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خرید پکیج

تعداد آیتم قابل مشاهده باقیمانده : 3 مورد

Considerations in selection of anesthetic techniques

Considerations in selection of anesthetic techniques

Patient considerations	Implications for anesthetic choices
Inability to tolerate procedure while awake with or without moderate sedation: Inability to lie motionless in the position required for the procedure (eg, orthopnea, essential tremor, persistent cough, or neck, back, or joint pain experienced in the required position) Inability to cooperate (eg, cognitive dysfunction, dementia, extreme anxiety) Inability to communicate (eg, language barriers, hearing deficits) Refusal to accept possibility of awareness during surgery	General anesthesia may be most appropriate. MAC or a neuraxial or other regional anesthetic technique with light or moderate supplemental sedation may be undesirable or inappropriate.
Expected difficulty controlling postoperative pain or desire to avoid opioids: Chronic opioid use Substance abuse Acute severe preoperative pain poorly managed with opioids Increased sensitivity to opioids	Multimodal postoperative analgesia opportunities (eg, long-acting local or peripheral anesthetic agents, continuous neuraxial analgesia, nonopioid analgesics, gabapentinoids) are appropriate.
Desire to avoid laryngoscopy with endotracheal intubation: Severe COPD or asthma with risk of bronchospasm	Local anesthesia with MAC, peripheral nerve block, or neuraxial anesthesia may be selected, particularly if likely to be sufficient to accomplish the surgical procedure without general anesthesia. An SGA can be considered for use as the primary airway device during general anesthesia for shorter procedures if risk of gastric aspiration is low, and the procedure will not require muscle relaxation or high airway pressures.
Desire to avoid perioperative respiratory depression: Obstructive sleep apnea Severe obesity Advanced age Severe comorbidities such as cardiopulmonary disease or neuromuscular weakness	General anesthesia may be undesirable. In some cases, local, regional, or neuraxial techniques may provide adequate intraoperative anesthesia without the use of general anesthesia, or may allow reduced dosing of supplemental systemic opioids. (However, general anesthesia may be necessary for certain surgical procedures, and in patients with dyspnea when lying flat or chronic coughing if that interferes with performance of the surgical procedure.) Systemic and neuraxial opioids are typically avoided or minimized by using alternative analgesic agents and/or techniques.
High risk for PONV: Severe preoperative nausea and vomiting History of severe PONV Recent administration of chemotherapeutic agents	General anesthesia may be less desirable, although antiemetic prophylactic agents can be administered. Local anesthesia with MAC, peripheral nerve block, or neuraxial anesthesia may be desirable if the selected technique is sufficient to accomplish the surgical procedure without general anesthesia. Systemic and neuraxial opioids are typically avoided or minimized.
Desired short length of stay in the PACU (eg, brief ambulatory procedures)	Neuraxial anesthesia may be less desirable due to the likely modest increase in duration of PACU stay.
High risk for SEH (eg, recent use of anticoagulant agents or antiplatelet agents [other than aspirin])	Neuraxial needle or catheter placement may be inappropriate. Local anesthesia with MAC, some peripheral nerve blocks, or general anesthesia is typically more appropriate.
Surgical considerations	Implications for anesthetic choice
Anticipated prolonged duration of surgery (eg, >3 hours)	General anesthesia may be most appropriate. MAC or a neuraxial or other regional anesthetic as the only technique is usually impractical, even with supplemental sedation.
Complete immobility required during procedure: Most intracranial procedures Cardiac surgical procedures Selected ophthalmologic procedures	General anesthesia with endotracheal intubation and use of neuromuscular blocking agents is usually necessary.
Limited airway access during procedure: Airway is within or near the surgical field Prone position	General anesthesia with endotracheal intubation may be most appropriate.
Expected severe postoperative pain: Open intrathoracic or intraabdominal procedures with large incision Major orthopedic surgical procedures	Multimodal postoperative analgesia opportunities (eg, local anesthesia, neuraxial analgesia, and/or peripheral nerve blocks) may be appropriate.

MAC: monitored anesthesia care; COPD: chronic obstructive pulmonary disease; SGA: supraglottic airway; PONV: postoperative nausea and vomiting; PACU: post-anesthesia care unit; SEH: spinal epidural hematoma.

Graphic 115300 Version 1.0

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