(高血压英文课件)-Anesthesia.ppt
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- 高血压英文课件 高血压 英文 课件 Anesthesia
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1、2007 PMCCAnesthesiaChapter 18Chapter Outline Introduce students toForms of anesthesiaAnesthesia guidelines1.Anesthesia modifiers Anesthesia Guidelines Anesthesia service includes Usual preoperative and postoperative visits Administration of the anesthetic for the site of surgery Anesthesia care duri
2、ng the procedure Administration of fluids and/or blood replacement Interpretation of noninvasive monitoring(blood pressure,ECG,temperature,oximetry,apnography,and mass spectrometry)Time Key element for reimbursement Starts when anesthesiologist begins preparing patient in OR Ends when anesthesiologi
3、st no longer in personal attendance and patient is safely placed under postoperative supervisionAnesthesia Modifiers Three sets of modifiers to consider Physical status HCPCS CPT CPT manual also includes codes for Reporting circumstances that could increase the difficulty of providing anesthesiaPhys
4、ical Status Modifiers P1Normal,healthy patient P2Patient with mild systemic disease(eg,mild,benign,hypertensive heart disease)well controlled on medication P3Patient with severe systemic disease(eg,benign,hypertensive heart and renal disease with congestive heart and renal failure)P4Patient with sev
5、ere systemic disease that is a constant threat to life(eg,hypertrophic obstetric cardiomyopathy with ESRD)awaiting heart transplant P5 Moribund patient who is not expected to survive without surgery P6A declared brain dead patient whose organs are being removed for donor purposesCPT Modifiers 22Unus
6、ual Procedural Services 23Unusual Anesthesia(Identifies a procedure that usually requires no anesthesia or local anesthesia.Under unusual circumstances,general anesthesia is required)32Mandated Services 51Multiple Services 53Discontinued Procedure 59Distinct Procedural Service(Identifies certain cir
7、cumstances when a physician may need to indicate that a procedure/service was distinct or independent from other services performed on the same day)HCPCS Level II ModifiersAAAnesthesia service performed personally by anesthesiologistADMedical supervision by a physician:more than four concurrent anes
8、thesia proceduresG8Monitored anesthesia care(MAC)for deep complex,complicated,or markedly invasive surgical procedureG9Monitored anesthesia care for patient who has history of severe cardiopulmonary conditionQBPhysician providing service in a rural HPSAQKMedical direction of two,three,or four concur
9、rent anesthesia procedures involving qualified individualsQSMonitored anesthesia care service(MAC)QXCertified registered nurse anesthetist(CRNA)service,with medical direction by a physicianQYMedical direction of one certified registered nurse anesthetist(CRNA)by an anesthesiologistQZCRNA service,wit
10、hout medical direction by a physicianTypes of Anesthesia General Anesthesia Results in loss of consciousness Produces amnesia by blocking the awareness center in the brain CPT codes 00100-01999 represent general anesthesia unless code description states otherwise Regional Anesthesia Blocks all painf
11、ul sensation to the specific region of the body innervated by the nerve or nerve plexus receiving the anesthetic Does not induce unconsciousnessTypes of AnesthesiaPeripheral Nerve Blocks Anesthetize individual nerves or nerve plexuses Anesthetic agent injected along the nerve rather than in the nerv
12、e Codes 64400-64530 Used to describe these services Nerve Blocks Anesthetize entire regions Spinal Anesthesia Used for major procedures performed below level of the diaphragm Relatively safe Provides excellent muscle relaxation Accomplished by placing needle between the vertebrae and injecting anest
13、hetic agent into the subarachnoid space Frequently used for pain management by anesthesiologistsTypes of Anesthesia Epidural Anesthesia Achieved by injecting anesthetic agent into epidural space of thoracic or lumbar interspaces Usually avoid postoperative headaches Intravenous Regional Blocks Used
14、for some procedures on extremities Pneumatic tourniquet applied to the limb and anesthetic agent is injected into the vein of the limb distal to the tourniquet Field Block Used to form barrier between operative site and nervous system Accomplished by multiple injections of local anesthetic agent Loc
15、al Anesthesia Applied topically or by local infiltrationPain Management Benefits of proper pain management Shorter hospital stays Increased mobilization Acute Pain May be experienced during postoperative period Included in surgeons fee Should only be turned over to a specialist when special circumst
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