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    Home > Active Ingredient News > Anesthesia Topics > 1 case of anaesthetic method sourcing in preoperative evaluation decision-making elderly patients.

    1 case of anaesthetic method sourcing in preoperative evaluation decision-making elderly patients.

    • Last Update: 2020-07-29
    • Source: Internet
    • Author: User
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    1!---- 1Patient data patient, female, 80 years old, height 154 cm, body mass 85 kg, body mass index (BMI) 35.8 kg/m2, obesityPatients are addicted to smokeless alcohol, the upper and lower jaws have active denturesDifficulty walking due to pain in the left knee joint, wheelchair replacement, oral sodium dichlorofenate 75mg, 1 time /dHypertension for 15 years, daily oral chlorosatan 50 mg, hydrochloroquine 12.5 mg conjure 1 tabletSelf-described history of coronary heart disease 30 years, the pre-cardiapath when the discomfort of taking 10 tablets of dansan drops can be alleviatedThe patient gave birth to 4 men and 1 woman, 13 years ago in the vertebral tube anaesthetic downstream uterine fibroid excision, anesthesia went smoothlyThe hospital was admitted on December 20, 2018 due to uterine prolapse (III degrees) and is scheduled to have a full-cut uterusThe patient's blood routine, biochemical and coagulation function was normal before surgeryChest slivers show weight gain in the texture of the double lung, and a little fuzzy spots can be seen in the lower left lung field, taking into account the possibility of a lower left lung infection (Figures 1A, B)Blood gas analysis tips: PH7.43, arterial blood oxygen fractionpressure (PaO2) 79.4mmHg, arterial blood oxygen saturation (SaO2) 95.6%, alyothial arterial oxygen differential (A-aDO2) 32.7mmHg, blood lactic acid (Lac) 2.20m/L, K-3.22m/LmolHowever, the patient is currently asymptomatic, white blood cell count 7.85 x 109/L in the normal rangeElectrocardiogram report is normal, cardiac ultrasound prompt: left ventricular blood score (LVEF) 71%, left ventricle fat, left heart enlargement, left ventricle diastogram function reducedIn order to further track lung infection and coronary heart disease, the patient's CT 3D imaging of the tracheotoary tree showed that: the upper lobe of the right lung, the upper part of the left lung lower tongue section of a small infection, the upper right lung after the upper leaf with mild bronchial dilationAfter consultation by the respiratory department, the diagnosis of bronchial dilation co-infection, with moxisha star 0.4g static drop anti-infection, does not affect the whole hemp surgeryCoronary CT 3D imaging shows: left front to lower near end tube wall calcified plaque formation, tube cavity light moderate narrow; In order to provide decision-making for the choice of anesthesia, the patient also carried out a lumbar positive side film, double oblique X-ray examination, showing a change in lumbar degenerative strain, lumbar 4 vertebrae slightly forward slip After the above examination, the anesthesiologist decided to operate on all mahjong and notify the gynaecologist On the morning of December 28th, the patient entered the room and decided to undergo a resoracytic complex anaesthetic in the trachea, in view of the patient's obesity and lumbar deformation The patient was full hemp induction, and the intubation went smoothly During surgery blood pressure (BP) was maintained at 110 to 140/70 to 80 mmHg, heart rate (HR) 60 to 70 times/min The smooth completion of the pubic hysterectomy, two-sided fallopian tube resection and vaginal closure under the cut-off position, the operation lasted 90min Intraoperative infusion 1000mL, urine volume of 300mL, retention catheter After surgery, he woke up the tube in the operating room and took the patient back to the ward with the self-controlled vein analgesic pump (PCIA) Patients return to the ward, fully awake can answer, give a thin pillow, shake the head of the bed 30 degrees Conscious throat discomfort, complaining that sputum can not cough out, ordered to drink water 100mL, and assist in the discharge of sputum As the old man usually likes to lie on the side, to assist him side-by-side change position After the operation of the 2nd day of the main complaint left knee joint swelling pain intensified, can not be lowered, consider with the operation of the cut-off stone position pull related, in addition to the use of PCIA, plus sodium difofenate 75mg, and Chinese medicine massage 2 times / d The patient was discharged from hospital on 1 January 2019 on the third day after the operation, when swelling in the left knee joint subsided and began to move away from bed 2 Discussion of China's over 60-year-olds in 2017 has reached 250 million, accounting for 17.9% of the country's total population, while the number of people over 80 years of age reached 29 million The elderly have many co-ills and are prone to heart, lung, brain and endocrine diseases, and it is very important for anesthesiologists to assess preoperative diseases To ascertain the extent of their co-ills, further examinations must be submitted and, if necessary, specialist consultations should be spent on a risk assessment Further examination of the patient in this case is chest CT and coronary CT The elderly's anaesthetic choice is basically divided into 2 kinds, one is whole hemp, one is intravertebral anesthesia or nerve block, this case patients due to lumbar deformation and obesity, in order to ensure the safety of anesthesia, the choice of general anesthesia Wake up quickly after surgery, pull the tube early, is conducive to postoperative recovery The elderly have high blood pressure, surgery morning is ordered to routine oral antihypertensive drugs, to prevent entering the chamber hypertension (morning hypertension) and heart and brain complications At the same time requires the room to remove the upper and lower jaw dentures, safe Talk to the patient after entering the room to relieve the mental tension and keep it in a pleasant mood Patient sentry BP140/70mmHg, HR70 times/min, anesthesia induced smoothly Elderly patients have a history of back and leg pain, surgical position placement can not be excessively held In this case, the patient was neglected to suffer from left knee bone joint disease, which aggravated the pain in the left knee after surgery and affected the early postoperative activity and postoperative recovery The use of multi-mode analgesia after surgery, the use of PCIA intravenously, oral nonsteroidal anti-inflammatory drugs and local anesthesia, can promote accelerated postoperative recovery Preoperative assessment, including anaesthetic risk assessment and medical humanities assessment, is the basis for our anaesthetic program, in-operative management and accelerated postoperative rehabilitation, which is conducive to strengthening the safety of anesthesia and improving the return of patients To this end, anesthesiologists should be good at finding problems, good at tracking problems, good at studying problems, that is, three "good at" This case found cardiopulmonary co-disease from the medical history, from the chest tablets, electrocardiograms and ultrasound general imaging tests to detect the disease, and then further from the chest and coronary CT to clarify the nature and extent of the disease, so as to implement anesthesia management To do a good job of preoperative assessment, anesthesiologists should work towards the direction of perioperative doctors: (1) have comprehensive clinical knowledge of internal and external departments; (2) familiar with the various clinical and imaging diagnostic examinations; (3) in-depth ward detection and identification of anaesthetic risks; and (4) good at communicating and building a community of the fate of the hemp In order to shorten the patient's inpatient examination and wait ingon time for surgery, the preoperative assessment should be moved to the clinic The National Health and Care Commission issued a notice in 2017 to set up anaesthetic clinics Preoperative assessment In addition to the regular preoperative visit, morning meeting shift discussion, should also strengthen the senior anesthesiologist preoperative consultation, and the whole hospital for major, critical, difficult surgery of the multidisciplinary joint preoperative room
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