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Anaesthesiology
American Society of Anesthesiologists Standards, Guidelines, and Statements
Built from Barash Clinical Anesthesia, 9th Edition
What’s inside
10 sections · 108 slides
Overview
- Scope of this collection
- Documents covered
- How to read the wording
Standards for Basic Anesthetic Monitoring
- Scope of the basic monitoring standards
- Two standards of basic anesthetic monitoring
- Standard I: continuous presence of qualified personnel
- Standard II: the four monitored functions
- Oxygenation: inspired gas
- Oxygenation: blood oxygen
- Ventilation: clinical and quantitative assessment
- Confirming airway device position
- Capnogram waveform phases
- Disconnection alarm during mechanical ventilation
- Ventilation monitoring in regional anesthesia and sedation
- Circulation monitoring requirements
- Accepted checks of circulatory function
- Body temperature monitoring
- Anesthesia workstation and monitoring display
- Waiving a marked requirement
Continuum of Depth of Sedation
- Origin and purpose of the sedation continuum
- Four levels of the sedation continuum
- Minimal sedation (anxiolysis)
- Moderate sedation / analgesia (conscious sedation)
- Deep sedation / analgesia
- General anesthesia
- Sedation continuum by response, airway, breathing and circulation
- Sedation levels compared across four features
- Rescue from a deeper level than intended
- What rescue means
Basic Standards for Preanesthesia Care
- Scope of the preanesthesia standards
- Responsibilities before delivering anesthesia care
- Purpose of the preanesthetic interview and examination
- Preanesthesia care as a sequence
Standards for Postanesthesia Care
- Scope of the postanesthesia standards
- The five postanesthesia standards
- Standard I: availability and governance of the recovery area
- Postanesthesia care unit
- Standard II: transport to the recovery unit
- Standard III: handover on arrival
- Standard IV: evaluation during recovery
- Standard IV: records and medical cover
- Standard V: discharge from the recovery unit
- Nursing standards referenced for the recovery unit
Operating Room Fires
- The fire triangle in the operating room
- Fire prevention measures
- Fire prevention measures as printed in the algorithm
- Identifying a high-risk procedure
- Team preparation for a high-risk procedure
- Steps before activating an ignition source
- Early warning signs of fire
- Response to an early warning sign
- Airway fire management
- Airway fire steps as printed in the algorithm
- Non-airway fire management
- If the fire is not extinguished at once
- Care after the fire is out
- Operating room fires algorithm
- Operating room fires algorithm
- APSF fire prevention algorithm: the risk question
- APSF oxygen decision steps
- APSF advice when an airway device is not feasible
- Fire prevention algorithm for patients at risk of surgical fire
Monitored Anesthesia Care
- Definition of monitored anesthesia care
- Indications for monitored anesthesia care
- Components of monitored anesthesia care
- Monitored anesthesia care as a three-phase service
- Depth of sedation within monitored anesthesia care
- Moderate sedation as a proceduralist-directed service
- Qualifications for giving moderate sedation
- Monitored anesthesia care versus moderate sedation
- Why small drug doses can still need an anesthesia provider
- Who should manage deep sedation
- Postprocedure responsibilities within monitored anesthesia care
- Flexibility and payment for monitored anesthesia care
Anesthesia Care with Do-Not-Resuscitate Orders
- Scope of the ethical guidelines
- Communication as the essential element
- Automatic suspension policies
- Three alternatives for the perioperative directive
- Limited attempt defined by specific procedures
- Limited attempt defined by goals and values
- Documentation requirements
- Reinstating the original directive
- Who should take part in the discussion
- Resolving conflicts over limits on intervention
- Institutional awareness and local modification
Preoperative Fasting and Aspiration Risk
- Scope of the fasting guidelines
- Minimum fasting periods before elective anesthesia
- Definitions used in the fasting recommendations
- Pharmacologic recommendations to reduce aspiration risk
- Fasting and pharmacologic recommendations to reduce pulmonary aspiration risk
- Fasting and pharmacologic recommendations to reduce pulmonary aspiration risk (continued)
- Fasting and pharmacologic recommendations to reduce pulmonary aspiration risk (continued)
- Drug classes listed in the guideline
Bringing It Together
- Core takeaways: monitoring and sedation
- Core takeaways: before, after and around anesthesia
- References
- References (continued)
- References (continued)
- Barash, Cullen, and Stoelting's Clinical Anesthesia, 9th Edition