MindMap Gallery Preparation before anesthesia
This review of pre-anesthesia preparation knowledge in clinical medicine covers two parts: physical and mental preparation of patients. Friends in this major and those who are interested should not miss it.
Edited at 2023-03-06 21:51:55El cáncer de pulmón es un tumor maligno que se origina en la mucosa bronquial o las glándulas de los pulmones. Es uno de los tumores malignos con mayor morbilidad y mortalidad y mayor amenaza para la salud y la vida humana.
La diabetes es una enfermedad crónica con hiperglucemia como signo principal. Es causada principalmente por una disminución en la secreción de insulina causada por una disfunción de las células de los islotes pancreáticos, o porque el cuerpo es insensible a la acción de la insulina (es decir, resistencia a la insulina), o ambas cosas. la glucosa en la sangre es ineficaz para ser utilizada y almacenada.
El sistema digestivo es uno de los nueve sistemas principales del cuerpo humano y es el principal responsable de la ingesta, digestión, absorción y excreción de los alimentos. Consta de dos partes principales: el tracto digestivo y las glándulas digestivas.
El cáncer de pulmón es un tumor maligno que se origina en la mucosa bronquial o las glándulas de los pulmones. Es uno de los tumores malignos con mayor morbilidad y mortalidad y mayor amenaza para la salud y la vida humana.
La diabetes es una enfermedad crónica con hiperglucemia como signo principal. Es causada principalmente por una disminución en la secreción de insulina causada por una disfunción de las células de los islotes pancreáticos, o porque el cuerpo es insensible a la acción de la insulina (es decir, resistencia a la insulina), o ambas cosas. la glucosa en la sangre es ineficaz para ser utilizada y almacenada.
El sistema digestivo es uno de los nueve sistemas principales del cuerpo humano y es el principal responsable de la ingesta, digestión, absorción y excreción de los alimentos. Consta de dos partes principales: el tracto digestivo y las glándulas digestivas.
Preparation before anesthesia
Physical preparation
Improve the patient's general condition
Improve patients' nutritional status
Correct severe anemia, water, electrolyte, acid-base imbalance and hypoalbuminemia
stop smoking
Increase physical strength
Practice deep breathing to improve cardiorespiratory reserve
Actively treat medical diseases
Cardiovascular System
Heart failure, atrial fibrillation or significantly enlarged heart
Digitalis drug treatment should be discontinued on the day of surgery. However, if atrial fibrillation is associated with a rapid ventricular rate, digitalis can be administered until the morning of the surgery.
Long-term use of beta-blockers to treat angina pectoris and arrhythmia
Generally, the medication should be continued until the day of surgery.
essential hypertension
The blood pressure should be lowered to at least below 180/110mmHg during elective surgery. Do not lower the blood pressure of patients with chronic hypertension too quickly;
Long-term use of antihypertensive medications
Generally, the medication should be continued until the day of surgery.
respiratory system
Control respiratory infections for 1 week
Stop smoking for at least 2 weeks
Central Nervous System
acute cerebral infarction
Should be postponed for 4 to 6 weeks
Parkinson's disease patient
brain function test
blood gas analysis
Instruct patients to exercise respiratory function
Drug use until surgery
Endocrine System
Hyperthyroidism
Preoperative preparation generally includes antithyroid drugs and iodine treatment
Indicators of adequate preparation before anesthesia
Basal metabolic rate<±20%
Pulse rate <90 beats/minute
The patient's mood is stable, sleeps well, and has gained weight, etc.
Primary aldosteronism and hypercortisolism
Before anesthesia, attention should be paid to correcting the imbalance of water, electrolytes and acid-base balance, and special attention should be paid to potassium supplementation.
Pheochromocytoma
Hypertension should be controlled as much as possible before surgery. While a-blockers are used to dilate blood vessels, fluid therapy should be actively carried out to expand blood volume.
diabetes
For elective surgery, fasting blood sugar should be controlled below 8.3mmol/L, preferably within the range of 6.1~7.2 mmol/L, and the maximum should not exceed 11.1mmol/L; urine glucose should be lower than (/-); urinary ketones (1)
Short-acting hypoglycemic drugs or those using regular insulin
Discontinue use on the morning of surgery
Long-acting hypoglycemic drugs
Stop taking it 2 to 3 days before surgery and switch to regular insulin.
liver function
Liver insufficiency
Mild
Tolerance to anesthesia and surgery has little impact
Moderate
Strict preparation to maximize liver function and systemic status
Severe
The risk is extremely high and any surgery is contraindicated
acute hepatitis
Surgery is contraindicated except for emergency rescue operations.
kidney function
Kidney failure no longer constitutes a contraindication for elective surgery
Renal function should be improved to the greatest extent before surgery. If dialysis is required, it should be performed within 24 hours of the planned surgery.
blood system
aldult
Hb >80g/l
Infants younger than 3 months
Hb >100g/l
Babies older than 3 months
Hb >90g/l
Platelet count is greater than 50*10^9/l
other
Preparation of medications for previous treatment
Antihypertensive drugs, antiarrhythmic drugs, cardiotonic drugs, endocrine drugs, etc.
It is generally not recommended to discontinue medication
Glucose oxidase inhibitors and tricyclic antidepressants
Need to stop taking the medicine for 2 to 3 weeks
aspirin
There is no risk of bleeding at doses of 3~10mg/kg per day
It is recommended that patients who take long-term high-dose aspirin exceeding 2g per day and who do not stop taking aspirin as early as possible before surgery should have coagulation function tests to evaluate their coagulation function.
Intravenous injection of 5000 units of unfractionated heparin (whole blood coagulation time is prolonged by 2 times)
Surgery is possible after 3-4 hours
If emergency surgery is required, protamine should be used to terminate anticoagulation before surgery.
Warfarin
Medication needs to be stopped for 3 to 5 days before surgery
Emergency surgery, add vitamin K
Temporarily stop anticoagulation for several hours and inject 250~500ml of plasma intravenously.
Strictly implement fasting and drinking before anesthesia
aldult
Fasting from easily digestible solid foods for at least 6 hours and fasting from fatty foods for at least 8 hours
newborn, infant
Withhold breast milk for at least 4 hours
Fasting of easily digestible solid foods, milk, formula and other non-human milk for at least 6 hours
Patients of all ages can drink something clear 2 hours before surgery
Treating a full stomach
Awake endotracheal intubation
Rapid induction of endotracheal intubation - cricoid cartilage presses against esophagus
Indwelling gastric tube
antiemetics, antacids
suction device
Postural adjustment
mental preparation
Relieve fears and worries
Increase confidence in overcoming disease
Sign an anesthesia informed consent form