Surgery and Healing in the Developing World - Dartmouth-Hitchcock

Anesthesia in the Third World
Table 2. ASA* physical status
Category Description
1 Healthy patient
2 Mild systemic disease – no functional limitation
3 Severe systemic disease – definite functional limitation
4 Severe systemic disease – that is a constant threat to life
5 Moribund patient unlikely to survive 24 hours with or without operation
*American Society of Anesthesiologist
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Setting Up the Operating Room
1. Decide which operating rooms to use.
2. Decide if locally available anesthesia machines are to be used.
3. Decide exactly where the operating tables will be placed. Placing two operating
tables in the same room is advantageous in that it allows one to practice
a team approach by cross-utilization of personnel and equipment.
4. Ensure that gas lines and electrical outlets (extension cords and multiple
outlets strips) are accessible at each table.
5. Determine which sites will have central piped-in oxygen and which will
require freestanding oxygen cylinders.
6. Locate the necessary H cylinders and place them in the appropriate places.
Screening
Patients will be seen by a surgeon first to determine if an operation is necessary,
then routed to you.
1. Do a preoperative evaluation on each patient considering age, current health,
coexisting diseases, medical history, and family history of a bleeding disorder,
and a physical examination including careful evaluation of the airway.
Use the standard American Society of Anesthesiology classification system
to assign your patient a risk category (Table 2).
2. Refer patients with complicated medical histories to the pediatrician or
internist.
3. Carefully evaluate chronic or subacute medical conditions during the screening
process and immediately prior to surgery.
4. Carefully evaluate patients for the presence of upper respiratory infections.
5. Record a set of vital signs for each patient during screening. These should
include: temperature, heart rate (HR), respiratory rate (RR), blood pressure
(BP) and oxygen saturation (SpO2).
6. Have blood drawn on all patients to check their hemoglobin.
7. Have a blood sample drawn on every patient scheduled for abdominal thoracic,
goiter, C-section, and gynecological procedures. This sample is to be
held in the blood bank for use in case there is a need for an emergency
transfusion.
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