眼科手術(shù)麻醉 英語(yǔ)教學(xué)課件

1、Anesthesia for Ophthalmic Surgery(眼科手術(shù)麻醉) Xuli Profile and Demandsfine procedure demands intraocular pressure ( IOP)airwayoculocardiac reflex (OCR)Preoperative Evaluation and Preparationpsychological preparationtreatment of the original diseasestreatment of the co-existing diseasesPremedicationantic

2、holinegics(抗膽堿藥):given intramuscularly, have no significant effects on IOP. However, applied topically to the eye may cause mydriasis (瞳孔散大) and may increase IOP.sedatives(鎮(zhèn)靜藥)analgesics(鎮(zhèn)痛藥)antiemetics(止吐藥)Anesthetic Techniques.local anesthesia.general anesthesiacomplications of retrobulbar block (

3、將局麻藥注入睫狀長(zhǎng)、短神經(jīng)及眼球筋膜囊內(nèi) )Important Points in Local Anesthesiaapplication of Adrenalinapplication of sedativesOCRToxicitty of local anestheticsImportant Points in General Anesthesiacareful monitoringsmooth anesthesiaapplication of muscle relaxantsprevention of OCRN2O on IOPanesthetics and IOPQuestionsWh

4、ats the main cause of exorbitant IOP during ophthalmic operations?Whats OCR and how to treat it?青光眼(glaucoma)病人的術(shù)前用藥、局麻用藥及全麻肌松藥應(yīng)用注意事項(xiàng)？視網(wǎng)膜脫離修補(bǔ)術(shù)中,手術(shù)需要往玻璃體內(nèi)注氣，應(yīng)用吸入全麻藥應(yīng)注意些什么？為什么？ THANK youDemandspatients cooperation and immobility perfect sedation and analgesia should be availablle.fixation of the eyeba

5、ll relaxation of the orbicularis oculi muscle(眼輪匝肌 ) and extraocular muscles(眼外肌 ) is necessary.IOP (眼內(nèi)壓)1、IOP：the pressure on the eyeball wall exerted by the intraocular contents. 3、The main determinant of IOP is the dynamic balance between the production of aqueous humor and its eventual eliminati

6、on.2、aqueous humor circulation4、the main cause of exorbitant IOP is the obstruction of the aqueous humor(房水) circulation. Several impact facts on IOP Mydriatic drugs(擴(kuò)瞳藥) Maneuvers (動(dòng)作行為) Hypercarbia (高碳酸血癥) and hypoxia (低氧血癥) Pressure on the eyeball Anesthetics:Most anesthetics reduce IOP. Only suc

7、cinylcholine and ketamine may increase IOP. Oculocardiac Reflex(OCR)眼心反射The OCR is a trigeminovagal reflex(三叉-迷走神經(jīng)反射) that may be induced by pressure on the eyeball, traction(牽拉) on the extraocular muscle(眼外肌), orbital(眼眶內(nèi)的) hematoma(血腫), ocular trauma(損傷), and eye pain, manifested by cardiac arrhyt

8、hmias(心律失常) such as bradycardia(心動(dòng)過(guò)緩), nodal rhythm(結(jié)性節(jié)律), ectopic beats(異位搏動(dòng)), ventricular fibrillation(心室纖維顫動(dòng)), or asystole(心臟停搏).Local Anesthesiatopical anesthesia(表面麻醉)infiltration anesthesia(浸潤(rùn)麻醉)nerve block(神經(jīng)阻滯)General Anesthesiawith endotracheal intubationwithout endotracheal intubationAnest

9、hetics and IOP Most general anesthetics are CNS depressants, they lower IOP. But succinylcholine causes a transient (46min) but significant increase in IOP of 10 to 20 mmHg.The effect of ketamine on IOP varies. Early studies reported an increase in IOP after intramuscular or intravenous administrati

10、on of ketamine. Ketamine given after premedication with diazepam and meperidine (哌替啶) does not affect IOP, and intramuscularly administered ketamine may even lower IOP in children.N2O on IOPOphthalmologists sometimes inject a small bubble of gas (e.g., SF6) into the vitreal (玻璃體的) cavity during reattachment (修補(bǔ)) of the retina (視網(wǎng)膜) so as to hold the retina in place under a long-acting bubble of stable size. N2O is more diffusible than SF6 and more soluble in water, and rapidly enters the gas bubble. Admin