動物醫(yī)學(xué)麻醉學(xué)07wasva吸入麻醉wsava2inhal agentswag49ch final

1、DeliveringInhalation Anaesthesia 輸送吸入麻醉Dr Colin DunlopDip. American College Vet. Anesthesiologists美國獸醫(yī)麻醉師學(xué)會會員Advanced Anaesthesia SpecialistsSydney, Australia澳大利亞, 悉尼, 高級麻醉師 Volatile Inhalation Anaesthetics揮發(fā)性的吸入麻醉劑- liquids at room temperature 室溫下是液體- is a vapour layer above the liquid 在液面有一層氣體 - c

2、oncentration of the vapour is up to 30 x above the anaesthetic level 揮發(fā)出的 藥物氣體濃度可以是麻醉劑量的30倍- this concentration is lethal 這個濃度是致死的Physical Properties of Volatile Anaesthetics 揮發(fā)性麻醉劑的 物理特性 “l(fā)iquids at room temperature” 室溫下是液體Agent 藥物Vapour Pressure mmHg 蒸汽壓Blood:Gas Solubility 氣:血溶解度MAC vol % 最小肺泡濃度I

3、soflurane 異氟烷240 (240/760=30%)1.271.30Halothane 氟烷2432.460.90Sevoflurane七氟烷 1600.622.10Desflurane地氟烷6640.427.20N2O 笑氣7600.47200%Methoxyflurane甲氧氟烷23150.24Anaesthetic Vaporisers麻醉蒸發(fā)罐Mix O2 with volatile vapour above the liquid 讓氧氣和液面上的揮發(fā)性氣體混合Predictable amount delivered可以預(yù)測麻醉量- vapour picked up by O2

4、 氧氣帶上了蒸發(fā)氣體- constant level delivered to breathing circuit 以穩(wěn)定的濃度進入麻醉回路內(nèi)Vaporiser Output Effect of Vapour Pressure, Temp. & Gas Flow蒸發(fā)罐的輸出量 受蒸汽壓，溫度，和氣流的影響Anaesthetic Vaporisers麻醉蒸發(fā)罐In-Circuit: gas flow over liquid by animals ventilation(dont ventilate animals!)在回路內(nèi)：動物呼吸時氣體經(jīng)過麻醉藥液面（不要輕易讓動物增加換氣）Out-of-C

5、ircuit: gas flow through vaporiser from pressurized O2 via the O2 flowmeter在回路外：高壓氧氣通過氣體流速計進入蒸發(fā)罐In-Circuit Vaporisers 7 kg回路內(nèi)設(shè)置蒸發(fā)罐 適用于大于 7公斤的動物- Variable output for variations in Temperature & Ventilation “glass jar” 麻醉藥輸出量與環(huán)境溫度和 動物的呼吸情況有關(guān)“ 玻璃罐” - Dial setting = IS NOT concentration 蒸發(fā)罐上的控制盤不等于麻醉藥濃度

6、- Inefficient: most of the breath volume passes through the vaporiser 沒有效率：大部分的呼吸氣量經(jīng)過蒸發(fā)罐- Not suitable for Non-Rebreathing circuits 不適用于非重吸入回路麻醉裝置 - Same vaporiser can work for a number of anaesthetic agents 同一蒸發(fā)罐可以用于好幾種麻醉劑- can use lower O2 flows: 10 ml/kg/min 可以使用底流速供氧Out-of-Circuit Vaporisers回路外裝

7、置蒸發(fā)罐- Constant output for variations in Temperature & Flow heavy brass 在溫度和流速改變時還可以有穩(wěn)定底麻醉輸出重金屬黃銅 - Dial setting = actual % concentration 控制盤上底底 刻度真實的麻醉藥濃度- Efficient: only a small portion of gas passes through the vaporiser & mixes with by-pass gas to produce an accurate mixture 效率高：只有少量的 氣體經(jīng)過蒸發(fā)罐，并和

8、繞行的氣體混合，產(chǎn)生精確的藥物混合- Vaporisers are specific for each anaesthetic agent & work for all circuits/all sizes of animal 蒸發(fā)罐只能使用特定的麻醉劑，但適用于各種回路和各種大小動物- Need higher O2 flows: 30 ml/kg/min start 開始時需要高流速的氧氣Physical Properties of Volatile Anaesthetics 揮發(fā)性麻醉劑的 物理特性 “l(fā)iquids at room temperature” 室溫下是液體Agent 藥物V

9、apour Pressure mmHg 蒸汽壓Blood:Gas Solubility 氣:血溶解度MAC vol % 最小肺泡濃度Isoflurane 異氟烷240 (240/760=30%)1.271.30Halothane 氟烷2432.460.90Sevoflurane七氟烷 1600.622.10Desflurane地氟烷6640.427.20N2O 笑氣7600.47200%Methoxyflurane甲氧氟烷23150.24Blood Gas Solubility (BGS) 血液氣體溶解度 BGS is a measure of the solubility of a gas

10、in blood 測量氣體在血液中的溶解度Inhaled anesthetics must be carried from the lungs to the brain by the blood 吸入的麻醉劑必須通過血液來達到大腦If a gas has a low BGS, the blood quickly es saturated and can release the anesthetic into the brain. 如果氣體的 血液溶解度低，會很快變成飽和，就可以很快把藥物釋放到大腦Low BGS = Fast Acting Anaesthetic 低血液氣體溶解度快速麻醉劑Br

11、ain大腦Blood血液Blood血液Lungs肺臟Inspired/ Expired Gas呼吸的氣體Effect of Blood:Gas Solubility on Uptake and Elimination of Inhalation Anaesthetics 血氣溶解度對吸入麻醉藥的吸收和排泄的影響B(tài)enefits Of A Low BGS 血液氣體溶解度的好處 Faster induction & transition from short acting IV anaesthetics to inhalation agents 誘導(dǎo)麻醉更快，也使靜脈給藥麻醉過渡到吸入麻醉很快 F

12、aster changes to anaesthetic depth for varying surgical stimulus during surgery 在手術(shù)過程中，因手術(shù)刺激程度不同而快速改變麻醉深度 Faster recovery from anaesthesia 麻醉后蘇醒過程也很快Physical Properties of Volatile Anaesthetics 揮發(fā)性麻醉劑的物理特性 “l(fā)iquids at room temperature” 室溫下是液體Agent 藥物Vapour Pressure mmHg 蒸汽壓Blood:Gas Solubility 氣:血溶解

13、度MAC vol % 最小肺泡濃度Isoflurane 異氟烷240 (240/760=30%)1.271.30Halothane 氟烷2432.460.90Sevoflurane七氟烷 1600.622.10Desflurane地氟烷6640.427.20N2O 笑氣7600.47200%Methoxyflurane甲氧氟烷23150.24MAC values differ for each anaesthetic agent 每種麻醉劑的最小肺泡濃度不一樣MAC: “the minimum concentration of an anesthetic that produces immob

14、ility in 50% of animals exposed to a painful stimulus” 最低肺泡有效濃度：“一個麻醉劑的最小濃度使得在受到疼痛刺激時50的動物沒有反應(yīng)?！盨urgical anaesthesia: around 1.5 x MAC as sole anaesthetic 外科麻醉：單一麻醉藥時，一般是MAC的1.5 倍Surgical anaesthesia: 1.25 MAC with premed. & IV induction 外科麻醉：如果有麻醉前給藥，或靜脈給藥誘導(dǎo)，可以是MAC的1.25倍0.9%Halo氟烷7.20%2.10%1.30%Des

15、地氟烷Sevo七氟烷Iso 異氟烷Anaesthetics depress ventilation as dose increases劑量大時麻醉藥抑制呼吸Respiratory Depression with Inhalational Drugs吸入麻醉藥的呼吸系統(tǒng)抑制Apneic Concentration (AC) is “the % concentration of anesthetic at which an animal will stop breathing spontaneously” 窒息濃度（AC）：能引起動物呼吸自動停止的麻醉藥濃度Apnoeic Index (AI) =

16、 AC MAC窒息指數(shù) （AI）= 窒息濃度最低肺泡有效濃度The AI provides a measure of how many multiples of MAC are required to cause apnea. 窒息指數(shù)表明幾倍MAC的麻醉藥濃度可以引起窒息The higher the AI, the greater the safety margin for respiratory depression.窒息指數(shù)越高麻醉劑的呼吸抑制安全范圍更大Comparison of Volatile Anaesthetics揮發(fā)性麻醉劑的比較 “l(fā)iquids at room tempe

17、rature” 室溫下是液體Agent 麻醉藥ml vapour/ml liquid毫升蒸汽/毫升液體Apnoeic Indexx MAC 窒息指數(shù)Metabolism %代謝百分率Isoflurane 異氟烷1952.60Halothane 氟烷2272.920Sevoflurane 七氟烷1853.53Desflurane 地氟烷210Not Done0N2O 笑氣GASNot Done?Methoxyflurane 甲氧氟烷2073.450Anaesthetics depress cardiac function as dose increases劑量增加時對心臟功能的抑制 - Card

18、iac Output & Blood Pressure decrease with dose 劑量增加會引起心臟輸出量和 血壓降低 - Heart rate changes are variable: ? increase with depth but may decrease with pain! 心率的變化不一：？麻醉加深時，疼痛減少了 - anaesthetics increase ventricular arrhythmias 麻醉加深引起心室心率不齊Inhalation Anaesthetics Increase Ventricular Arrhythmias吸入麻醉劑加劇心室心律失

19、常Ventricular Arrhythmias Effect of Pre-anaesthesia Oxygen心室心律失常麻醉前供氧的影響O2 by face mask 100 ml/kg/min面罩給氧，每分鐘每公斤體重100毫升Geriatric Anaesthesia老年動物的麻醉Change in Renal Function with Age年老和腎功能改變Loose +/- 60% renal function before BUN and creatinine rise!在BUN和肌酐升高之前，約有60的腎功能丟失Geriatric Anaesthesia老年動物的麻醉Cha

20、nge in Renal Function with Age年老和腎功能改變Elevated liver enzymes in healthy dogs ? normal; Liver disease (jaundice) care健康動物的肝功酶升高？正常；肝臟疾?。S疸） 小心Comparison of Volatile Anaesthetics揮發(fā)性麻醉劑的比較 “l(fā)iquids at room temperature” 室溫下是液體Agent 麻醉藥ml vapour/ml liquid毫升蒸汽/毫升液體Apnoeic Indexx MAC 窒息指數(shù)Metabolism %代謝百分率I

21、soflurane 異氟烷1952.60Halothane 氟烷2272.920Sevoflurane 七氟烷1853.53Desflurane 地氟烷210Not Done0N2O 笑氣GASNot Done?Methoxyflurane 甲氧氟烷2073.450Comparison of Volatile Anaesthetics揮發(fā)性麻醉劑的比較 “l(fā)iquids at room temperature” 室溫下是液體Agent 麻醉藥ml vapour/ml liquid毫升蒸汽/毫升液體Apnoeic Indexx MAC 窒息指數(shù)Metabolism %代謝百分率Isofluran

22、e 異氟烷1952.60Halothane 氟烷2272.920Sevoflurane 七氟烷1853.53Desflurane 地氟烷210Not Done0N2O 笑氣GASNot Done?Methoxyflurane 甲氧氟烷2073.450Anaesthetic Delivery & Cost 麻醉劑的供給和成本 Isoflurane: 195 ml vapor/ml 異氟烷：195毫升氣/毫升液Vap 2% & O2 flow 1000 ml/min= 20 ml vapor/min 蒸發(fā)麻醉劑的濃度2和氧氣流速20毫升蒸發(fā)氣/分鐘20 x 60 min = 1200 ml vap

23、/hr 1200ml 蒸發(fā)氣/小時1200/195 = 6 ml liquid/hr = 6 ml 液體/小時In Australia: 6 x 30c = AU$1.80/hr 1.8 澳元 /小時Client Communication 與顧客的溝通How do you discuss anesthesia and with your clients Risk vs Quality 如何與顧客討論麻醉衡量麻醉危險性與動物生活質(zhì)量Should you market anaesthesia in your practice?是否可以在醫(yī)院內(nèi)推銷麻醉？ Does this influence p

24、ricing? 這是否影響到標價？What are the vet. or client concerns for considering a particular approach to anaesthesia? 當(dāng)面對一個特定的麻醉操作，獸醫(yī)或主人在關(guān)心什么？Can marketing & pricing anaesthesia appropriately influence profitability? 推銷麻醉和合理麻醉標價是否影響效益？Oral Translation Done by INTERVET PPT Translation Done by Hills China今天本講座的

25、翻譯:英特威公司寵物事業(yè)部技術(shù)總監(jiān)梁燕明主任獸醫(yī)電子郵件： 幻燈片翻譯為：美國希爾思寵物營養(yǎng)中國部戴庶 獸醫(yī)師 （獸醫(yī)事務(wù)經(jīng)理）張瑩 獸醫(yī)師 （技術(shù)服務(wù)經(jīng)理）電子郵件： 電子郵件： 如果發(fā)現(xiàn)有錯誤請向他們反饋。謝謝！OH&S & Waste AnaestheticGas Management麻醉廢氣的管理Dr Colin DunlopDip. American College Vet. Anesthesiologists美國獸醫(yī)麻醉師學(xué)會會員Advanced Anaesthesia SpecialistsSydney, Australia澳大利亞, 悉尼, 高級麻醉師 Excess Or Wa

26、ste Anaesthetic Gas (WAG) 過量麻醉氣體或麻醉廢氣 the anaesthetic supplied to a breathing circuit is absorbed by the animal (15 ml O2/kg/min 6 ml O2/kg/min = 9 ml/kg/min)呼吸回路中1/2的麻醉劑被動物吸收Excess gas (WAG) is pushed out of the “pop-off” valve & then through the ducting to the exterior vent point by the continual

27、O2 flow from the pressurised cylinder把多余的氣體從氣壓安全閥排出，然后通過從高壓氣罐持續(xù)來的氧氣把它們從管道流到外部排氣處排出Volatile anaesthetics in the vapour phase are similar to all gases so diffuse rapidly into the room air, so scavenge the WAG氣體狀態(tài)下的揮發(fā)性麻醉劑與所有的氣體都相似，可以迅速擴散到室內(nèi)空氣內(nèi)，所以要排除麻醉廢氣Comparison of Volatile Anaesthetics揮發(fā)性麻醉劑的比較 “l(fā)iqu

28、ids at room temperature” 室溫下是液體Agent 麻醉藥ml vapour/ml liquid毫升蒸汽/毫升液體Apnoeic Indexx MAC 窒息指數(shù)Metabolism %代謝百分率Isoflurane 異氟烷1952.60Halothane 氟烷2272.920Sevoflurane 七氟烷1853.53Desflurane 地氟烷210Not Done0N2O 笑氣GASNot Done?Methoxyflurane 甲氧氟烷2073.450Occupational Safety: Fluoride ion production職業(yè)安全：氟離子的生成Occ

29、upational Safety 職業(yè)安全Evidence for health problems from WAG is only suggestive 麻醉廢氣對健康的 影響只是一種推測Pregnant women have increased risk of abortion (? other factors)懷孕婦女增加流產(chǎn)的危險（？其他因素）minimise WAG pollution of work areas: 50 ppm = smell threshold減小麻醉廢氣對工作環(huán)境的污染 50 ppm = 嗅覺閾值Scavenge WAG from anaesthetic cha

30、mbers & face masks麻醉箱 & 面罩中麻醉廢氣的清除Pregnant women should avoid WAG exposure when chambers are opened 當(dāng)麻醉箱敞開時，懷孕婦女應(yīng)避免與麻醉廢氣接觸Waste Anaesthetic Gas (WAG) Management 麻醉廢氣的處理WAG absorbed by charcoal (- N2O)用活性炭吸附麻醉廢氣WAG ducted to the atmosphere麻醉廢氣導(dǎo)管連接到大氣中Anaesthetic molecule life up to 30 yrs麻醉劑分子可存在30年之

31、久Use lower O2 flows: less WAG/cost使用低氧氣流量：減少麻醉廢氣/花費Recovery rooms: large & ventilated恢復(fù)室：寬敞 & 通風(fēng)Passive “Through-the-Wall” WAG systems被動的“穿墻”麻醉廢氣裝置Vent to the atmosphere與大氣相連Fit with an insect screen裝上窗紗網(wǎng)布 NO resistance無阻力Distance less than 6 m. 20 mm ID pipe)距離小于6 m. 內(nèi)徑20 mm的管Longer distances use l

32、arger pipe 使用較長的距離則需要更大的管Active Waste Anaesthetic Gas (WAG) systems主動麻醉廢氣裝置WAG passive from “pop-off” valve麻醉廢氣從氣壓安全閥中被動排出blow or suck WAG to the building vent or to activated charcoal將麻醉廢(吹或吸)氣排到建筑通風(fēng)管道中或排到活性炭中used with long distances to vent用遠距離的抽風(fēng)機Need +ve/-ve pressure relief device 需要緩減正負壓力的裝置Act

33、ivated charcoal WAG canisters活性炭麻醉廢氣過濾罐Absorb anaesthetic vapour (not N2O)吸收麻醉蒸汽（而不是N2O）Increase charcoals weight by 20%使活性炭重量增加20%500g charcoal absorbs 125ml anaesthetic liquid500克的活性炭吸收125毫升麻醉劑液體discard charcoal when opening a new 250 ml bottle (125 ml is in the animal/s)開啟新的250毫升瓶子時，就該扔掉活性炭了Human

34、 facemasks have activated charcoal人用面罩含有活性炭Work Habits That Reduce WAG Pollution降低麻醉廢氣污染的工作習(xí)慣Only turn the vaporizer on when the breathing circuit is connected to the patient and the ET tube cuff is inflated當(dāng)呼吸回路與動物連接以及氣管插管套囊充氣后才開啟蒸發(fā)罐End anaesthesia: before disconnection turn off the vap. & O2 flow, then empty the breathing bag into the WAG system結(jié)束麻醉：在斷開連接之前關(guān)閉蒸發(fā)罐&氧氣流動，然后將呼吸氣囊中氣體排到麻醉廢氣系統(tǒng)中Flush the circuit 1 x with O2 , then disconnect the animal用氧氣“沖洗”整個回路，然后與動物斷開連接Fill vaporizers at the end of the day - turn OFF before opening每天最后要補充滿蒸發(fā)罐 在打開蓋之前先關(guān)閉開關(guān)Dont