheticTechniques,Quality,safety,efficiency,andthecostofdrugsandequipmentareimportantconsiderationsinchoosingananesthetictechniqueforoutpatientsurgery,AnetheticTechniques,Theabilitytodeliverasafeandcost-effectivegeneralanestheticwithminimalsideeffectsandrapidrecoveryiscriticalinabusyoutpatientsurgeryunitGeneralanesthesiaremainsthemostwidelyusedanesthetictechniqueformanagingambulatorysurgery,SpecificconsideratinsinGeneralAnesthesia,AirwaymanagementIntravenousanestheticdrugsInhaledanestheticdrugsAnalgesicsMusclerelaxantsReversalofdrugeffects,RegionalanesthesiaMonitoredanesthesiacare(MAC),DischargeCriteria,VitalsignsAmbulationNauseaandvomitingPainSurgicalbleeding,麻醉后监测治疗室,PostanestheticCareUnit(PACU),主要任务,收治对象当日全麻病人术后未苏醒者非全身麻醉后病人情况尚未稳定者麻醉后神经功能未恢复者目的监护和治疗病人在麻醉恢复过程中所出现的生理功能紊乱与ICU的区别麻醉苏醒期的监护和治疗，短时间、一般性的麻醉恢复,PACU处理的常见问题,呼吸道梗阻通气不足低氧血症低血压高血压心律失常恶心、呕吐低温神志观察,离开恢复室的标准,呼吸循环神志椎管内麻醉平面稳定,PACU的设置和管理,设置足够的照明足够的空间足够的装备必备的药物管理,呼吸道梗阻,上呼吸道梗阻舌后坠上呼吸道分泌物聚积咽或喉梗阻喉头水肿下呼吸道梗阻呼吸道分泌物、呕吐物、血液和脓液等阻塞下呼吸道支气管痉挛,麻醉苏醒期,终止给予麻醉药物至病人清醒的时间，可分为下面四个时相感觉和运动功能逐步恢复出现自主呼吸，并能逐渐自行调控呼吸道反射恢复清醒,Sveralintravenousanestheticsforuseduringambulatoryanesthesia,Intermidiaterecoveryafterpropofol,desflurane(N2O),orpropofol-desfluraneanesthesia,Postoperativenauseaafterpropofol,deflurane,orprofofol-defluraneanesthesia,Ri