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,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,*,*,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,*,*,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,*,*,郧阳医学院麻醉学系,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,*,*,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,*,*,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,*,*,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,*,*,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,*,*,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,*,*,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,*,*,第二十二章 口腔颌面外科手术的麻醉,Oral and maxillofacial surgery anesthesia,郧阳医学院麻醉学系,第二十二章 口腔颌面外科手术的麻醉Oral and ma,1,口腔颌面外科包括除眼科、耳鼻喉科以外的颌面部及口腔内需要用手术治疗的全部疾病，其中主要为先天性畸形整形术、肿瘤切除术及外伤修复术,口腔颌面外科包括除眼科、耳鼻喉科以外的颌,2,教学大纲,掌握：口腔颌面外科手术的麻醉后评估及处理,熟悉：麻醉后病人的处理,了解：口腔颌面外科手术的特点,教学大纲掌握：口腔颌面外科手术的麻醉后评估及处理,3,第一节口腔 颌面外科病人与手术特点及麻醉处理,Characteristics of the patients and the operation. Anesthesia management.,第一节口腔 颌面外科病人与手术特点及麻醉处理Charact,4,一、常见口腔腭面外科病人的解剖及生理改变,1),先天性唇裂、腭裂,Congenital lip and palate cleft,由于口、鼻腔相通,，致使吸吮、进食障碍，患儿常有不同程度的,营养不良和贫血。此类患儿还常并发先天性心脏病，心功能也较差。,2),双侧颞颌关节强直,Bilateral temporomandibular joints rigidity,可因长期,不能开口或开口困难，造成进食障碍，使全身营养状态低下,。,一、常见口腔腭面外科病人的解剖及生理改变1) 先天性唇裂、腭,5,3),口腔肿瘤,Oral tumor,如肿瘤侵袭到咽、软腭、口底和翼腭韧带，不仅,张口困难，也阻塞咽部，使气管插管难以施行，且常伴有低氧血症,4),口腔及颌面部外伤,Trauma,如波及软腭、咽旁、舌根及舌底，不仅组织肿胀使,咽部变窄,，,也极易形成血肿阻塞咽部,上或下颌骨骨折,的变形移位，可引起,脱位性窒息,3) 口腔肿瘤 Oral tumor,6,5),颌胸、颌 颈粘连,Mandible-thorax, mandible-neck adherence,头颈部呈固定状态，使头部极度前屈，喉头明显移位，气管也随粘连瘢痕移向左侧或右侧，使,病人不能仰头，也无法行气管造口,6),口周瘢痕挛缩病人,scar formation and contractions around the mouth,，使口裂极度变小，病人根本,无法张口,，喉镜与气管导管难以进入口腔,7),小下颌病人,Congenital maxillofacial deformity,舌体位于较小的,下颌腔内，并且此类病人的声门位置较高，使气管插管困难,5) 颌胸、颌 颈粘连 Mandible-thorax,7,二、口腔颌面外科手术的特点,Characteristics of the surgery,1麻醉医师与麻醉机远离手术部位,2一部分病人有张口困难,3一部分病人有呼吸道梗阻,4一部分病人气管插管困难,5手术后要保持气道通畅。,6避免伤口不被呕吐物污染,二、口腔颌面外科手术的特点Characteristics,8,三、针对手术特点进行的麻醉处理,How to deal with the mentioned problems,For patients with airway obstruction, dont use respiration suppressive drugs as premedications,To ensure the airway, we should administer tracheal intubation or tracheostomy（气管造口术）,三、针对手术特点进行的麻醉处理How to deal wi,9,To fix the tracheal tube and connecting tube in position, protect the anaesthetic tubing from dislodgement,此外，为防止导管在弯曲时管腔折屈或压偏，最好采用管壁带细金属丝或尼龙丝做管壁支架的导管,Choose an appropriate intubation route,nasal intubution,Oral intubution,To fix the tracheal tube and,10,Hypotension technique,Use this technique in important procedure. The hypotensive duration should be short SBP90mmHg, MBP60mmHg,To fulfil respiration self-regulation, the postoperative resuscitation should be quick,Prevent postoperative nausea and vomiting-related to pharyngeal stimulation, postoperative pain, anesthetic drugs etc,Hypotension technique,11,第二节麻醉选择及常用麻醉方法,The anesthetic choices and common anesthetic methods,凡手术创伤大、手术出血多、手术时间长、儿童及不合作的成年人、术者在术中难以保持呼吸道通畅、以及有可能发生反流误吸的病人，均选用全身麻醉,第二节麻醉选择及常用麻醉方法The anesthetic,12,第三节麻醉管理与麻醉后处理,Management during and after anesthesia,(一) During anesthesia,(1) Ensure the airway,Causes of airway obstructions : Tongue falling down, laryngo spasm, bronchiospasm ,secretions,blood and debris drain into larynx, tracheal tube kinking,(2) Maintain statisfied ventilation,Inadequate ventilation may result in hypoxaemia, hypercapnia,第三节麻醉管理与麻醉后处理Management durin,13,The criteria of satisfied ventilation:,SpO,2,98-100% P,ET,CO,2,30-45mmHg,Blood-gas analysis,TV 8-10ml/kg (Neonate 6-7ml/kg),Rf 12/min (Neonate Rf ),The criteria of satisfied vent,14,(二)Management after anesthesia,(1) Airway management,Extubation conditions:,Completely awake. normal ventilation,SPO,2,96% (air inhalation) Normal muscle tonicity, smooth respiration,Prevent laryngeal edema after extubation,(二)Management after anesthesia,15,Delayed extubation:, Pharyngeal damage due to tracheal,intubation, The involved operation range is large, Restrictive dressings（敷料） applied after,surgery, Narrowed pharyngeal cavity due to trauma,Delayed extubation:,16,(2) Prevent postoperative nausea and,vomiting,(3) Prevent the complications related to,anesthesia,Nasal-pharyngeal mucosal haemorrhage（鼻咽粘膜出血）,Nasal-pharyngeal mucosal fall off,Pharyngeal edema,(2) Prevent postoperative naus,17,（4）Postoperative maxilla sinus（颌窦） inflammation,Choose appropriate size tracheal tube,Use tracheal tube lubricant（滑润剂）,Apply humidification（湿化） of inspired,gases,High-volume, low-pressure cuffs may be,preferred for long-term intubation,（4）Postoperative maxilla sinus,18,
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