Clinical Anaesthesiology,Qiu Wei Fan Associate professor Department of Anaesthesiology Rui Jin Hospital Shanghai Second Medical University,Local Anaesthetic techniques,Features of local anaesthesia Methods of local anaesthesia Complications of local anaesthesia Regional block equipment Spinal, epidural, & caudal blocks Peripheral nerve blocks,Preoperative assessment and premedication Purpose,Establish rapport with the patient Obtain a history and perform a physical examinations Order a special investigations Assess the risks of anaesthesia and surgery and if necessary postpone or cancel the date of surgery Instutite preoperative management Prescribe premedication and the anaesthesia management,Preoperative assessment and premedication,Routine preoperative anaesthetic evaluation History Current problem Other known problems Medication history,Preoperative assessment and premedication Medication history,Allergies Drug intolerances Present therapyPrescriptionNonprescription,NontherapeuticAlcoholTobacco Illicit,Preoperative assessment and premedication,Previous anaesthetics, surgery, and obstetric deliverries Family history Review of organ systems Last oral intake,Preoperative assessment and premedication Review of organ systems,General Respiratory Cardiovascular Renal Gastrointestinal Hematologic,Preoperative assessment and premedication Review of organ systems,Neurologic Endocrine Psychiatric Orthopedic Dermatologic,Preoperative assessment and premedication Physical examination,Vital signs Airway Heart Lungs Extremities Neurologic examination,Preoperative assessment and premedication Laboratory evaluation,Hematocrit or hemoglobin concentration All menstruating women All patients over 60 years of age All patients who are likely to experience significant blood loss and may require transfusion Serum glucose and creatinine (or blood urea nitrogen) concentration: all patients over 60 years of age Electrocardiogram: all patients over 40 years of age Chest radiogram: all patients over 60 years of age,ASA classification,I A normal healthy patient other than surgical pathology- without systemic disease. II A patient with mild systemic disease no functional limitations. III A patient with moderate to severe systemic disturbance duo to medical or surgical disease- some functional limitation but not incapacitating.,ASA classification,IV A patient with severe systemic disturbance which poses a constant threat to life and is incapacitating. V A moribund patient not expected to survive 24 hours with or without surgery. E If the case is an emergency, the physical status is followed by the letter “E”-, “IIE”.,American Society of Anaesthesiologists classification and perioperative mortality rates,Class Mortality Rate I 0.06-0.08% II 0.27-0.4% III 1.8-4.3% IV 7.8-23% V 9.4-51%,Documentation,Informed Consent The preoperative note The intraoperative anaesthesia record The postoperative notes,Local Anaesthetic techniques Features of local anaesthesia,Preservation of consciousness The quality of early postoperative analgesia Simplicity of administration Sympathetic blockade attenuation of the stress response Minimal depression of ventilation,Local Anaesthetic techniques Methods of local anaesthesia,Surface anaesthesia Local infiltration Field block Regional blocks (Spinal, epidural, & caudal blocks) Peripheral nerve blocks,Complications of local anaesthesia,Local anaesthetic toxicity( Systemic toxicity): Cardiovascular, Respiratory， Cerebral and Immunologic Hypotension Motor blockade Pneumothorax Urinary retention Neurological complications Equipment problems,Local anaesthetic toxicity,Systemic toxicity Cardiovascular: Cardiac dysrhythmia or circulatory collapse is often the presenting sign of local anaesthetic overdose during anaesthesia.,Local anaesthetic toxicity,Systemic toxicity Respiratory: Lidocaine depresses hypoxic drive. Apnea can result from phrenic and intercostal nerve paralysis or depression of the medullary respiratory center.,Local anaesthetic toxicity,Systemic toxicity Cerebral:Early symptoms are circumoral numbness, tongue paresthesia, and dizziness. Sensory complaints may include tinnitus and blurred vision.Excitatory signs often precede central nerve system depression.,Local anaesthetic toxicity,Systemic toxicity Immunologic: True hypersensitivity reactions to local anaesthetic agents- as distinct from systemic toxicity due to excessive plasma concentration- are quite uncommon.,Regional block equipment,Spinal needles (26G) Pencil-point 24G needles Catheters Label syringes A short length of tubing Nerve stimulators Local anaesthetic drugs,Complications of local anaesthesia Hypotension,Sympathetic blockade Total spinal blockade Vasovagal attack Anaphylactoid reaction,Regional block,Subarachnoid block(SAB): Spinal anaesthesia Extradural nerve block: Epidural anaesthesia may be performed in the sacral(caudal block), lumbar, thoracic or cervical regions.,