全麻概念专题知识讲座.pptx

,单击此处编辑母版标题样式,单击此处编辑母版文本样式,第二级,第三级,第四级,第五级,#,全麻概念专题知识讲座,全麻概念专题知识讲座,第1页,General anesthesia,is an altered physiologic state characterized by reversible loss of consciousness,analgesia of the entire body,amnesia and some degree of,muscle relaxation.,Induction Maintenance Recovery,Definition of General Anesthesia,全麻概念专题知识讲座,第2页,1.,Induction of General Anesthesia,Definition,全麻诱导是指病人从清醒转为能够进行手术操作麻醉状态过程。,There are some complications or risks in this stage,e.g.reduction of blood pressure,arrhythmia,myocardial ischemia.,全麻概念专题知识讲座,第3页,Induction of General Anesthesia,-,Methods,Rapid-sequence Intravenous Induction,全麻概念专题知识讲座,第4页,Agent,induction dose(mg/Kg),Diazepam,0.2,Midazolam,0.1-0.2,Thiopental,3-5,Etomidate,0.3,ketamine,1-2,Propofol,1.5-2.5,Fentanyl,5-6,g/kg,Intravenous induction agents,全麻概念专题知识讲座,第5页,Muscle Relaxants,depolarizing,nondepolarizing,dose(mg/kg),Succinycholine,1-2,vecuronium,0.08-0.1,atracurium,0.3-0.6,pancuronium,0.08-0.1,Rocuronium,0.6-1,全麻概念专题知识讲座,第6页,Induction of General Anesthesia,Rapid-sequence Intravenous Induction,-,Disadvantage and Complications,Regurgitation and Vomitting,Cardiovascular depression,Respiratory depression,Histamine release,Pain on injection,Hiccup and muscle movements,全麻概念专题知识讲座,第7页,Induction of General Anesthesia,Inhalational Induction-Indications,young children,myasthenia gravies,upper airway,obstruction,e.g.Epiglottitis,lower airway obstruction with foreign body,bronchopleural fistula or empyema,no accessible veins,全麻概念专题知识讲座,第8页,Induction of General Anesthesia,Inhalational Induction-Methods,Initially,nitrous oxide 70%in oxygen is used and anesthesia is deepened by gradual introduction of increments of a volatile agent,e.g.Halothane 1-3%,Enflurane 1.5-2.5%,Isoflurane 1-2%.,全麻概念专题知识讲座,第9页,Induction of General Anesthesia,Inhalational Induction-characteristics,Spontaneous ventilation is to be maintained.,the face mask is applied firmly as consciousness,is lost and the airway is supported manually.,Insertion of an oropharyngeal airway,a laryngeal,mask airway or a tracheal tube may be considered,when anesthesia has been established.,全麻概念专题知识讲座,第10页,Induction of General Anesthesia,Inhalational Induction,Disadvantage and Complications,Slow induction of anesthesia,Airway obstruction,bronchospasm,Laryngeal spasm,hiccups,Environmental pollution,全麻概念专题知识讲座,第11页,Induction of General Anesthesia,Induction with spontaneous ventilation-,Indications,Airway obstruction,anticipant difficult intubation,全麻概念专题知识讲座,第12页,Induction of General Anesthesia,Induction With Spontaneous Ventilation,-,Characteristics,Maintaining spontaneous ventilation,throughout the procedure,Sufficient surface anesthesia,全麻概念专题知识讲座,第13页,Induction of General Anesthesia,Intravenous induction following conscious intubation-Indications,Patient with the risk of regurgitation,Patient with postural hypotension,following anesthesia(e.g.paraplegia),全麻概念专题知识讲座,第14页,Induction of General Anesthesia,Other induction methods,intramuscular injection of ketamine,take midazolam orally,administration of fentanyl via mucosa,全麻概念专题知识讲座,第15页,注意事项,保持呼吸道通畅-首要任务,保持一定麻醉深度，减轻插管应激反应,静脉用药按,Kg,体重计算、维持循环稳定,诱导前，准备好麻醉机和插管用具，监测生命体征,面罩加压给氧时，,TV,不宜过大，防止气体进入胃内胃胀气、返流,全麻概念专题知识讲座,第16页,Maintenance of general anesthesia,镇静,sedation,镇痛,analgesia,肌松,muscle relaxation,全麻概念专题知识讲座,第17页,Maintenance of general anesthesia,Inhalational agents,Intravenous anesthetics,Opioids,Muscle relaxants,全麻概念专题知识讲座,第18页,全麻维持与诱导紧密衔接,了解手术进程，麻醉深度与手术刺激相适应,做好呼吸管理，保持气道通畅，人工通气监,测,P,ET,CO,2,、S,P,O,2,及血气分析:,颅脑手术,P,a,CO,2,维持30-35,mmHg,冠心病病人,P,a,CO,2,不宜太低，以免冠脉痉挛,注意事项,全麻概念专题知识讲座,第19页,注意事项,使用肌松监测仪指导肌松剂使用,充分镇静、防止术中知晓,维持生命体征和内环境平稳，及时,处理术中失血性休克、过敏性休克、,心律失常等异常情况,全麻概念专题知识讲座,第20页,Recovery,Antagonizing residual neuromuscular blockade,Extubation,Airway supporting,Recovery position is benefit to avoid airway obstruction,全麻概念专题知识讲座,第21页,全麻概念专题知识讲座,第22页,Recovery,严格掌握拔管指征，过早、过晚拔管均会造成严重后果,自然清醒，必要时使用催醒药,MACawake:,肺泡气内吸入麻醉药浓度降至0.4,MAC（0.5,或0.58,MAC）,时，95%病人能按指令睁眼,全麻概念专题知识讲座,第23页,4.,Monitoring depth of anesthesia,Stages of anesthesia,全麻概念专题知识讲座,第24页,全麻概念专题知识讲座,第25页,