preoperative anesthesia and premedication

8/12/2019 Preoperative Anesthesia and Premedication

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PREOPERATIVE ANESTHESIA and

PREMEDICATIONdr. Ratna E. Hutapea Sp. An



Routine preoperative anestheticevaluation

I. History1. Current problem2. Other known problems3. Medication history

• Allergies• Drug intolerances• Present theraphy

PrescriptionNonprescription

• Non therapeuticAlcoholTobacco

• Illicit4. Previous anesthetics,

surgery, and obstetricdeliveries

5. Family history

6. Review of organ systemGeneral (Including activity level)RespiratoryCardiovascularRenalGastrointestinalHematologicNeurologicEndocrinePsychiatricOrthopedicDermatologic

7. Last oral intake



Routine preoperative anestheticevaluation

II. Physical Examination1. Vital signs2. Airway3. Heart4. Lungs5. Extremities6. Neurologic examination

III. Laboratory Evaluation

Routine preoperative laboratory evaluation ofasymtomatic, apparently healthypatients.

Hematocrit or hemoglobin concentration :• All menstruating woman• All patients over 60 years of age• All patients who are likely to experience

significant blood lose and may requiretranfusion.

Serum glucose and creatinin ( or blood urea

nitrogen )Concentration : all patients over 60 yearsof age

Electrocardiogram : all patients over 40 yearsof age

Chest radiograph: all patients over 60 years ofage



The Anesthetic plan

PremedicationType of anesthesia

General

Airway managementInductionMaintenanceMuscle relaxation

Local or regional anesthesiaTechnique

AgentsMonitored anesthesia care

Supplemental oxygenSedation

Intraoperative managementMonitoringPositioningFluid managementSpecial techniques

Postoperative managementPain control

Intensive carePostoperative ventilationHemodynamic monitoring



ASA Physical

1. A normal healthy patient2. A patient with mild systemic disease and no

function limitations3. A patient with moderate to severe systemic

disease that results in some functionallimitation

4. A patient with severe systemic disease that is aconstant threat to life and functionallyincapacitating

5. A moribund patient whi is not expected tosurvive 24 hours with or without surgery

6. A brainded patient whose organs are beingharvested

E. If the procedure is an emergency, the physicalstatus is followed by “E”



American Society of

Anesthesiologists classification andperioperative mortality rates

Class Mortality Rate

1 0,06-0,08 %

2 0,27-0,4%

3 1,8-4,3%

4 7,8-23%5 9,4-51%



Common Problems Amenable toTreatment before Anesthesia and

Operation• Anxiety• Amnesia• Pain• Salivation and airway secretions•

Vagal reflexes• Hypertensive reponses• Seizure• Aspiration of gastric contents• Nausea and vomiting• Infection• Reactions to intravenous contrast media• Latex allergy• Continuation of preoperative theraphy



Commondly used premedications



Informed Consent

Etis otonomi pasien adalah suatu hak yangharus dihargai oleh setiap praktisi ilmukedokteran.

Hak pasien untuk memilih tanpa dipengaruhioleh orang lain.

Praktisi juga terikat oleh kewajiban untukmemberikan informasi seutuhnya kepadapasien.



Masukan Oral

Refleks laring mengalami penurunan saat anestesia.

Regurgitasi isi lambung dan kotoran yg terdapat dalam jalan napasmerupakan risiko utama.

Untuk meminimalkan risiko tersebut, pasien dijadwalkan puasa sebelum

induksi anestesia.

Dewasa : 6-8 jamAnak kecil : 4-6 jam

Bayi : 3-4 jam

Makanan berlemak boleh 5 jam sebelum induksianestesiaMinuman bening,air putih,teh manis sampai 3 jam

sebelum induksiMinum obat dengan air putih dalam jumlah terbatas

boleh 1 jam sebelum induksi

preoperative anesthesia and premedication

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