麻醉概述英文课件

ANESTHESIOLOGY Pei Xuxing Department of Anesthesiology Peoples Hospital of Henan Province Contents 1. The history of anesthesiology 2. The scope of anesthesiology 3. Classification of Anesthesia 4. Definition of Anesthesia 5. Preparing for anesthesia The History of Anesthesiology Anesthetic practices date from ancient times The History of Anesthesiology Modern anesthesiology began in 1846 - Ether was used as an anesthetic agent in humans. William T. G. Morton (1819-1868) The History of Anesthesiology Modern inhalation anesthetics were developed from 1950s to 1960s Intravenous anesthesia first began in 1872- Use of choral hydrate. From then, many other intravenous agents were developed. Muscle relaxants resulted in evolution of anesthesiology-Curare(箭毒 )was firstly used in 1942 The History of Anesthesiology The original of modern local anesthesia was credited to use of cocaine in 1884. Subarachnoid anesthesia - 1898. Caudal epidural anesthesia- 1901. lumbar epidural anesthesia - 1921 The Scope of Anesthesiology 1.Clinical anesthesia 2.Pain management 3.First-aid and resuscitation 4.Intensive care 8 术 前 给药 麻醉 诱导 麻醉 维 持 呼吸管理 气管插管 控制呼吸 辅 助呼吸 循 环 管理 麻醉深度 容量 血管活性 药 苏 醒 麻醉恢复 静脉 诱导 全凭静脉麻醉 （ TIVA） 拔管 术 后疼痛管理 全身麻醉 过 程 吸入 诱导 吸入麻醉 静吸 复合麻醉 Definition of Anesthesia Anesthesia is always defined by drug- induced changes in behavior or perception. The components of general anesthetic state include unconsciousness, amnesia( 健忘 ), analgesia(镇 痛 ), immobility, and attenuation of autonomic nervous system responses to noxious stimulation. Course of Anesthesia Anesthesia induction Anesthesia maintenance Anesthesia recovery Classification of Anesthesia General anesthesia Inhalation anesthesia Intravenous anesthesia Combined anesthesia Intravenous Venous-inhalation Intrathecal block- general anesthesia Local anesthesia Topical anesthesia Infiltration anesthesia Nerve block Nerve plexus block Intrathecal block: Subarachnoid block, epidural block and caudal block Monitoring During Anesthesia The Cardiovascular System The Respiratory System Liver and kidney function Central nerve system Coagulation function Pain Management Postoperative analgesia Delivery analgesia Acute and chronic pain cure Cancer analgesia Preparing For Anesthesia Preoperative visit Preoperative evaluation: History, physical examination, laboratory evaluation Preoperative fasting Coexisting disease therapy Equipment preparation Preoperative medication Purposes of the preoperative visit 1. Establish rapport with the patient 2. Obtain a history and perform a physical examinations 3. Order a special investigations 4. Assess the risks of anesthesia and surgery 5. Institute preoperative management Routine Preoperative Anesthetic Evaluation History Review of organ system clinical examination Laboratory Evaluation ASA Physical Status Classification Class Definition 1 A normal healthy patient. 2 A patient with mild systemic disease and no functional limitation 3 A patient with moderate to severe systemic disease that results in some functional limitation 4 A patient with severe systemic disease that is a constant threat to life and functionally incapacitating 5 A moribund patient who is not expected to survive 24 hours with or without surgery E If the procedure is an emergency, the physical status is followed by “ E” Preoperative Fasting The time of fasting solid is more than 12 hours, and fluid is more than 4 hours. The time of fasting breast milk is 8 hours in baby. If necessary, baby should be transfused. Coexisting Disease Therapy Coexisting disease may affect outcome adversely if not under optimum control. The coexisting disease must be treated properly before any nonurgent surgery . Coexisting disease and drug treatment may interact with anesthesia and surgery in several ways Coexisting Disease Therapy 1.The course of the disease may be modified by anesthesia or surgery. 2.Influence the effects of anesthesia. 3.Both disease and drug treatment may influence choice of anesthetic technique. 4.Drug treatment may modify the normal compensatory physiological responses Choice of Anesthesia Factors to choice a anesthetic technique 1.Patient condition 2.Surgery category 3.The technical and theoretic level of anesthetist 4.Anesthetics 5.Anesthesia and monitor equipment Equipment and drug Preparation Anesthetic machine 1.Electrical supply 2.All essential equipment is present and correctly assembled 3.Medical gas supply 4.Vaporizers 5.Breathing system: Ventilators Equipment and drug Preparation Ancillary Equipment 1.laryngoscopes, intubation aids 2.Face masks, airways, tracheal tubes and connectors 3.Suction apparatus Equipment and drug Preparation Monitoring equipment and drug 1.NIBP,