眼科手术麻醉英语教学ppt课件

眼科手眼科手术麻醉英麻醉英语教学教学课件件眼科手术麻醉英语教学课件眼科手术麻醉英语教学课件眼科手术麻醉2021/4/2722021/4/2722021/4/2732021/4/273 Pro Demandsfine procedure demands intraocular pressure(IOP)airwayoculocardiac reflex(OCR)2021/4/274 Pro Demandsfine procedure dePreoperative Evaluation and Preparationpsychological preparationtreatment of the original diseasestreatment of the co-existing diseases2021/4/275Preoperative Evaluation and PPremedicationanticholinegics(抗胆碱药抗胆碱药):given intramuscularly,have no significant effects on IOP.However,applied topically to the eye may cause mydriasis(瞳孔散大瞳孔散大)and may increase IOP.sedatives(镇静药镇静药)analgesics(镇痛药镇痛药)antiemetics(止吐药止吐药)2021/4/276Premedicationanticholinegics(抗Anesthetic Techniques.local anesthesia.general anesthesia2021/4/277Anesthetic Techniques.local ancomplications of retrobulbar block(将局将局麻药注入睫状长、短神经及眼球筋膜囊麻药注入睫状长、短神经及眼球筋膜囊内内)Important Points in Local Anesthesiaapplication of Adrenalinapplication of sedativesOCRToxicitty of local anesthetics2021/4/278complications of retrobulbar bImportant Points in General Anesthesiacareful monitoringsmooth anesthesiaapplication of muscle relaxantsprevention of OCRN2O on IOPanesthetics and IOP2021/4/279Important Points in General AnQuestionsWhats the main cause of Whats the main cause of exorbitantexorbitant IOP during ophthalmic operations?IOP during ophthalmic operations?Whats OCR and how to treat it?Whats OCR and how to treat it?青光眼青光眼(glaucoma)(glaucoma)病人的术前用药、局麻用病人的术前用药、局麻用药及全麻肌松药应用注意事项？药及全麻肌松药应用注意事项？视网膜脱离修补术中视网膜脱离修补术中,手术需要往玻璃体内注手术需要往玻璃体内注气，应用吸入全麻药应注意些什么？为什么气，应用吸入全麻药应注意些什么？为什么？2021/4/2710QuestionsWhats the main causeTHANK THANK youyou2021/4/2711THANK you2021/4/2711Demandspatients cooperation and immobility perfect sedation and analgesia should be availablle.fixation of the eyeball relaxation of the orbicularis oculi muscle(眼轮匝肌眼轮匝肌)and extraocular muscles(眼外肌眼外肌)is necessary.2021/4/2712Demandspatients cooperation aIOP(眼内压眼内压)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 circulation4、the main cause of exorbitant IOP is the obstruction of the aqueous humor(房水房水)circulation.2021/4/2713IOP(眼内压)1、IOP：the pressure on2021/4/27142021/4/27142021/4/27152021/4/2715Several impact facts on IOP Mydriatic drugs(扩瞳药扩瞳药)Maneuvers(动作行为动作行为)Hypercarbia(高碳酸血症高碳酸血症)and hypoxia(低低氧血症氧血症)Pressure on the eyeball Anesthetics:Most anesthetics reduce IOP.Only succinylcholine and ketamine may increase IOP.2021/4/2716Several impact facts on IOP MyOculocardiac Reflex(OCR)眼心反射眼心反射The OCR is a trigeminovagal reflex(三叉三叉-迷走神迷走神经反射经反射)that may be induced by pressure on the eyeball,traction(牵拉牵拉)on the extraocular muscle(眼外肌眼外肌),orbital(眼眶内的眼眶内的)hematoma(血肿血肿),ocular trauma(损伤损伤),and eye pain,manifested by cardiac arrhythmias(心律失常心律失常)such as bradycardia(心动过缓心动过缓),nodal rhythm(结性节律结性节律),ectopic beats(异位搏动异位搏动),ventricular fibrillation(心室纤维颤动心室纤维颤动),or asystole(心脏停搏心脏停搏).2021/4/2717Oculocardiac Reflex(OCR)眼心反射TLocal Anesthesiatopical anesthesia(表面麻醉表面麻醉)infiltration anesthesia(浸润麻醉浸润麻醉)nerve block(神经阻滞神经阻滞)2021/4/2718Local Anesthesiatopical anesthGeneral Anesthesiawith endotracheal intubationwithout endotracheal intubation2021/4/2719General Anesthesiawith endotra2021/4/27202021/4/2720Anesthetics 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(哌哌替替啶啶)does not affect IOP,and intramuscularly administered ketamine may even lower IOP in children.2021/4/2721Anesthetics and IOP Most generN2O on IOPOphthalmologists sometimes inject a small bubble of gas(e.g.,SF6)into the vitreal(玻玻璃璃体体的的)cavity during reattachment(修修补补)of the retina(视视网网膜膜)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 enters the gas bubble.Administrating N2O after the injection of SF6,the size of the injected gas bubble rapidly.And then both bubble size and IOP decrease along with the discontinuation of N2O.2021/4/2722N2O on IOPOphthalmologists som汇报结束谢谢大家!请各位批评指正汇报结束谢谢大家!请各位批评指正