Prepare a Patient for General Anesthesia 081-833-4522

1
Prepare a Patient for General Anesthesia081-833-4
522

• INSTRUCTOR
• SFC HILL

2
OBJECTIVE

• As a Special Forces Medic, prepare a patient for
  general parenteral anesthesia, in accordance with
  JSOMTC student manual of anesthesia.

3
REASON

• As a Special Forces Medic preparation of the
  patient and yourself will be a critical task in
  the successful performance of general parenteral
  anesthesia

4
PROCEDURES

• The Preanesthetic Visit
• Prep for general parenteral anesthesia
• Emergency prep for general parenteral anesthesia

5
The Preanesthetic Visit

• The preanesthetic visit is conducted so the
  anesthetist can meet with the patient for the
  purpose of identifying any possible complications
  prior to the anesthetic procedure and alleviating
  the patients possible anxiety or fear of
  anesthesia/surgery

6
Preanesthetic Visit

• Should take place at least 24 hours prior to the
  scheduled procedure
• If possible, it should be conducted prior to
  emergency administration of anesthesia

7
Preanesthetic Visit

• What are some possible problems or complication
  that can be identified prior to the
  administration of anesthesia?

8
Preanesthetic Visit

• Tracheal Intubation Problems
• Allergies
• Drug interactions
• Previous Exposure to Anesthesia
• Concurrent Illnesses
• Classification of Physical Status

9
Tracheal Intubation Problems

• Short Thick Neck
• Disease of Pharynx or Larynx
• Tracheal Deviation
• Small Mouth
• Stiff Temporomandibular Joint
• Prominent Upper Incisors

10
Tracheal Intubation Problems

• Chipped or Cracked Enamel
• Caries
• Loose Teeth
• Dentures, Crowns

11
Allergies

• All Pharmacological Agents are potential
  allergens
• Emergency drugs for anaphylactic shock must be on
  hand prior to administration of any drug
• Take detailed History to differentiate between
  side effects and allergic reaction

12
DRUG INTERACTIONS

• Note present drug therapy
• Research any present drug therapies verses the
  anesthetic therapy plan for this procedure
• Many drugs will not interact well with anesthetic
  agents

13
Previous Exposure to Anesthesia

• Repeat use of certain anesthetic agents may cause
  hepatic damage or stress
• Take a detailed History of previous use of
  anesthesia
• Agents that caused problems in the past should
  not be repeated
• Take a detailed History of any previous
  difficulties

14
Concurrent Illnesses

• Common Cold
• Liver Disease
• Diabetes Mellitus
• Anemia
• COPD
• Heart Disease
• Essential Hypertension

15
Classification of Physical Illnesses

• Class I- fit and healthy
• Class II- Mild systemic illness
• Class III- Severe systemic illness that is not
  incapacitating
• Class IV- Incapacitating, systemic, life
  threatening illness
• Class V- Expectant, with or without surgery
• E- Emergency

16
Record information

• Record all the information from the preanesthetic
  visit into the preanesthetic summary of the
  patients SF 517

17
Patient Instructions

• Review the upcoming procedure with the patient
• Ensure the patient understands his/her
  responsibilities prior to the planned procedure

18
Prep for general parenteral anesthesia
19
Review and Prep

• Review the patients SF517
• Prepare the anesthetist cart and all equipment to
  be utilized during the procedure to include
  back-up and emergency equipment

20
Receive the patient

• Identify patient and reconfirm type and location
  of procedure
• Converse with the patient to establish his or her
  mental status
• Establish the patients compliance with his or her
  preanesthetic orders
• Review the procedure once again with the patient
• Calm and reassure the patient

21
Prepare the patient

• Establish baseline set of vitals for the patient
• Establish the patient on 2 liters a minute,
  humidified oxygen
• Establish patient on monitors
• Establish IV access, Normal Saline, TKO

22
Administer Premedication

• Administer antisialagogue (Atropine, .4-.6mg deep
  IM 45 minutes prior to induction)
• Administer sedative (Promethazine, 25-50mg PO 30
  minutes prior to induction)
• Continue to monitor the patients vitals every 15
  minutes until induction
• Move the patient to the OR

23
Emergency prep for general parenteral anesthesia
24
Receive the patient

• Identify the patient and attempt to obtain a
  brief but thorough history
• Work with the surgical team to establish the
  patients condition (A-B-C) and level of
  consciousness
• Perform life saving measures
• If the patient is conscious and orientated X 3,
  converse with the patient to establish his or her
  mental status
• If the patient is conscious and orientated X 3,
  attempt to calm and reassure the patient

25
Prepare the patient

• Obtain vitals of the patient
• Establish and maintain the patients airway
• Establish the patient on 6 - 15 liters a minute,
  humidified oxygen

26
Prepare the patient

• Draw blood for grouping and cross-matching
• Establish large bore IV access and prepare for
  fluid resuscitation and possible transfusion
• Establish patient on monitors
• Establish nasogastric tube

27
Administer Premedication

• Administer antisialagogue (Atropine, .4-.6mg deep
  IM)
• Administer sedative (Promethazine, 25-50mg slow
  IV)

28
Prepare for induction

• Prepare for induction of anesthesia
• Emergency patients should be stabilized prior to
  induction of anesthesia whenever possible.
• With the unstable patient, induction should
  proceed when only the immediate surgical
  intervention will save the patients life

29
SUMMARY OF PROCEDURES

• The Preanesthetic Visit
• Prep for general parenteral anesthesia
• Emergency prep for general parenteral anesthesia

30
RESTATEDOBJECTIVE

• As a Special Forces Medic, prepare a patient for
  general parenteral anesthesia, in accordance with
  JSOMTC student manual of anesthesia.