30 minutes before the end of the operation, these problems should be worthy of the anesthesiologist’s attention

A long-term general anesthesia operation has finally begun with your waiting, and the finishing work will begin, and the operation will be over in half an hour.
At this time, the focus of the anesthesiologist’s attention will be from the maintenance of intraoperative anesthesia to the recovery of the patient.
Make preparations for the final smooth awakening and extubation.
These preparations include complete analgesia, corrected anemia, warm body temperature, adequate capacity, etc.
, which should be done without fail.

It has always been believed that for any intervention that will be applied to patients, clinicians should estimate its expected effects, and prepare before then, and strictly observe afterwards.

Patients undergoing general anesthesia during the operation have been under the close care of the anesthesiologist.
After the operation, the patient needs to quickly adapt to this new state.
Near the end of the operation is the time for the anesthesiologist to adjust the function status of the patient’s various organs, and at the same time provide for the patient to wake up.
Good conditions are like a long-distance race.
When you get to the end, you have to adjust your state and sprint with full blood.

The following is a brief summary of the issues that the anesthesiologist should focus on 30 minutes before the end of general anesthesia: stable vital signs are the most basic and most important condition.

The most important thing is to assess the patient's cardiopulmonary function and whether it is suitable for subsequent recovery and extubation.

Appropriate in-out and out-of-income statistics should never be done at the end of the operation.
It is best to make statistics every 1-2 hours for large and long-term operations; there is no clear definition of the final in-out and out-of-incidence (usually net inflow).
Restrictions, different operations can vary widely; generally speaking, for patients with no obvious shock before surgery: 500~2000ml for adults and no more than 24h physiological requirements for children, volume monitoring can provide more personalized assessment.

At the same time, it needs to be emphasized that for elderly patients and patients with poor cardiopulmonary function, it is necessary to consider the recovery of volume and blood vessel tension after awakening from general anesthesia, and the relative volume will increase, which may increase the heart and lung burden and the incidence of postoperative complications.

Perfect analgesia.
Anesthesiologists who have worked in the clinic for many years know how important analgesia is during the patient's recovery period.
This has also been supported by a large number of studies; it is generally recommended to start the recovery period 20-30 minutes before the end of the operation.
There are many medicines that can be used for analgesia, and sufentanil is recommended; better tube-resistant, quiet and agitation-free awakening experience all benefit from perfect analgesia, which is the prerequisite for high-quality awakening.

Slowly reduce the depth of sedation and recovery of consciousness is a prerequisite; the current general anesthesia maintenance drugs maintain a short maintenance time and quick recovery of consciousness, but rapidly reducing the concentration of sedative drugs or awakening patients can lead to postoperative delirium, delayed respiratory depression and other complications disease.

For sevoflurane, high flow rate and rapid elution may increase the incidence of postoperative delirium, while the depth of sedation during resuscitation and extubation of propofol may be deeper, and the quality of tube resistance and resuscitation may be better; it is recommended for long-term intraoperative ether maintenance For the patients, close inhalation anesthesia (maintain a small flow) 0.
5~1h before the end of the operation, and switch to propofol to maintain awakening, which may be more effective.

In addition, it is still necessary to consider the effects of dextromethorphan, midazolam and other medium and long-acting sedative drugs on recovery.

There is no residual muscle relaxation.
Of course, it is difficult to do without any residual muscle relaxation when you wake up, but you must use this as your belief.

More than 50% of postoperative complications related to anesthesia are related to residual muscle relaxation.
The residual muscle relaxation is harmful to no benefit during the recovery period.
As long as the residual muscle relaxation is suspected to affect breathing, it should be antagonized at the right time.

Stable internal environment, lung ventilation function, acid-base balance, electrolytes, anemia, and microcirculation can all be insighted through a blood gas analysis.

If possible, it is necessary to do a blood gas analysis 30 minutes before the end of the operation.
Generally, there will be no large fluctuations in the volume at this time, and there is enough time to improve if the internal environment is abnormal.

The description of warm body temperature may not be appropriate, but intraoperative hypothermia is still a problem that is easily ignored by anesthesiologists; the importance of intraoperative heat preservation is self-evident, and the adverse effects of hypothermia during postoperative recovery are more intuitive; in Patients who wake up from the chills will burn your previous preparations, because once you find that your body temperature has dropped, the remedial effect is usually very slow, and most patients will remember that they woke up after the operation: it was really cold.

Surgery and general anesthesia will cause different physiological changes to patients.
Our final job is to adjust the functions of various important organs in the body and begin to allow patients to adapt themselves to this "new" body.

The anesthesiologist’s work is meticulous.
You need to pay attention to all the conditions related to the patient except for the surgical operation.
The above is only a brief summary of the most worthy of attention before the patient wakes up.
Compared with the actual work, it is inevitable that there are omissions.
Welcome everyone to discuss and enlighten me.

Recommendation: A minimalist gastric ultrasound guide, which will take you over a long period of time after you learn it.
Have you been aware of these risks?