耳鼻喉科手术麻醉.ppt

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,*,*,*,Anesthesia For Ear,，,Nose and Throat Surgery,耳鼻喉科手术麻醉,by XuLi,Profile and Demands,difficult airway,cardiac arrhythmia,：,applicattion of Epinephrine,reflex of carotid sinus,etc.,N,2,O and middle ear pressure,Preoperative Evaluation and Preparation,Interview,(,麻醉前访视,),Premedication,(,麻醉前用药,),：,sedatives(,镇静药,),anticholinegics(,抗胆碱药,),Choice of anesthesia,local anestehsia,：,to those cooperative ones undergoing short-term and simple,operations,general anesthesia,：,to those ones cant be undertaken operations under local anesthesia,Several common ENT operations,*,operation of ear,*,operation of nasal cavity,(,鼻腔,),and nasal sinus,(,鼻窦,),*,tonsillectomy,(,扁桃体摘除术,),*,total throat resection,(,全喉截除术,),*,Endoscopy,(,内镜检查,),and endoscopic surgery,(,内镜手术,),PS,：婴幼儿气管、支气管异物取出术,病情：急,(urgent),、重,(severe),、危,(dangerous),麻醉：全麻，配合充分表麻,要求麻醉既不加重缺氧又能迅速诱导至足够深度,管理：术前,:,准备应迅速、利索，呼吸困难,(dyspnea),的应急处理,*,术中,:,积极防治喉、气管、支气管痉挛、缺氧、气道内出血、气管破裂,(split),或气胸,(pneumothorax),、喉头水肿,(laryngeal edema),等,*,术毕,:,充分供氧，待患者清醒良好、呼吸通畅，吸空气,SPO2,基本正常后方可出手术室,Questions,Try to describe the factors causing arrhythmia during ENT surgery.,“,全喉截除术”中，发生颈外静脉破裂，除了紧急止血外还应警惕什么情况的发生？如何处理？,中耳手术时，吸入全麻的使用应注意什么？,THANK YOU,！,Difficult airway,*,1Difficult intubation,*,2compromised airway,N,2,O and middle ear pressure,The middle ear and paranasal sinus(,鼻旁窦,)are normal body air cavities that consist of open,nonventilated spaces.The blood/gas coefficient(,系数,)is 0.013 for nitrogen versus 0.46 for N,2,O.When inhaled in high concentrations,N,2,O enters the air cavities faster than nitrogen can leave.In a fixed cavity such as the middle ear,the result is an increase in pressure.After discontinuation of N,2,O,the gas is rapidly reabsorbed,marked,negative middle ear pressure may develop.,Difficult intubation,anatomic abnormalities,：,micrognathia(,小颌,),limited jaw motion,or congenital syndromes(craniofacial dysostoses)etc.,Other causes,：,o,besity,acromegaly(,肢端肥大症,),cervical spine problems,rheumatoid arthritis(,风湿性关节炎,),and even gastric reflux(,返流,),Compromised airway,Pathologic conditions above the glottis may prevent a clear view of the glottic opening,whereas subglottic lesions permit a good view of the vocal cords,but they require careful placement of a small endotracheal tube or bronchoscope.,Operations of ears,operations of ear concha,(,耳廓,),and concha tract,(,外耳道,),：,local anesthesia(to cooperative patients),operations inside ears,：,general anesthesia,Microsurgery,(,显微外科手术,),：,controlled hypotension(,控制性低血压,)is sometimes needed,N,2,O and middle ear pressure,Operation of nasal cavity and nasal sinus,local anesthesia,general anesthesia,Tonsillectomy,attention,：,topical anesthesia and cough reflex,general anesthesia and the management of airway,emergent surgery for bleeding after tonsillectomy and the anesthetic management,bleeding after onsillectomy,problems:hypo-volemia,full stomach,and airway obstruction.,induction of anesthesia:,good suctioning of blood,、,a rapid-sequence induction of anesthesia with application of cricoid pressure and slight head-down positioning of the patient will protect the trachea and glottis from aspiration of blood.after induction,a nasogastric(,鼻胃的,)tube may be placed and removed.,extubation:as with elective tonsillectomy,extubation is safest with the patient awake.,Total throat resection,profile of the operation,：,wide range,，,deep reach,，,airway obstruction of some extent,anesthetic mangement,：,general anesthesia with endotracheal intubation through tracheotomy,attention,：,*,reflex of carotid sinus(,颈动脉窦反射,),*split(,破裂,)of main line(,大静脉,),气栓,(gas embolism),*evaluation of respiration function and corresponding treatment,Endoscopy and endoscopic surgery,Profile,：,interaction of anesthetic and surgical management with the compromised airway,inconsistency,(,矛盾,),between the operation and anesthetic recovery,Anesthesia selection for endoscopy and endoscopic surgery,*,local anesthesia,：,try to perform local anesthesia to the cooperative adult patients especially to those with some extent of airway obstruction during short-term operations,*,general anesthesia,：,mainly fits children patients,General anesthesia for endoscopy and endoscopic surgery,with,endotracheal intubation,：,thin tube,without,endotracheal intubation,1intensive inhalation anesthesia induction companied by topical anesthesia,2 with a thin plastic tube above the carina(,隆突,)to supply oxygen or to ventilate by connecting a high frequency jet ventilator(,高频喷射通气机,),，,perform a short-term operation under the usage of scoline(,琥珀胆碱,),3supply oxygen via the lateral tube of the bronchoscope(,气管镜的侧管,),