Question

Create a chart with the headings Local Anesthesia and General Anesthesia. Compare and contrast the preoperative and postoperative needs with each type of anesthesia

Answer 1

Pre-requisites:

history
It is important to have a good history of the patient, which includes these components: History of the current illness (HPI, a short history behind the current medical condition leading to a surgical intervention and that the appropriate surgical means), Carl's medical history (PMH , it is very important written comorbidities, especially those involving the heart, lungs, liver, kidney, paying special attention to hypertension, diabetes, coronary artery disease, reactive airway disease, recent lung infections and a history of stroke or myocardial infarction), Carl Surgical history (PSH: type of surgery, type of anesthesia received (regional, monitored anesthetic care (MAC) or general anesthesia), some complications of anesthesia (difficult intubation, prolonged awakening, difficulty in evacuating, postoperative nausea and vomiting, etc.), and no medical history is available prior to anesthesi a), allergies (including a specific reaction), current medications (subpart PA Particular attention to dosage is final management of blood pressure medications, antiplatelet medications (aspirin, Plavix), diabetes medications (oral and parenteral) and steroids), family medical history (a family member has problems operating with general anesthesia), social history (tobacco consumption, alcohol consumption and illicit drugs 6), modified system review (chest pain, dyspnea, orthopnea, acid reflux symptoms, metabolic equivalents (METS: 2 flights of stairs, walk down the block)) and laboratory values ​​and recent studies (Basic calcium and magnesium standard panel, CBC with platelets, PT / PTT / INR, EKG of 12 shunts, chest X-ray, stress echocardiogram test in the last 5 years and coronary catheterization report).

In addition to the medical history, it is important to conduct a focused physical examination (to eradicate the weight of all internal organs (in kilograms), 4 inputs, mental status, cardiovascular examination, pulmonary auscultation, airway tear in Mallampati score, teething, neck range of motion and TMJ).

Most patients also want to talk a lot, especially after reviewing the available anesthetic options and fears, benefits, and well-being of each treatment option. Because it is equally important for us is the salvation of administered anesthesia is to perform it in patients with fear, and outside of (that is, the regional block anesthetic plan with a slight sedation can be pleasant to the result of the surgical perspective, but if also you are patient; one fear or another can keep the rules, remembered by a rather non-existent Awake, you, and conscious in the operation of the vow, therefore, such as The safety of the patients must be even, not only the risk) .

Physical examination
Focused on physical examination should include:

* general
BMI
jaundice
* Respiratory tract
Mallampati score / mouth opening
mobility of the cervical spine
joint mobility
Teeth (mainly disease / loose / artificial)
thyromental distance
pulmonary
auscultation
and form of thoracic expansion
oxygen saturation in ambient air
CV reason |
Because the auscultation of sound
Driven
a site of access to the vein
edema
venous pressure
BP (including drop off the grid if relevant) / heart rate / pace
can
* Motor and sensory function
* cognitive function
* hematological
petechiae
bruises
Clinical anemia
* Testing Labs training
Who they are for the patient, and in the fear of better living conditions, it is not necessary to have an account with a small number of those who undergo preoperative Labs,

In the last 40 years, the ECG is recommended for all general anesthetics (50 women). However, recent data suggests that this should lead to something established. So, in the "preoperative electrocardiogram patient, Rudge Predictive abnormalities of the" total of 1,149 electrocardiograms So, questioning patients with 89 (7.8%) significant is to have an abnormality. Having other patients at significantly higher risk with electrocardiograms, who were on energy management will affect those over 65 years of age, who had a one-year history of heart failure, high cholesterol, angina, myocardial infarction or severe valve. all five patients (0.44%) had basalovoi electrocardiograms, in the absence of risk factors. Operative in consideration of factors ECG and other tests Includes the type of surgery, blood and fluid changes that are expected, and act in a preoperative time-out tests required.

British National Institute for Health and Clinical Excellence (adipose) published in 2003 on the basis of a systematic review of the literature on this topic in the guide and the guide can be found here. This is the reason why everything qualifies and aggravates the disease and comorbidities at the time of the trial experience and is intended to broadly reflect between renal function and blood gas.

In addition to the routine outcome of the experiment, which is trying to improve current cardiac outcomes, it has led to the use of a more invasive cardiac evaluation. In this way, “These are the results that most patients would confirm, including high-risk patients who are undergoing high-risk surgery, regardless of whether or not they will be similar to the results of the switch to another invasion of I work for a living, the reasons are just. Such a process that can be performed must be done in patients with the disease, the coronary ischemic internal part is destruction. "