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Therapy-based indications radiation therapy x x x use of anticoagulants x x use of digoxin and diuretics x x x use of statins x x use of steroids x x x Procedure-based indications Procedure with significant blood loss x x Procedure with radiographic dye x Adapted from Miller’s Anesthesia, 6th ed. 2005 Churchill Livingstone, An Imprint of Elsevier. THe PreoPerATIve PATIenT evAluATIon ● 95
96 ● AnesthesiA student survivAl Guide Anesthetic Plan Upon gathering information from a patient’s history, exam, physical and laboratory results, the patient is then assigned an ASA (American Society of Anesthesiologists) physical status classification (see Table 8.4 below). The ASA status is a standardized way to communicate with other clinicians about the patient’s overall medical condition. The information obtained from a history, physical exam, and discussion with the patient can help generate a reasonable and safe anesthetic plan. The purpose of the plan is to provide an anesthetic that is tailored to each individual patient and the anticipated procedure. For example, deciding on general anesthesia versus regional depends on the patient’s co-morbidities and the nature of the operation. Planning to perform an awake intubation versus an intubation after the induction of general anesthesia would be indicated for patients with a difficult airway and/or mask ventilation. The plan also includes possible preoperative invasive catheter placement (arterial and/or central venous catheters) for close monitoring of high-risk patients, and a preliminary plan for the place of recovery after surgery (i.e., PACU vs. ICU). Anesthesia is a proactive specialty rather than reactive because the pre anesthetic evaluation can prompt change in patient management (see Table 8.5), leading to optimum patient care and outcome. Anesthesia Consent Form The purpose of the anesthesia consent form (also see Chap. 31, on Ethical Issues) is to discuss with the patient or their representative the types of anesthetic options available for the planned procedure and explain possible risks and benefits that encompass the anesthetic plan. Table 8.4 ASA physical status classifications. ASA Class I A normal healthy patient ASA Class II A patient with mild systemic disease ASA Class III A patient with severe systemic disease that limits activity, but is a constant threat to life ASA Class Iv A patient with incapacitating system disease that is a constant threat to life ASA Class v A moribund patient not expected to survive 24 h with or without surgery e Designates an emergency surgical procedure (i.e., Class Ie) American Society of Anesthesiologists Newsletter, 1963.
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Anesthesia Student Survival Guide
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Editors Jesse M. Ehrenfeld, MD, MPH
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Foreword As anesthesiologists and H
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Contents Case Studies xvii Section
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ContEntS ● xi 19 Physiology and A
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Contributors Basem Abdelmalak, MD S
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David C. Lai, MD Partner, Allenmore
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CASE STUDIES In order to focus your
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CASE StUDIES ● xix inhalation ane
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CASE StUDIES ● xxi around the job
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CASE StUDIES ● xxiii ● Although
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CASE StUDIES ● xxv ● You plan a
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CASE StUDIES ● xxvii ● What oth
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CASE StUDIES ● xxix Chapter 23 Ca
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CASE StUDIES ● xxxi of her left h
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CASE StUDIES ● xxxiii speechless.
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CASE StUDIES ● xxxv things go ver
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How to Be a “Star” Student, Car
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hOw tO Be A “stAr” student, CAr
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Pre-Op Holding Area Preoperative Ev
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History of Anesthesia and Introduct
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history of AnesthesiA And introduct
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Pharmacology Section II
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30 ● AnesthesiA student survivAl
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Table 11.3 Data typically obtained
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AnesthesiA eQuiPment And mOnitOrs
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Anesthetic Techniques: General, Sed
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Anesthetic techniques: GenerAl, sed
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Table 12.2 Stages of general anesth
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Table 12.6 (continued) Anesthetic t
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Anesthetic Techniques: Regional Ant
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Figure 13.2 Surface anatomy for neu
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Table 13.1 Risks of neuraxial anest
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Anesthetic techniques: reGionAl ●
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Table 14.6 Advantages, disadvantage
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Table 14.11 Transfusion of bloodpro
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Chapter 15 IV, Gastric Tube, Arteri
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iv, GAstric tube, ArteriAl & centrA
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Common Intraoperative Problems Fran
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Pneumothorax Uncommon, but may spon
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COMMON INTRAOPERATIVE PROBLEMS ●
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Table 16.3 Common intraoperative dy
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Table 16.3 (continued) Problem Diff
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Systems Physiology and Anesthetic S
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Chapter 20 Physiology and Anesthesi
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PhysioloGy And AnesthesiA for Gener
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Anesthesia for Urological Surgery P
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AnesthesiA for uroloGicAl surGery
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Physiology and Anesthesia for Pedia
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PhysioloGy And AnesthesiA for PediA
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Table 22.6 Common pediatric emergen
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Physiology and Anesthesia for Elder
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PhysioloGy And AnesthesiA for elder
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Chapter 24 Ambulatory Surgery and O
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AmbulAtOry Surgery ANd Out-Of-Or (O
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Perioperative Acute and Chronic Pai
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PerioPerAtive ACute And ChroniC PAi
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Chapter 27 Postoperative Anesthesia
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POstOPerAtive AnesthesiA CAre unit
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Introduction to Critical Care Bever
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introduction to criticAl cAre ● 4
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SVR = [(MAP - CVP)/CO] ´ 80 introd
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● ● ● ● ● introduction to
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Chapter 29 Professionalism, Safety,
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ProfessionAlism, sAfety, And teAmwo
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Chapter 30 Quality Assurance, Patie
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QuAlity AssurAnce, PAtient And Prov
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Chapter 32 Clinical Simulation in A
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Table 32.1 Matrix of categories of
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CliniCAl simulAtion in AnesthesiA e
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ASA Difficult Airway Algorithm Appe
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518 ● ANESTHESIA STUDENT SURVIVAL
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