经典课件《全身麻醉VIP

麻醉医学知识概要,解放军23医院手术室阿迪拉,全身麻醉GeneralAnesthesia,概念：麻醉药经呼吸道吸入或静脉、肌肉注射进入人体内，产生中枢神经系统的抑制，临床表现为神志消失、全身的痛觉消失，遗忘，反射抑制和一定程度的肌肉松弛的麻醉方法。,吸入麻醉药一般不作为首选麻醉。,静脉麻醉药,经静脉注射进入体内，通过血液循环作用于中枢神经系统而产生全身麻醉作用的药物。硫喷妥钠氯胺酮乙托醚酯异丙酚羟丁酸钠,Musclerelaxants,肌肉松弛药Musclerelaxants,去极化肌松药depolarizingMusclerelaxants琥珀胆碱（司可林，Succinylcholine,scoline）Dose：1-1.5mg/kgIVOnsetofaction:within60secondsDurationofaction:3-5minutesMetabolism:byplasmacholinesteraseUsesTofacilitateendotrachealintubationinfull-stomachpatientsTomaintainparalysisforshortprocedures,肌肉松弛药Musclerelaxants,去极化肌松药depolarizingMusclerelaxants琥珀胆碱（司可林，Succinylcholine,scoline）AdverseeffectsMusclepainsBradycardiaHyperkalaemiaIncreaseinintracranialpressureandintraocularpressureProlongedactionMalignanthyperthermia,肌肉松弛药Musclerelaxants,非去极化肌松药non-depolarizingMusclerelaxants常用药物阿曲库铵Atracurium维库溴胺Vecuronium潘库溴胺Pancuronium哌库溴胺pipecuronumUsesTofacilitateendotrachealintubationTomaintainparalysisduringanesthesiaandintheICU拮抗药：新斯的明neostigmine,肌肉松弛药Musclerelaxants,注意事项一定要行气管插管和控制呼吸。无镇静和镇痛作用，不能单独使用。琥珀胆碱可引起血钾升高，眼压和颅内压升高，因此严重创伤、烧伤、截瘫、青光眼、颅内压升高者禁用；体温降低可延长肌松药的作用，吸入麻醉药、某些抗生素（如链霉素、庆大霉素和多粘菌素）及硫酸镁等，可增强非去极化肌松药的作用。合并有神经肌接头疾患者，如重症肌无力，禁用非去极化肌松药。有的肌松药有组胺释放作用，哮喘和过敏者慎用,麻醉性镇痛药,吗啡morphine杜冷丁pethidine芬太尼fentanyl,麻醉辅助用药,安定（地西泮，diazepam）咪唑安定(咪达唑仑，midazolam)异丙嗪（非那根，promethazine）氟哌利多（氟哌啶,droperidol）,全身麻醉的实施,诱导Induction维持Maintainance苏醒Awareness,监测monitoring,心血管系统监测临床观察心电图无创血压有创血压中心静脉压肺动脉楔压,CO,呼吸系统监测临床观察脉搏血氧饱和度呼气末二氧化碳监测血气分析潮气量、分钟通气量、气道压力、呼吸频率,麻醉机Anesthesiamachine,气源gassource蒸发器vaporizer呼吸环路breathingcirclesystem麻醉呼吸器ventilator,全身麻醉并发症,呼吸系统返流与误吸呼吸道梗阻上呼吸道下呼吸道呼吸抑制肺部并发症,循环系统低血压与高血压心律失常与心跳骤停神经系统术中知晓苏醒延迟其他：体温胃肠道,病例讨论,病例1：3个月婴儿病例2：,呼吸道管理Airwaymanagement,双腔气管导管,Mallampati评估法,Mostcommoncause:tongueand/orepiglottis,舌后坠,单手抬颏法,舌后坠,双手托下颌法,“地包天”,面罩通气,操作技术,面罩的放置,单手法,面罩通气,操作技术,面罩的放置,双手托下颌法,面罩通气,操作技术,面罩的放置,双手托下颌法,口咽通气道oropharyngealairway,舌后坠,口咽通气道,不准确的放置,Tooshort,鼻咽通气道,Nasopharyngealairway,舌后坠,鼻咽通气道,Esophageal-TrachealCombitube,A=esophagealobturator;ventilationintotracheathroughsideopenings=BC=trachealtube;ventilationthroughopenendifproximalendinsertedintracheaD=pharyngealcuff;inflatedthroughcatheter=EF=esophagealcuff;inflatedthroughcatheter=GH=teethmarker;blindlyinsertCombitubeuntilmarkerisatlevelofteeth,DistalEnd,ProximalEnd,B,C,D,E,F,G,H,A,Esophageal-TrachealCombitubeInsertedinEsophagus,A=esophagealobturator;ventilationintotracheathroughsideopenings=BD=pharyngealcuff(inflated)F=inflatedesophageal/trachealcuffH=teethmarkers;insertuntilmarkerlinesatlevelofteeth,D,A,D,B,F,H,喉罩laryngealmaskairwayLMA,TheLMAisanadjunctiveairwaythatconsistsofatubewithacuffedmask-likeprojectionatdistalend.,是处理困难气道的推荐方法之一不需暴露，盲探置入用于困难气道作用更佳安全时限2小时即使位置不佳，多数情况也可保持良好的通气效果,困难气道的常用方法,置入喉罩通气,经鼻或口置管保留自主呼吸易成功需要特殊的技术和设备损伤较小反复操作易致损伤,纤支镜引导插