外科學(xué)教學(xué)課件：全麻

1、Clinical Anaesthesiology (General Anaesthesia),教學(xué)要求,全麻方法 全麻藥物 麻醉深度的判斷 氣管插管方法、適應(yīng)癥、并發(fā)癥 全麻并發(fā)癥 麻醉監(jiān)測,Contents,Methods of General Anaesthesia Anaesthetics Guegels Classic Signs of Anaesthesia Methods, Indications & Complications of Intubation Complications of General Anaesthesia Monitoring During Anaesthe

2、sia,Methods of General Anaesthesia,Inhalation anaesthesia Intravenous anaesthesia Intramuscularly Rectally Orally Balanced anaesthesia,Inhalational Anaesthetic Agents,Agent MAC% Vapor Pressure Blood/Gas Partition Nitrous oxide 105 - 0.47 Halothane 0.74 243 2.4 Enflurane 1.68 175 1.9 Isoflurane 1.15

3、240 1.4 Desflurane 6.0 681 0.42 Sevoflurane 1.7 157 0.66,Intravenous Anaesthetic Agents,Agent Induction dose (mgkg-1) Thiopentone 3-5 Etomidate 0.3 Propofol 1.5-2.5 Ketamine 2,Drugs Used to Supplement Anaesthesia,Analgesics Opioid Agonists Natural opium alkaloids: Morphine,Codeine Semisynthetic opiu

4、m alkaloid: Diamorphine Synthetic opioids: Pethidine, Fentanyl, Alfentanil, Sufentanil, Remifentanil Partial Opioid Agonists Buprenorphine Opioid Agonist/Antagonists Pentazocine Opioid Antagonists Naloxone,Muscle Relaxants,Neuromuscular Blocking Agents are divided into two classes Depolarizing Nonde

5、polarizing,Muscle Relaxants,Depolarizing Short-acting Succinylcholine Decamethonium,Nondepolarizing Long-acting Tubocurarine Metocurine doxacurium Pancuronium Pipecurium Intermediate-acting Atracurium Vecuronium Short-acting Mivacurium,Preparation for Anaesthesia,Preoperative assessment Equipment fo

6、r monitoring The anaesthetic machine Equipment for tracheal intubation,General Anaesthesia,Induction of Anaesthesia Maintenance of Anaesthesia Emergence and Recovery,Intravenous Induction,Agent Induction dose (mgkg-1) Thiopentone 3-5 Etomidate 0.3 Propofol 1.5-2.5 Ketamine 2,Inhalational Induction,A

7、gent MAC% Nitrous oxide 105 Halothane 0.74 Enflurane 1.68 Isoflurane 1.15 Desflurane 6.0 Sevoflurane 1.7,Maintenance of Anaesthesia(Control of Depth of Anaesthesia),Minimum alveolar concentration (MAC) MAC is the minimum alveolar concentration (at one atmosphere) of an inhaled anaesthetic agent, whi

8、ch prevents reflex movement in response to surgical incision in 50 % of subjects.,Guegels Classic Signs of Anaesthesia,Stage 1 (Stage of analgesia) From start of induction of anaesthesia to loss of consciousness. Stage 2 (Stage of excitement) From loss of consciousness to beginning of regular respir

9、ation. Stage 3 (Surgical anaesthesia) From the beginning of regular respiration to respiratory arrest.,Guegels Classic Signs of Anaesthesia,The stage 3 is divided into four planes. Plane 1 From the onset of regular breathing to the cessation of eyeball movements. Plane 2 From the cessation of eyebal

10、l movements to the beginning of intercostal paralysis. Plane 3 From the beginning of intercostal paralysis to the completion of intercostal paralysis. Plane 4 From completion of intercostal paralysis to diaphragmatic paralysis.,Guegels Classic Signs of Anaesthesia,Stage 4 Stage of impending respirat

11、ory and circulatory failure (Medullary paralysis) from the onset of diaphragmatic paralysis to cardiac arrest.,Airway Maintenance,Use of the facemask Use of the laryngeal mask airway (LMA) Use of the oropharyngeal airway Use of the nasopharyngeal airway Tracheal intubation,Methods of Tracheal Intuba

12、tion,Oral-tracheal intubation Naso-tracheal intubation Flexible fiberoptic nasotracheal intubation Blind intubation of the tracheal under light wands Tracheal intubation under seeing optical stylet,Indications of Tracheal Intubation,Provision of a clear airway An unusual position Operations on head

13、and neck Protection of respiratory tract During anaesthesia using IPPV and muscle relaxants To facilitate suction of respiratory tract During thoracic operations,Oral-tracheal intubation,Oral-tracheal intubation,Tracheal intubation under seeing optical stylet,Complications of Intubation While the Tu

14、be is in Place,Malposition Unintentional extubation Endobrochial intubation Laryngeal cuff position,Airway trauma Mucosal inflammation and ulceration Excoriation of nose Tube malfunction Ignition Obstruction,Complications of Intubation Following Extubation,Airway trauma Edema and stenosis (glottic,

15、subglottic, tracheal ) Hoarseness (vocal cord granuloma or paralysis ),Laryngeal malfunction Regurgitation Aspiration Physiologic reflexes Laryngospasm,Complications During Anaesthesia,Arrhythmias Bradycardia Tachycardia Atrial arrhythmias Ventricular arrhythmias (Premature ventricular contractions

16、(PVCs) Heart block,Complications During Anaesthesia,Hypotention Decreased cardiac output Decreased venous return Myocardial Vasodilation Drugs Septicaemia Hypovolaemia Haemorrhage,Complications During Anaesthesia,Hypertension Hypervolaemia Myocardial ischaemia Cardiac arrest Embolism Hypoxaemia,Comp

17、lications During Anaesthesia,Hypercapnia Hypocapnia Respiratory obstruction Intubation problems Aspiration of gastric contents Hiccups Adverse drug effects,Complications During Anaesthesia,Malignant hyperthermia (MH) Hyperthermia Hypothermia Acute intermittent porphyria(AIP) Awareness Injury,Monitor

18、ing During Anaesthesia,Cardiac Monitors,Arterial blood pressure Noninvasive arterial blood pressure Invasive arterial blood pressure monitoring,Electrocardiography Central venous catheterization Pulmonary artery catheterization Cardiac output,Invasive Arterial Blood Pressure Monitoring (Selection of Artery for Cannulation),Radial artery Brachial artery Ulnar artery femoral artery Dorsalis pedis Posterior tibial artery Axillary artery,Monitoring During Anaesthesia,Respiratory System Monitoring,Precordial & easophageal stethoscope Breathing circuit pressure & exhaled t