2. ANESTHESIOLOGY Peng Zhanglong Department of Anesthesiology Rui Jin Hospital Shanghai Second Medical University 1 1

3. Contents 1. The history of anesthesiology 2. The scope of anesthesiology 3. Classification of Anesthesia 4. Definition of Anesthesia 5. Preparing for anesthesia 6. Premedication 2 2

4. The History of Anesthesiology  Anesthetic practices date from ancient times  Modern anesthesiology began in 1842 --- Ether was used as an anesthetic agent in humans.  Modern anesthesiology only became firmly established less than six decades ago 3

5.  Modern inhalation anesthetics were developed from 1950s to 1960s  Intravenous anesthesia first began in 1872--- Use of choral hydrate. From then, many other intravenous agents were developed.  Muscle relaxants resulted in evolution of anesthesiology---Curare( 箭毒 )was firstly used in 1942 4 The History of Anesthesiology

6.  The original of modern local anesthesia was credited to use of cocaine in 1884.  Subarachnoid anesthesia --- 1898. Caudal epidural anesthesia--- 1901. lumbar epidural anesthesia --- 1921 5

7. 1. Clinical anesthesia 2. Pain management 3. First-aid and resuscitation 4. Intensive care 6 The Scope of Anesthesiology

8. Definition of Anesthesia Anesthesia is always defined by drug-induced changes in behavior or perception( 感觉 ). The components of general anesthetic state include unconsciousness, amnesia( 健忘 ), analgesia( 镇痛 ), immobility, and attenuation of autonomic nervous system responses to noxious stimulation. 7

9. Course of Anesthesia Anesthesia induction Anesthesia maintenance Anesthesia recovery 8

10. Classification of Anesthesia General anesthesia Inhalation anesthesia Intravenous anesthesia Combined anesthesia Intravenous Venous-inhalation Intrathecal block- general anesthesia Local anesthesia Topical anesthesia Infiltration anesthesia Nerve block Nerve plexus block Intrathecal block: Subarachnoid block, epidural block and caudal block 9

11. Some special measures during anesthesia Deliberate hypotension( 控制性低血压 ) Deliberate hypothermia( 控制性低温 ) Acute isovolumic hemodilution( 急性等容量血液稀释 ) Acute hypervolumic hemodilution( 急性高容量血液稀释 ) Cardiac pulmonary bypass( 心肺转流 ) 10

12. Monitoring During Anesthesia The Cardiovascular System The Respiratory System Liver and kidney function Central nerve system Coagulation function 11

13. Pain Management Postoperative analgesia Delivery analgesia Acute and chronic pain cure Cancer analgesia 12

14. Preoperative visit Preoperative evaluation: History, physical examination, laboratory evaluation Preoperative fasting Coexisting disease therapy Equipment preparation Preoperative medication 13 Preparing For Anesthesia

15. Purposes of the preoperative visit 1. Establish rapport with the patient 2. Obtain a history and perform a physical examinations 3. Order a special investigations 4. Assess the risks of anesthesia and surgery 5. Institute preoperative management 14

16. History Review of organ system clinical examination Laboratory Evaluation 15 Routine Preoperative Anesthetic Evaluation

17. ASA Physical Status Classification Class Definition 1 A normal healthy patient. 2 A patient with mild systemic disease and no functional limitation 3 A patient with moderate to severe systemic disease that results in some functional limitation. 4 A patient with severe systemic disease that is a constant threat to life and functionally incapacitating. 5 A moribund patient who is not expected to survive 24 hours with or without surgery. E If the procedure is an emergency, the physical status is followed by “ E ” Mortality Rate(%) 0.1 0.2 1.8 7.8 9.4 16

18. Preoperative Fasting The time of fasting solid is more than 6 hours, and fluid is more than 2 hours. The time of fasting breast milk is 4 hours in baby. If necessary, baby should be transfused. 17

19. Coexisting Disease Therapy Coexisting disease may affect outcome adversely if not under optimum control. The coexisting disease must be treated properly before any non – urgent surgery. Coexisting disease and drug treatment may interact with anesthesia and surgery in several ways 18

20. Coexisting Disease Therapy 1. The course of the disease may be modified by anesthesia or surgery. 2. Influence the effects of anesthesia. 3. Both disease and drug treatment may influence choice of anesthetic technique. 4. Drug treatment may modify the normal compensatory physiological responses 19

21. Choice of Anesthesia Factors to choice a anesthetic technique 1. Patient condition 2. Surgery category 3. The technical and theoretic level of anesthetist 4. Anesthetics 5. Anesthesia and monitor equipment 20

22. Anesthetic machine 1. Electrical supply 2. All essential equipment is present and correctly assembled 3. Medical gas supply 4. Vaporizers 5. Breathing system: Ventilators 21 Equipment and drug Preparation

23. Ancillary Equipment 1. laryngoscopes, intubation aids 2. Face masks, airways, tracheal tubes and connectors 3. Suction apparatus 22 Equipment and drug Preparation

24. Monitoring equipment and drug 1. NIBP, SpO2, ECG, etc. 2. Ephedrine, Atropine, etc 3. Anesthetics 23

25. Preoperative Medication  Sedation and hypnosis  Analgesia  Drying of airway secretions  Attenuate vagal reflexes and sympathoadrenal responses Goals for pharmacologic premedication 24

26. Preoperative Medication Sedative Benzodiazepines( 苯二氮 ): Diazepam, Lorazepam, Midazolam Phenothiazines( 吩噻嗪 ) ： Promethazine Hypnotics Barbiturates( 巴比妥 ): Phenobarbital Drugs used for pharmacologic premedication 25

27. Preoperative Medication Butyrophenones( 丁酰苯 ) ： Droperidol, Haloperidol Analgesia Opioid: Morphine, Meperidine, Fentanyl Anticholinergic agents Atropine, Scopolamine Other special drugs β-receptor blocker, Calcium channel blocker 26

28. Preoperative Medication Announcements 1. General status 2. Age 3. Disease 4. Others 27

29. 谢 thanks