Anaesthesia for the high risk patient Brugge 26 feb 2015

71 Pages·2015·15.47 MB·Dutch

Anaesthesia for the high risk patient
Brugge 26 feb 2015

Preparation?
Perfection in Anaesthesia?
Help reducing surgical problems by adapting anaesthesia?
JPM 2015 1
Voorbeeld vragen Vives 2015
•  Geef 2 voorbeelden hoe het aspiratie risico peri
operatief beperkt kan worden en leg uit waarom.
•  Geef 2 voorbeelden hoe het infectie risico peri
operatief beperkt kan worden en leg uit waarom.
•  Geef 2 voorbeelden hoe atelectase peri operatief
beperkt kan worden en leg uit waarom.
•  Geef 2 voorbeelden hoe de post operatieve
pijnverdoving verbeterd kan worden en leg uit
waarom.
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High risk patient
1.  Improve pre operative preparation or cancel
surgery.
2.  Perfection in Anaesthesia? Use common
knowledge, improve knowledge.
Do better and you will be better.
3.  Help reduce surgical problems by adapting
the anesthesia.
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Anesthetic related mortality declined
Bainbridge The Lancet 2012, 380: 1075
•  0,001 % dead rate ( 1 / 100 000)
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But total peri op mortality remains high
•  Pearse Mortality after surgery in Europe. The Lancet 2012, 380: 1059
•  60 day Mortality 4 % with 75% not admitted to ICU.
•  Belgie : in hospital mort 3,2% 3.200/100.000 vs 1/100.000
•  Nederland 2%
•  Duitsland 2,5 %
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Anesthesia should focus on total 60 days mortality
instead of improving further its own safety only.
60 days
peri operative
Health
care
Surgery
Is surgery more dangerous?
Should we focus on morbidity? Anesthesia
JPM 2015 6
Perfection in anaesthesia/
facilitate surgery
1.  Reduce anaesthesia trauma
2.  Reduce aspiration risk
3.  Reduce infection risk
4.  Reduce lung atelectasis
5.  Reduce inflammation, keep perfusion & oxygenation.
6.  Reduce post op pain.
7.  Reduce long term anesthesia effects.
8.  Prevent cardiac ischemia, arythmia / pulmonary
bronchoconstriction, respiratory muscle weakness
9.  Reduce post operative bleeding.
10. Improve surgical access and visibility…
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JPM 2015
Who has increased risk for anesthesia?
•  A patient diseased with an organ dysfunction
–  Cardiac disease -> cardiac failure
–  Pulmonary disease -> ventilatory failure
–  Renal disease -> renal failure
–  Liver disease -> liver failure
–  Morbid obesity -> metabolic syndrome
•  Very young – very old
•  Very low body weight and under nutrition
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Perfection in the details
•  What is proven yet but is not done always.
•  What seems to be correct but is (can) not be
proven yet.
–  Do not wait for evidence based or double blinded
study if no risk to use.
•  Do research clinical, animal, theoretical
•  Adapt your theory, methodology, technology.
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What to do?
1.  Reduce anaesthesia trauma
2.  Reduce aspiration risk
3.  Reduce infection risk
4.  Reduce lung atelectasis
5.  Reduce inflammation, oedema, keep tissue perfusion.
6.  Reduce post op pain.
7.  Reduce long term anaesthesia effects.
8.  Prevent cardiac ischemia, arrhythmia / pulmonary
bronchoconstriction, respiratory muscle weakness
9.  Reduce post operative bleeding.
10. Improve surgical access and visibility…
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JPM 2015