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1、非住院病人的麻醉,Outpatient Anesthesia,Benefits of Ambulatory Surgery,Patient preference, especially children and elderly Lack of dependence on availability of hospital beds Greater flexibility in scheduling operations Low morbidity and mortality Lower incidence of infection,Lower incidence of respiratory c
2、omplications Higher volume of patients (greater efficiency) Shorter surgical waiting lists Lower overall procedural costs Less preoperative testing and postoperative medication,Benefits of Ambulatory Surgery,Patient Selection,Duration of surgery Less than 90 minutes Patient characteristics Malignant
3、 hyperthermia susceptibility Observe for at least 4 hours postoperatively Extremes of age Age alone should not be considered a deterrent in the selection,Contraindications to Outpatient Surgery,Serious, potentially life-threatening diseases that are not optimally managed (ASA):brittle diabetes, unst
4、able angina, symptomatic asthma Morbid obesity complicated by hemodynamic or respiratory problems Drug therapy: monoamine oxidase inhibitors; acute substance abuse,Contraindications to Outpatient Surgery,Ex-premature infants less than 60 weeks postconceptual age Lack of a responsible adult at home t
5、o care for the patient on the evening after surgery,Preoperative Preparation,Aimed at reducing the risks inherent in ambulatory surgery, improving patient outcome, and making the surgical experience pleasant for the patient and family,Preoperative Preparation,Prepatation should minimize patient anxi
6、ety through pharmacologic and non-pharmacologic means and should reduce potential postoperative problems by use of appropriate premedication,Nonpharmacologic Preparation,Pharmacologic prepatation,Anixolysis and sedation Analgesics Prevention of nausea and vomiting Prevention of aspiration pneumoniti
7、s,Nothing-by-mouth Guidelines,Anethetic Techniques,Quality, safety, efficiency, and the cost of drugs and equipment are important considerations in choosing an anesthetic technique for outpatient surgery,Anethetic Techniques,The ability to deliver a safe and cost-effective general anesthetic with mi
8、nimal side effects and rapid recovery is critical in a busy outpatient surgery unit General anesthesia remains the most widely used anesthetic technique for managing ambulatory surgery,Specific consideratins in General Anesthesia,Airway management Intravenous anesthetic drugs Inhaled anesthetic drug
9、s Analgesics Muscle relaxants Reversal of drug effects,Regional anesthesia Monitored anesthesia care(MAC),Discharge Criteria,Vital signs Ambulation Nausea and vomiting Pain Surgical bleeding,麻醉后监测治疗室,Postanesthetic Care Unit (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
10、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
11、行调控 呼吸道反射恢复 清醒,Sveral intravenous anesthetics for use during ambulatory anesthesia,Intermidiate recovery after propofol, desflurane( N2O), or propofol-desflurane anesthesia,Postoperative nausea after propofol, deflurane, or profofol-deflurane anesthesia,Risk Factors for Postoperative Nausea and Vomiting,Predisposing factors Increased gastric volume Anesthetic technique Surgical/diagnostic procedure Postoperative factors,