眼科手術(shù)麻醉英語教學(xué)課件

Anesthesia

forOphthalmicSurgery

(眼科手術(shù)麻醉)

XuliAnesthesia

forOphthalmicSu1眼科手術(shù)麻醉英語教學(xué)課件2眼科手術(shù)麻醉英語教學(xué)課件3ProfileandDemandsfineproceduredemands

intraocularpressure(IOP)airwayoculocardiacreflex(OCR)ProfileandDemandsfineproc4PreoperativeEvaluation

andPreparationpsychologicalpreparationtreatmentoftheoriginaldiseasestreatmentoftheco-existingdiseasesPreoperativeEvaluation

andP5Premedicationanticholinegics(抗膽堿藥):givenintramuscularly,havenosignificanteffectsonIOP.However,appliedtopicallytotheeyemaycausemydriasis(瞳孔散大)andmayincreaseIOP.sedatives(鎮(zhèn)靜藥)analgesics(鎮(zhèn)痛藥)antiemetics(止吐藥)Premedicationanticholinegics(抗6AnestheticTechniques.localanesthesia.generalanesthesiaAnestheticTechniques.localan7complicationsofretrobulbarblock(將局麻藥注入睫狀長、短神經(jīng)及眼球筋膜囊內(nèi))ImportantPointsinLocalAnesthesiaapplicationofAdrenalinapplicationofsedativesOCRToxicittyoflocalanestheticscomplicationsofretrobulbarb8ImportantPointsinGeneralAnesthesiacarefulmonitoringsmoothanesthesiaapplicationofmusclerelaxantspreventionofOCRN2OonIOPanestheticsandIOPImportantPointsinGeneralAn9QuestionsWhat’sthemaincauseofexorbitant

IOPduringophthalmicoperations?What’sOCRandhowtotreatit?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？視網(wǎng)膜脫離修補術(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？QuestionsWhat’sthemaincause10THANKyouTHANKyou11Demandspatient’scooperationandimmobility

—>perfectsedationandanalgesiashouldbeavailablle.fixationoftheeyeball—>relaxationoftheorbicularisoculimuscle(眼輪匝肌)andextraocularmuscles(眼外肌)isnecessary.Demandspatient’scooperationa12IOP(眼內(nèi)壓)1、IOP：thepressureontheeyeballwallexertedbytheintraocularcontents.

3、ThemaindeterminantofIOPisthedynamicbalancebetweentheproductionofaqueoushumoranditseventualelimination.2、aqueoushumor

circulation4、themaincauseofexorbitantIOPistheobstructionoftheaqueoushumor(房水)circulation.

IOP(眼內(nèi)壓)1、IOP：thepressureon13眼科手術(shù)麻醉英語教學(xué)課件14眼科手術(shù)麻醉英語教學(xué)課件15SeveralimpactfactsonIOP

Mydriaticdrugs(擴瞳藥)

Maneuvers

(動作行為)

Hypercarbia(高碳酸血癥)andhypoxia(低氧血癥)

Pressureontheeyeball

Anesthetics:MostanestheticsreduceIOP.OnlysuccinylcholineandketaminemayincreaseIOP.SeveralimpactfactsonIOPMy16OculocardiacReflex(OCR)

眼心反射TheOCRisatrigeminovagalreflex(三叉-迷走神經(jīng)反射)thatmaybeinducedbypressureontheeyeball,traction(牽拉)ontheextraocularmuscle(眼外肌),orbital(眼眶內(nèi)的)hematoma(血腫),oculartrauma(損傷),andeyepain,manifestedbycardiacarrhythmias(心律失常)suchasbradycardia(心動過緩),nodalrhythm(結(jié)性節(jié)律),ectopicbeats(異位搏動),ventricularfibrillation(心室纖維顫動),orasystole(心臟停搏).OculocardiacReflex(OCR)

眼心反射T17LocalAnesthesiatopicalanesthesia(表面麻醉)infiltrationanesthesia(浸潤麻醉)nerveblock(神經(jīng)阻滯)LocalAnesthesiatopicalanesth18GeneralAnesthesiawithendotrachealintubationwithoutendotrachealintubationGeneralAnesthesiawithendotra19眼科手術(shù)麻醉英語教學(xué)課件20AnestheticsandIOP

MostgeneralanestheticsareCNSdepressants,theylowerIOP.

Butsuccinylcholinecausesatransient(4~6min)butsignificantincreaseinIOPof10to20mmHg.TheeffectofketamineonIOPvaries.EarlystudiesreportedanincreaseinIOPafterintramuscularorintravenousadministrationofketamine.Ketaminegivenafterpremedicationwithdiazepamandmeperidine(哌替啶)doesnotaffectIOP,andintramuscularlyadministeredketaminemayevenlowerIOPinchildren.AnestheticsandIOPMostgener21N2OonIOPOphthalmologistssometimesinjectasmallbubbleofgas(e.g.,SF6)intothevitreal(玻璃體的)cavityduringreattachment(修補)oftheretina(視網(wǎng)膜)soastoholdtheretinainplaceunderalong-actingbubbleofstablesize.N2OismorediffusiblethanSF6andmoresolubleinwater,andrapidlyentersthegasbubble.AdministratingN2OaftertheinjectionofSF6,thesizeoftheinjectedgasbubblerapidly.

AndthenbothbubblesizeandIOPdecreasealongwith

thediscontinuationofN2O.N2OonIOPOphthalmologistssom22Anesthesia

forOphthalmicSurgery

(眼科手術(shù)麻醉)

XuliAnesthesia

forOphthalmicSu23眼科手術(shù)麻醉英語教學(xué)課件24眼科手術(shù)麻醉英語教學(xué)課件25ProfileandDemandsfineproceduredemands

intraocularpressure(IOP)airwayoculocardiacreflex(OCR)ProfileandDemandsfineproc26PreoperativeEvaluation

andPreparationpsychologicalpreparationtreatmentoftheoriginaldiseasestreatmentoftheco-existingdiseasesPreoperativeEvaluation

andP27Premedicationanticholinegics(抗膽堿藥):givenintramuscularly,havenosignificanteffectsonIOP.However,appliedtopicallytotheeyemaycausemydriasis(瞳孔散大)andmayincreaseIOP.sedatives(鎮(zhèn)靜藥)analgesics(鎮(zhèn)痛藥)antiemetics(止吐藥)Premedicationanticholinegics(抗28AnestheticTechniques.localanesthesia.generalanesthesiaAnestheticTechniques.localan29complicationsofretrobulbarblock(將局麻藥注入睫狀長、短神經(jīng)及眼球筋膜囊內(nèi))ImportantPointsinLocalAnesthesiaapplicationofAdrenalinapplicationofsedativesOCRToxicittyoflocalanestheticscomplicationsofretrobulbarb30ImportantPointsinGeneralAnesthesiacarefulmonitoringsmoothanesthesiaapplicationofmusclerelaxantspreventionofOCRN2OonIOPanestheticsandIOPImportantPointsinGeneralAn31QuestionsWhat’sthemaincauseofexorbitant

IOPduringophthalmicoperations?What’sOCRandhowtotreatit?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？視網(wǎng)膜脫離修補術(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？QuestionsWhat’sthemaincause32THANKyouTHANKyou33Demandspatient’scooperationandimmobility

—>perfectsedationandanalgesiashouldbeavailablle.fixationoftheeyeball—>relaxationoftheorbicularisoculimuscle(眼輪匝肌)andextraocularmuscles(眼外肌)isnecessary.Demandspatient’scooperationa34IOP(眼內(nèi)壓)1、IOP：thepressureontheeyeballwallexertedbytheintraocularcontents.

3、ThemaindeterminantofIOPisthedynamicbalancebetweentheproductionofaqueoushumoranditseventualelimination.2、aqueoushumor

circulation4、themaincauseofexorbitantIOPistheobstructionoftheaqueoushumor(房水)circulation.

IOP(眼內(nèi)壓)1、IOP：thepressureon35眼科手術(shù)麻醉英語教學(xué)課件36眼科手術(shù)麻醉英語教學(xué)課件37SeveralimpactfactsonIOP

Mydriaticdrugs(擴瞳藥)

Maneuvers

(動作行為)

Hypercarbia(高碳酸血癥)andhypoxia(低氧血癥)

Pressureontheeyeball

Anesthetics:MostanestheticsreduceIOP.OnlysuccinylcholineandketaminemayincreaseIOP.SeveralimpactfactsonIOPMy38OculocardiacReflex(OCR)

眼心反射TheOCRisatrigeminovagalreflex(三叉-迷走神經(jīng)反射)thatmaybeinducedbypressureontheeyeball,traction(牽拉)ontheextraocularmuscle(眼外肌),orbital(眼眶內(nèi)的)hematoma(血腫),oculartrauma(損傷),andeyepain,manifestedbycardiacarrhythmias(心律失常)suchasbradycardia(心動過緩),nodalrhythm(結(jié)性節(jié)律),ectopicbeats(異位搏動),ventricularfibrillation(心室纖維顫動),orasystole(心臟停搏).OculocardiacReflex(OCR)

眼心反射T39LocalAnesthesiatopicalanesthesia(表面麻醉)infiltrationanesthesia(浸潤麻醉)nerveblock(神經(jīng)阻滯)LocalAnesthesiatopicalanesth40GeneralAnesthesiawithendotrachealintubationwithoutendotrachealintubationGeneralAnesthesiawithendotra41眼科手術(shù)麻醉英語教學(xué)課件42AnestheticsandIOP

MostgeneralanestheticsareCNSdepressants,theylowerIOP.

Butsuccinylcholinecausesatransient(4~6min)butsignificantincreaseinIOPof10to20mmHg.TheeffectofketamineonIOPvaries.Earlystudiesrepo