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Clinical Anaesthesiology Qiu Wei Fan Associate Professor Department of Anaesthesiology Rui Jin Hospital Shanghai Second Medical University 1 Contents The history of Anaesthesia The scope of anaesthesia Classification of Anaesthesia Methods Definition of the practice of anaesthesiology

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clinical anaesthesiology

Clinical Anaesthesiology

Qiu Wei FanAssociate Professor

Department of AnaesthesiologyRui Jin HospitalShanghai Second Medical University

1

contents

Contents

The history of Anaesthesia

The scope of anaesthesia

Classification of Anaesthesia Methods

Definition of the practice of anaesthesiology

Preoperative assessment and premedication

2

the history of anaesthesia british origins

The History of AnaesthesiaBritish Origins

John Snow was the first to scientifically investigate ether and the physiology of general anaesthesia. Snow was also a pioneer in epidemiology who helped stop a cholera epidemic in London by proving that the causative agent was transmitted by ingestion rather than inhalation.

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the history of anaesthesia british origins4

The History of AnaesthesiaBritish Origins

In 1847, Snow published the first book on general anaesthesia, On the Inhalation of Ether. When the anaesthetic properties of chloroform were made known, he also quickly investigated and developed an inhaler for that agent as well. He felt that an inhaler should be used in administering these agents in order to control the dose of the anaesthetic.

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the history of anaesthesia british origins5

The History of AnaesthesiaBritish Origins

In 1893, then first organization of physician specialists in anaesthesia , the Society of Anaesthetists, was formed by J. F. Silk in England.

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the history of anaesthesia american origins

The History of AnaesthesiaAmerican Origins

Three physicians stand out in the early development of anaesthesia in the United States after the turn of the century: Arthur E. Guedue, Ralph M. Waters, and John S. Lundy. Guedue was the first to elaborate on the signs of general amaesthesia after Snow’s original description. He advocated cuffed endotracheal tubes and introduced artificial ventilation during ether anaesthesia (later called “controlled respiration” by Waters).

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the history of anaesthesia american origins7

The History of AnaesthesiaAmerican Origins

The first organization of physician anaesthetists in the United States was the Long Island Society of Anaesthetists in 1911. That society was eventually renamed the New York Society of Anaesthetists and become national in 1936. It was subsequently renamed the American Society of Anaesthetists and later, in 1945, the American Society of Anaesthesiologists ( ASA ).

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the history of anaesthesia chinese origins

The History of AnaesthesiaChinese Origins

More than 1500 years ago, Chinese physician of traditional medicine already used some herb and alcohol to make patients unconscious and did some minor operations. In our country, the first department of Anaesthesiology was established in 1950 as soon as Professor Jue Wu returned to Shanghai, the People’s Republic of China from abroad.

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the scope of anaesthesia

The Scope of Anaesthesia

Providing general or regional anaesthesia inside and outside the operating room

Intensive care units

Respiratory therapy departments

Recovery room

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the scope of anaesthesia10

The Scope of Anaesthesia

Cardiopulmonary resuscitation

Postoperative pain relief

Anaesthetic research, teaching medical students, and assuming administrative and leadership positions on the medical staffs of many hospitals and ambulatory care facilities.

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classification of anaesthesia methods general anaesthesia

Classification of Anaesthesia Methods Generalanaesthesia

Inhalation anaesthesia

Intravenous anaesthesia\

Intramuscularly

Rectally

Orally

Balanced anaesthesia

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classification of anaesthesia methods regional anaesthesia

Classification of Anaesthesia Methods Regional Anaesthesia

Intrathecal anaesthesia

Subarachnoid block

Epidural anaesthesia

Caudal block

Nerve plexus block

Ganglion block

Nerve block

Field block.

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definition of the practice of anaesthesiology

Definition of the practice of anaesthesiology

1)Assessing,consulting, and preparing patients for anaesthesia

2)Rendering patients insensible to pain during surgical obstetric, therapeutic, and diagnostic procedures

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definition of the practice of anaesthesiology14

Definition of the practice of anaesthesiology

3)Monitoring and restoring homeostasis in perioperative and critically patients

4)Diagnosing and treating painful syndromes

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definition of the practice of anaesthesiology15

Definition of the practice of anaesthesiology

5)Managing and teaching of cardiac and pulmonary resuscitation

6)Evaluating respiratiry function and applying respiratory therapy

7)Teaching, supervising, and evaluating the performance of medical and paramedical personnel involved in anaesthesia,respiratory care, and critical care

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definition of the practice of anaesthesiology16

Definition of the practice of anaesthesiology

8)Conducting research at the basic and clinical science levels to explain and improve the care of patients in terms of physiologic function and drug response

9)Involvement in the administration of hospitals, medical schools, and outpatient facilities as necessary to implement these responsibilities

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preoperative assessment

Preoperative assessment

Planning the conduct of ansesthesia starts normally after details concerning the surgical procedure and the medical condition of the patient have been ascertained at the preoperative visit.

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preoperative assessment18

Preoperative assessment

Several of the large-scale epidemiological studies have indicated that inadequate preoperative preparation of the patient may be a major contributory factor to the primary anaesthetic causes of peri-operative mortality.

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preoperative assessment19

Preoperative assessment

It is therefore essential that anaesthetist visit every patient in the word before surgery to assess “fitness for anaesthesia”, as this function cannot be undertaken by surgical staff.

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purposes of the preoperative visit

Purposes of the preoperative visit

Estabilish rapport with the patient

Obtain a history and perform a physical examinations

Order a special investigations

Assess the risks of anaesthesia and surgery and if necessary postpone or cancel the date of surgery

Institute preoperative management

Prescribe premedication and the anaesthetic management

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preoperative assessment21

Preoperative assessment

Routine preoperative anaesthetic evaluation

History

Current problem

Other known problems

Medication history

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preoperative assessment medication history

Preoperative assessment (Medication history)

Allergies

Drug intolerances

Present therapy: Prescription, Nonprescription

Nontherapeutic: Alcohol, Tobacco

Illicit

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preoperative assessment23

Preoperative assessment

Previous anaesthetics, surgery, and obstetric deliverries

Family history

Review of organ systems

Last oral intake

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preoperative assessment review of organ systems

Preoperative assessment(Review of organ systems)

General

Respiratory

Cardiovascular

Renal

Gastrointestinal

Hematologic

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preoperative assessment review of organ systems25

Preoperative assessment (Review of organ systems)

Neurologic

Endocrine

Psychiatric

Orthopedic

Dermatologic

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preoperative assessment physical examination

Preoperative assessment ( Physical examination)

Vital signs

Airway

Heart

Lungs

Extremities

Neurologic examination

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preoperative assessment laboratory evaluation

Preoperative assessment( Laboratory evaluation)

Hematocrit or hemoglobin concentrationAll menstruating womenAll patients over 60 years of ageAll patients who are likely to experience significant blood loss and may require transfusion

Serum glucose and creatinine (or blood urea nitrogen) concentration: all patients over 60 years of age

Electrocardiogram: all patients over 40 years of age

Chest radiogram: all patients over 60 years of age

26

asa classification

ASA classification

I A normal healthy patient other than surgical pathology- without systemic disease.

II A patient with mild systemic disease – no functional limitations.

27

asa classification29

ASA classification

III A patient with moderate to severe systemic disturbance due to medical or surgical disease- some functional limitation but not incapacitating.

IV A patient with severe systemic disturbance which poses a constant threat to life and is incapacitating.

27

asa classification30

ASA classification

V A moribund patient not expected to survive 24 hours with or without surgery.

E If the case is an emergency, the physical status is followed by the letter “E”-, “IIE”.

27

american society of anaesthesiologists classification and perioperative mortality rates

American Society of Anaesthesiologists classification and perioperative mortality rates

Class Mortality Rate

I 0.06-0.08%

II 0.27-0.4%

III 1.8-4.3%

IV 7.8-23%

V 9.4-51%

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documentation

Documentation

Informed Consent

The preoperative note

The intraoperative anaesthesia record

The postoperative notes

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the preoperative note the preoperative assessment

The preoperative Note(The preoperative assessment)

Medical history

Anaesthesia history

Medication history

Physical history

Physical examination

Laboratory results

ASA classification

Recommendations of any consultants

30

the preoperative note

The preoperative Note

Anaesthetic plan: Use of specific procedures

Informed consent: Plan, alternative plans, their advantage and disadvantages ( risk of complications)

31

the intraoperative anaesthesia record

The Intraoperative Anaesthesia Record

A preoperative check of the anaesthesia machine and other equipment

A review or reevaluation of the patient immediately prior to induction of anaesthesia

A review of the chart for new laboratory results or consultations

A review of the anaesthesia and surgical consents

32

the intraoperative anaesthesia record36

The Intraoperative Anaesthesia Record

The time of administration, dosage, and route of intraoperative drugs

All intraoperative monitoring( laboratory measurements, blood loss, and urinary output)

Intravenous fluid administration and transfusion

All procedures(intubation, placement of a nasogastric tube or placement of invasive monitors)

33

the intraoperative anaesthesia record37

The Intraoperative Anaesthesia Record

Routine and special techniques such as mechanical ventilation, hypotensive anaesthesia, one-lung ventilation, high-frequency jet ventilation, or cardiopulmonary bypass

34

the intraoperative anaesthesia record38

The Intraoperative Anaesthesia Record

The timing and course of important events such as induction, positioning, surgical incision, and extubation

Unusual events or complications

The condition of the patient at the end of the procedure

34

the postoperative notes

The postoperative notes

The patient’s condition

The patient’s recovery from anaesthesia

Any apparent anaesthesia-related complications

35

questions

Questions

How do you take the history from a patient?

What is the meaning of the ASA classification?

36