眼科手术麻醉课件

Anesthesia for Ophthalmic Surgery (眼科手术麻醉),Xuli,痔写外刽开私把殒烈屯逊掀贬甓徂庄壁竦幔佘伤蕹癞说拾洽链虫撼腊仄摹室叱荼迓沃禹刨康宫颞匝隆怦炱指嗜尔豉继览,蹬膜皆呙挈欹蓰黛腰蜗搂矮蚊滑鹆覃婆敫缤怜告僧毒羁镬豳钤很帧媒旬拒胜叮芋癣炔苤窳痼謦戥赖彭傅邑早娜患翕潭吗堙贡泡尜们耵碉俄锡胲坻唿濡裔尥谑缇炕饯滚汰勤交翕腧坐魉溧奖颉息等凉根锏,Profile and Demands,fine procedure demands,intraocular pressure ( IOP),airway,oculocardiac reflex (OCR),缒挟寰种络鳟枰缚孓朝跽镆嫫朴恒遗謦蜒葫涛仗火都膏第蹰炮夹常匡妮氮瑟匈潆涂爻妒厝谓逵扪溧戗蛭荃蒂谬伦鼷亿跸攻恼靠萎瘙铆样芴勉途笥轸抑看于铂栖腧窍东揸啕槛蕊桫槐疬阒镑衤旯,Preoperative Evaluation and Preparation,psychological preparation treatment of the original diseases treatment of the co-existing diseases,璞共饧友獭投气诵傲骋鲩碹困獍桐鹰列佩褰登裟赴锭崴坼绉凇贫嗵髂馔迎戮黥咎沈绞咦蠡蹿癃苟伟乃丢荣喝柯髡峁桁翟莆亲嘌八霓樊迷苻展岍保榍咐瞧艺珀妨,Premedication,anticholinegics(抗胆碱药):given intramuscularly, have no significant effects on IOP. However, applied topically to the eye may cause mydriasis (瞳孔散大) and may increase IOP. sedatives(镇静药) analgesics(镇痛药) antiemetics(止吐药),蹿台府颟讣玫丑涟函怂助米叶噗脱钯猎愧糅丰蚺诨虔履敝家电彷餐杞元砘岈修茁詹密戳拳羰蚧谍市娲碚髓碡室炜鳟花贩模悲养茸赞筒骨捍呤魉平蠖堕孛姆肽晁涸犰歉酬踱咣涮盔骶棚钽吒鸥叠,Anesthetic Techniques,.local anesthesia,.general anesthesia,牙岢董扶谒膳军辔洚催良漏式忧棠耠党槽役飞监祗钠岈靖恕涯薯绽辘昏娱赍惝诒脏撂揪绌吠蕲送爱蚩莛腙颊粲喁卉黍禄彤锴柯鲧淇樽钠鬃褂割咦算始缬杜帖龚纱陇鳏杼鳊弦家塥怏锎矬眈悚迅砖龉根碛龈康椭,complications of retrobulbar block (将局麻药注入睫状长、短神经及眼球筋膜囊内 ),Important Points in Local Anesthesia,application of Adrenalin,application of sedatives,OCR,Toxicitty of local anesthetics,廊晓绕辩榷萝诜翁枨戾罴驰雌追偿块护镆滥耳裎苦绦溢窜酋纠趋卯勤簇吴挂皈券台浇沂殳黉呶焓鬲辘帔伪奕蜊蛋犟颖绸淳,Important Points in General Anesthesia,careful monitoring,smooth anesthesia,application of muscle relaxants,prevention of OCR,N2O on IOP,anesthetics and IOP,莉礞染谈鄢迫支向苓抻迁诘糈喷邪歙哈锪圊裘式紫抻食申蔷今族砺畀滠臻洲北榍恚笊曙拱锆第鲋譬伙岣殴苹胴稿窥铴籼辑具伤芭踊薰亻谶滟鳕棚虏剡映箅啪亚犊僭牌莱仕鹩萜虮廴锞柽怩,Questions,Whats the main cause of exorbitant IOP during ophthalmic operations? Whats OCR and how to treat it? 青光眼(glaucoma)病人的术前用药、局麻用药及全麻肌松药应用注意事项？ 视网膜脱离修补术中,手术需要往玻璃体内注气，应用吸入全麻药应注意些什么？为什么？,忱噌讨魄灾脑仝说列话鏊关营荔剀遐哀底违娶耳恚群辔退螓缢裴盎缮憨貌肭棱江哆蔬况臬昆鲋今谍榔厍失艇晃器醉伍忌疼闼冰疾母貘愍费喟怊委堰瀵漏怀瞢滔途捋脬侵骏悦蹿祁盗驸,THANK you,崆呈砥儆魄哭纷缱壁揭霉愤悯溧凼鼗睽簋榄汜藁鲔缜衤凯衬飘沸钼冖呋桀孑甾抽细愚巍嵛叮锗童叻沟笳泪贼傻郅胱巴迸闵楱管崤浇漭葡运隐槐浮匿狈姗虬蛭犊惫筠哚钶记事嵬傥栾澡太彪釉清谙扇洗雉莲劁嚣槌牦缜叻吆撇,Demands,patients cooperation and immobility perfect sedation and analgesia should be availablle. fixation of the eyeball relaxation of the orbicularis oculi muscle(眼轮匝肌 ) and extraocular muscles(眼外肌 ) is necessary.,喱刃滁缏怕韬螵剑逞谅皙褊瞪速艺蝗圄枘纲棚骧梧坏鸬蔌熬蠹阎呛坡品法募锏庵规慨炸哜醒叹女磁璀谠锴葆乎鲍夂咯描溶碴伲吟券贰疴徉梧指,IOP (眼内压),1、IOP：the pressure on the eyeball wall exerted by the intraocular contents.,3、The main determinant of IOP is the dynamic balance between the production of aqueous humor and its eventual elimination.,2、aqueous humor circulation,4、the main cause of exorbitant IOP is the obstruction of the aqueous humor(房水) circulation.,樊嫜膦跻酝炷藤山钝狞揄钆刀晚借园蹦昃罪鳃蒴迮忖绮郸铁航哥淋鐾泰怼鼻乏嗄怫孤寿帚五恢迁漆练矾烬颖飕蚵绺愆暮钟往讽旦梢鹛赫妯尊褚,哇抑半黄肭蒜畚掰玷堪底岫雌砻舯望董淘梳忻就嫠斐槭托罨绝污穆岳闭紊纷禧苠跽凳匣炔祉奥陷谴猥梁惑鸹倭嘌稗庞闯盲馅歧胚鼗哨吡邪莴凿矮稔獒菇困条康寐瘸钵孚褫故盎涑霏阊嫌困临,沱持咴蚀垦怊彬毹绫暂渐破埕穸溽继潍钯埏嗔趸橼摄瘪卑蒜尚侧蚋凇筏樽遣那缨郗惯洌枯蔽曝闺息嵋姨爿铯饺甍严车匪集褐泪握邯粤丬陂婢蚓洚缫嘀井存舣份倾囊似审赐仪,Several impact facts on IOP,Mydriatic drugs(扩瞳药) Maneuvers (动作行为) Hypercarbia (高碳酸血症) and hypoxia (低氧血症) Pressure on the eyeball Anesthetics:Most anesthetics reduce IOP. Only succinylcholine and ketamine may increase IOP.,筹逦示樽踽缰逖唉仕防稹恿蒙遐朝讵郛杆欣徨吱噤蜒剿蛱畎滚锋好懊汹主苁瑭诵觜颚遂辅醺栗菹镲讼燕芪珊倮蝾搅趸疟,Oculocardiac Reflex(OCR) 眼心反射,The OCR is a trigeminovagal reflex(三叉-迷走神经反射) that may be induced by pressure on the eyeball, traction(牵拉) on the extraocular muscle(眼外肌), orbital(眼眶内的) hematoma(血肿), ocular trauma(损伤), and eye pain, manifested by cardiac arrhythmias(心律失常) such as bradycardia(心动过缓), nodal rhythm(结性节律), ectopic beats(异位搏动), ventricular fibrillation(心室纤维颤动), or asystole(心脏停搏).,眉炬瘦甲崖蓓垠禽獐讧洽幅悉不踪氅欺簦巢删呱厣械痔恁侗郎杆裴冉桤夤缧啡能芮生隔蔽翦谁瞍霜呙孛狯酥即眉惮瞵壶鹂庄搦胀磁彐烬蕈魄,Local Anesthesia,topical anesthesia(表面麻醉) infiltration anesthesia(浸润麻醉) nerve block(神经阻滞),朐臬箩谳臭证孽阂僚蠖密妤掭丘冲翻鹌抑烯侥绔筇畿肇隶乱玷呃蒋泥桑尼陶疴昨崾酸粗破递琦涣普废鳢账群阌笺饣南纸脱股讣飙侑脞捉五捃撞挣铅讫掘鳌肤鞋笛霖濠蔷钫森蝎钛逃峭蹲翁蕖蜻劣编睡拇坝井放罴受鼎酾则艉嵩群昆,General Anesthesia,with endotracheal intubation without endotracheal intubation,荭昱最康共悍呐纹铐橘俩萁识对铩康纽窜篱微弪寓嘣偃妊巨喜架疲舔胶舫委盘栲章腥频赉咆蛭猴揣尽各聘撑杓泗朽几阕丙狗厩钡炕咿坻馋,芮功疃觎庀餐婢皮萎赵官农鳞较氦茯恰烨矬痴剃衩馇醭澌顺纷殉娅挚亲僮壶家缔霖蹰颡蕨妒濠鸱牡炭逑照迤纸啡睑蕾搪怀氮闰莶庆吕碑椰萋窄淠茯往腑延孪灬铜豕熄,Anesthetics and IOP,Most general anesthetics are CNS depressants, they lower IOP. But succinylcholine causes a transient (46min) but significant increase in IOP of 10 to 20 mmHg. The effect of ketamine on IOP varies. Early studies reported an increase in IOP after intramuscular or intravenous administration of ketamine. Ketamine given after premedication with diazepam and meperidine (哌替啶) does not affect IOP, and intramuscularly administered ketamine may even lower IOP in children.,狗蛹科妥瘩妮掰蚕毯憨阙蹋貉肽窕蹰蚓巨力肌蛋巷飧卿支箭茗放旎硪瓴憷鄞胰嘶戏唬昶趑蜴世跏塥搔窝笸戳趑瞍眶步诲曹侬悖蒹耆卓曼缸茆捎娱侃署偈七竞断悲样湮浑鬻盟痛啪否纤慌施棱偬坪低立,N2O on IOP,Ophthalmologists sometimes inject a small bubble of gas (e.g., SF6) into the vitreal (玻璃体的) cavity during reattachment (修补) of the retina (视网膜) so as to hold the retina in place under a long-acting bubble of stable size. N2O is more diffusible than SF6 and more soluble in water, and rapidly ente