全麻概念專題知識專家講座

Chapter6

BasicConceptofGeneralAnesthesia全麻概念專題知識專家講座第1頁

Generalanesthesiaisanalteredphysiologicstatecharacterizedbyreversiblelossofconsciousness,analgesiaoftheentirebody,amnesiaandsomedegreeofmusclerelaxation.

Induction→Maintenance→Recovery

DefinitionofGeneralAnesthesia全麻概念專題知識專家講座第2頁1.InductionofGeneralAnesthesia

Definition

全麻誘導是指病人從清醒轉(zhuǎn)為能夠進行手術(shù)操作麻醉狀態(tài)過程。

Therearesomecomplicationsorrisksinthisstage,e.g.reductionofbloodpressure,arrhythmia,myocardialischemia.全麻概念專題知識專家講座第3頁

InductionofGeneralAnesthesia--Methods

①

Rapid-sequenceIntravenousInduction全麻概念專題知識專家講座第4頁

Agent

inductiondose(mg/Kg)Diazepam0.2Midazolam0.1-0.2Thiopental3-5Etomidate0.3ketamine1-2Propofol1.5-2.5Fentanyl5-6μg/kgIntravenousinductionagents全麻概念專題知識專家講座第5頁

MuscleRelaxantsdepolarizingnondepolarizingdose(mg/kg)

Succinycholine

1-2

vecuronium0.08-0.1

atracurium0.3-0.6

pancuronium0.08-0.1

Rocuronium0.6-1

全麻概念專題知識專家講座第6頁InductionofGeneralAnesthesia

①

Rapid-sequenceIntravenousInduction

--DisadvantageandComplications

●

RegurgitationandVomitting●

Cardiovasculardepression●

Respiratorydepression●

Histaminerelease●Painoninjection

●Hiccupandmusclemovements全麻概念專題知識專家講座第7頁InductionofGeneralAnesthesia

②

InhalationalInduction--Indications

●

youngchildren

●

myastheniagravies

●upperairwayobstruction,e.g.Epiglottitis

●

lowerairwayobstructionwithforeignbody

●

bronchopleuralfistulaorempyema

●

noaccessibleveins

全麻概念專題知識專家講座第8頁InductionofGeneralAnesthesia

InhalationalInduction--Methods

Initially,nitrousoxide70%inoxygenisusedandanesthesiaisdeepenedbygradualintroductionofincrementsofavolatileagent,e.g.Halothane1-3%,Enflurane1.5-2.5%,Isoflurane1-2%.

全麻概念專題知識專家講座第9頁InductionofGeneralAnesthesia

InhalationalInduction--characteristics

●

Spontaneousventilationistobemaintained.

●thefacemaskisappliedfirmlyasconsciousnessislostandtheairwayissupportedmanually.

●Insertionofanoropharyngealairway,alaryngealmaskairwayoratrachealtubemaybeconsideredwhenanesthesiahasbeenestablished.

全麻概念專題知識專家講座第10頁InductionofGeneralAnesthesia

InhalationalInduction

DisadvantageandComplications

●

Slowinductionofanesthesia

●Airwayobstruction,bronchospasm

●Laryngealspasm,hiccups

●

Environmentalpollution

全麻概念專題知識專家講座第11頁

InductionofGeneralAnesthesia

③

Inductionwithspontaneousventilation--Indications

●Airwayobstruction

●anticipantdifficultintubation

全麻概念專題知識專家講座第12頁

InductionofGeneralAnesthesia

InductionWithSpontaneousVentilation

--Characteristics

●Maintainingspontaneousventilation

throughouttheprocedure●Sufficientsurfaceanesthesia全麻概念專題知識專家講座第13頁InductionofGeneralAnesthesia

④

Intravenousinductionfollowing

consciousintubation--Indications

●Patientwiththeriskofregurgitation

●Patientwithposturalhypotension

followinganesthesia(e.g.paraplegia)

全麻概念專題知識專家講座第14頁InductionofGeneralAnesthesia

⑤

Otherinductionmethods

●intramuscularinjectionofketamine

●takemidazolamorally

●administrationoffentanylviamucosa

全麻概念專題知識專家講座第15頁注意事項

保持呼吸道通暢---首要任務(wù)

保持一定麻醉深度，減輕插管應(yīng)激反應(yīng)靜脈用藥按Kg體重計算、維持循環(huán)穩(wěn)定誘導前，準備好麻醉機和插管用具，監(jiān)測生命體征面罩加壓給氧時，TV不宜過大，防止氣體進入胃內(nèi)→胃脹氣、返流

全麻概念專題知識專家講座第16頁⒉Maintenanceofgeneralanesthesia

鎮(zhèn)靜sedation

鎮(zhèn)痛analgesia

肌松musclerelaxation全麻概念專題知識專家講座第17頁⒉Maintenanceofgeneralanesthesia

InhalationalagentsIntravenousanestheticsOpioidsMusclerelaxants全麻概念專題知識專家講座第18頁

全麻維持與誘導緊密銜接了解手術(shù)進程，麻醉深度與手術(shù)刺激相適應(yīng)做好呼吸管理，保持氣道通暢，人工通氣監(jiān)測PETCO2、SPO2及血氣分析:

顱腦手術(shù)PaCO2維持30-35mmHg

冠心病病人PaCO2不宜太低，以免冠脈痙攣

注意事項全麻概念專題知識專家講座第19頁注意事項■使用肌松監(jiān)測儀指導肌松劑使用

■充分鎮(zhèn)靜、防止術(shù)中知曉

■維持生命體征和內(nèi)環(huán)境平穩(wěn)，及時處理術(shù)中失血性休克、過敏性休克、心律失常等異常情況全麻概念專題知識專家講座第20頁⒊Recovery

AntagonizingresidualneuromuscularblockadeExtubationAirwaysupportingRecoverypositionisbenefittoavoidairwayobstruction全麻概念專題知識專家講座第21頁全麻概念專題知識專家講座第22頁⒊Recovery

嚴格掌握拔管指征，過早、過晚拔管均會造成嚴重后果自然清醒，必要時使用催醒藥MACawake:肺泡氣內(nèi)吸入麻醉藥濃度降至0.4MAC（0.5或0.58