眼科手术麻醉英语教学课件

眼科手术麻醉英语教学课件2021/4/2722021/4/273ProDemandsfineproceduredemands

intraocularpressure(IOP)airwayoculocardiacreflex(OCR)2021/4/274PreoperativeEvaluation

andPreparationpsychologicalpreparationtreatmentoftheoriginaldiseasestreatmentoftheco-existingdiseases2021/4/275Premedicationanticholinegics(抗胆碱药):givenintramuscularly,havenosignificanteffectsonIOP.However,appliedtopicallytotheeyemaycausemydriasis(瞳孔散大)andmayincreaseIOP.sedatives(镇静药)analgesics(镇痛药)antiemetics(止吐药)2021/4/276AnestheticTechniques.localanesthesia.generalanesthesia2021/4/277complicationsofretrobulbarblock(将局麻药注入睫状长、短神经及眼球筋膜囊内)ImportantPointsinLocalAnesthesiaapplicationofAdrenalinapplicationofsedativesOCRToxicittyoflocalanesthetics2021/4/278ImportantPointsinGeneralAnesthesiacarefulmonitoringsmoothanesthesiaapplicationofmusclerelaxantspreventionofOCRN2OonIOPanestheticsandIOP2021/4/279QuestionsWhat’sthemaincauseofexorbitant

IOPduringophthalmicoperations?What’sOCRandhowtotreatit?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？2021/4/2710THANKyou2021/4/2711Demandspatient’scooperationandimmobility

—>perfectsedationandanalgesiashouldbeavailablle.fixationoftheeyeball—>relaxationoftheorbicularisoculimuscle(眼轮匝肌)andextraocularmuscles(眼外肌)isnecessary.2021/4/2712IOP(眼内压)1、IOP：thepressureontheeyeballwallexertedbytheintraocularcontents.

3、ThemaindeterminantofIOPisthedynamicbalancebetweentheproductionofaqueoushumoranditseventualelimination.2、aqueoushumor

circulation4、themaincauseofexorbitantIOPistheobstructionoftheaqueoushumor(房水)circulation.

2021/4/27132021/4/27142021/4/2715SeveralimpactfactsonIOP

Mydriaticdrugs(扩瞳药)

Maneuvers

(动作行为)

Hypercarbia(高碳酸血症)andhypoxia(低氧血症)

Pressureontheeyeball

Anesthetics:MostanestheticsreduceIOP.OnlysuccinylcholineandketaminemayincreaseIOP.2021/4/2716OculocardiacReflex(OCR)

眼心反射TheOCRisatrigeminovagalreflex(三叉-迷走神经反射)thatmaybeinducedbypressureontheeyeball,traction(牵拉)ontheextraocularmuscle(眼外肌),orbital(眼眶内的)hematoma(血肿),oculartrauma(损伤),andeyepain,manifestedbycardiacarrhythmias(心律失常)suchasbradycardia(心动过缓),nodalrhythm(结性节律),ectopicbeats(异位搏动),ventricularfibrillation(心室纤维颤动),orasystole(心脏停搏).2021/4/2717LocalAnesthesiatopicalanesthesia(表面麻醉)infiltrationanesthesia(浸润麻醉)nerveblock(神经阻滞)2021/4/2718GeneralAnesthesiawithendotrachealintubationwithoutendotrachealintubation2021/4/27192021/4/2720AnestheticsandIOP

MostgeneralanestheticsareCNSdepressants,theylowerIOP.

Butsuccinylcholinecausesatransient(4~6min)butsignificantincreaseinIOPof10to20mmHg.TheeffectofketamineonIOPvaries.EarlystudiesreportedanincreaseinIOPafterintramuscularorintravenousadministrationofketamine.Ketaminegivenafterpremedicationwithdiazepamandmeperidine(哌替啶)doesnotaffectIOP,andintramuscularlyadministeredketaminemayevenlowerIOPinchildren.2021/4/2721N2OonIOPOphthalmologistssometimesinjectasmallbubbleofgas(e.g.,SF6)intothevitreal(玻璃体的)cavityduringreattachment(修补)oftheretina(视网膜)soastoholdtheretinainplaceunderalong-actingbubbleofstablesize.N2OismorediffusiblethanSF6andmoresolubleinwater,andrapidlyentersthegasbubble.AdministratingN2Oaftertheinjecti