PREOPERATIVE ANESTHESIA and

PREMEDICATION
dr. Ratna E. Hutapea Sp. An
Routine preoperative anesthetic
evaluation

I. History
1. Current problem
2. Other known problems
3. Medication history
Allergies
Drug intolerances
Present theraphy
Prescription
Nonprescription
Non therapeutic
Alcohol
Tobacco
Illicit
4. Previous anesthetics,
surgery, and obstetric
deliveries
5. Family history


6. Review of organ system
General (Including activity level)
Respiratory
Cardiovascular
Renal
Gastrointestinal
Hematologic
Neurologic
Endocrine
Psychiatric
Orthopedic
Dermatologic
7. Last oral intake


Routine preoperative anesthetic
evaluation
II. Physical Examination
1. Vital signs
2. Airway
3. Heart
4. Lungs
5. Extremities
6. Neurologic examination
III. Laboratory Evaluation

Routine preoperative laboratory evaluation of
asymtomatic, apparently healthy
patients.
Hematocrit or hemoglobin concentration :
All menstruating woman
All patients over 60 years of age
All patients who are likely to experience
significant blood lose and may require
tranfusion.
Serum glucose and creatinin ( or blood urea
nitrogen )
Concentration : all patients over 60 years
of age
Electrocardiogram : all patients over 40 years
of age
Chest radiograph: all patients over 60 years of
age
The Anesthetic plan
Premedication
Type of anesthesia
General
Airway management
Induction
Maintenance
Muscle relaxation
Local or regional anesthesia
Technique
Agents
Monitored anesthesia care
Supplemental oxygen
Sedation
Intraoperative management
Monitoring
Positioning
Fluid management
Special techniques
Postoperative management
Pain control
Intensive care
Postoperative ventilation
Hemodynamic monitoring
ASA Physical

1. A normal healthy patient
2. A patient with mild systemic disease and no
function limitations
3. A patient with moderate to severe systemic
disease that results in some functional
limitation
4. A patient with severe systemic disease that is a
constant threat to life and functionally
incapacitating
5. A moribund patient whi is not expected to
survive 24 hours with or without surgery
6. A brainded patient whose organs are being
harvested
E. If the procedure is an emergency, the physical
status is followed by E
American Society of
Anesthesiologists classification and
perioperative mortality rates
Class Mortality Rate
1 0,06-0,08 %
2 0,27-0,4%
3 1,8-4,3%
4 7,8-23%
5 9,4-51%
Common Problems Amenable to
Treatment before Anesthesia and
Operation
Anxiety
Amnesia
Pain
Salivation and airway secretions
Vagal reflexes
Hypertensive reponses
Seizure
Aspiration of gastric contents
Nausea and vomiting
Infection
Reactions to intravenous contrast media
Latex allergy
Continuation of preoperative theraphy
Commondly used premedications
Informed Consent
Etis otonomi pasien adalah suatu hak yang
harus dihargai oleh setiap praktisi ilmu
kedokteran.
Hak pasien untuk memilih tanpa dipengaruhi
oleh orang lain.
Praktisi juga terikat oleh kewajiban untuk
memberikan informasi seutuhnya kepada
pasien.
Masukan Oral
Refleks laring mengalami penurunan saat anestesia.
Regurgitasi isi lambung dan kotoran yg terdapat dalam jalan napas
merupakan risiko utama.
Untuk meminimalkan risiko tersebut, pasien dijadwalkan puasa sebelum
induksi anestesia.

Dewasa : 6-8 jam
Anak kecil : 4-6 jam
Bayi : 3-4 jam
Makanan berlemak boleh 5 jam sebelum induksi
anestesia
Minuman bening,air putih,teh manis sampai 3 jam
sebelum induksi
Minum obat dengan air putih dalam jumlah terbatas
boleh 1 jam sebelum induksi