歲月麻醉

Anesthesia,Joyful Life
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Perioperative Medicine

新名詞? How about Perioperative physician? 今年年會的主席報告,指出,麻醉科的前途在Perioperative care,就 schedule operation而言,麻醉科目前已經做到, Pre-operative evaluation ( Clinics 術前門診 and Ward visit(病房訪視),Postoperative care units (恢復室),有些科室如果還負責ICU,就將術後照護的期間,從數小時 Extend 到數天!Postoperative Pain control 現在也是歸麻醉科整合與教育訓練的單位,除了wound care,沒辦法之外,其餘的Perioperative 圍術期,Nutuition, Infection control, glucose control,thromboemolism prevention,medication (停藥,加藥),airway mangement,transfusion等都是可以發展的方向。



另外,對於急診手術,參與與介入Emergency Medicine也是一個方向,尤其是ABC,其中A,airway mangement本來就是麻醉的東西,現在被急診『整碗旁去』,也是可以再要回來! 急診插管,除非是Crash airway, 其餘的Emergency, semi-elective intubation, 都應該有麻醉科醫師參與的影子,在目前急診醫學的期刊,所有RSI插管有好的結果,其後頭都有一個但書,那就是Well -educated and trained airway management program, Plus, supervision system. 這個說穿了,或者說,最省時省力的作法就是麻醉科要直接介入。

麻醉科常常對於緊急的搶救手術時有微詞,不是抱怨,沒有好好插管,就是沒有插A-line,沒有備血,Fluid 輸太多,或太少等等等,這些,可以經由現場直接介入得到解決,急診是多學科通力合做的場合,麻醉醫師進入急診,雖是創舉,但不奇怪!

如此一來,Perioperative Physicain 才能名至實歸!

2010 Perioperative medicine summit March 3-6於邁阿密舉行(第四屆)

Cleveland Clinic Jouranl of Medicine Perioperative Medicine 專輯

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