经典课件《全身麻醉》

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,麻醉医学知识概要,解放军23医院手术室,阿迪拉,全身麻醉 General Anesthesia,概念：,麻醉药经呼,吸道吸入,或,静脉,、,肌肉注射,进入人体内，产生,中枢神经系统的抑制,，临床表现为,神志消失,、,全身的痛觉消失,，,遗忘,，,反射抑制,和一定程度的,肌肉松弛,的麻醉方法。,吸入麻醉药,一般不作为首选麻醉。,静脉麻醉药,经静脉注射进入体内，通过血液循环作用于中枢神经系统而产生全身麻醉作用的药物。,硫喷妥钠,氯胺酮 乙托醚酯,异丙酚,羟丁酸钠,Muscle relaxants,肌肉松弛药 Muscle relaxants,去极化肌松药 depolarizing Muscle relaxants,琥珀胆碱司可林，Succinylcholine,scoline,Dose：1-1.5mg/kg IV,Onset of action:within 60 seconds,Duration of action:3-5 minutes,Metabolism:by plasma cholinesterase,Uses,To facilitate endotracheal intubation in full-stomach patients,To maintain paralysis for short procedures,肌肉松弛药 Muscle relaxants,去极化肌松药 depolarizing Muscle relaxants,琥珀胆碱司可林，Succinylcholine,scoline,Adverse effects,Muscle pains,Bradycardia,Hyperkalaemia,Increase in intracranial pressure and intraocular pressure,Prolonged action,Malignant hyperthermia,肌肉松弛药 Muscle relaxants,非去极化肌松药 non-depolarizing Muscle relaxants,常用药物,阿曲库铵 Atracurium,维库溴胺 Vecuronium,潘库溴胺 Pancuronium,哌库溴胺 pipecuronum,Uses,To facilitate endotracheal intubation,To maintain paralysis during anesthesia and in the ICU,拮抗药：新斯的明 neostigmine,肌肉松弛药 Muscle relaxants,本卷须知,一定要行气管插管和控制呼吸。,无镇静和镇痛作用，不能单独使用。,琥珀胆碱可引起血钾升高，眼压和颅内压升高，因此严重创伤、烧伤、截瘫、青光眼、颅内压升高者禁用；,体温降低可延长肌松药的作用，吸入麻醉药、某些抗生素如链霉素、庆大霉素和多粘菌素及硫酸镁等，可增强非去极化肌松药的作用。,合并有神经肌接头疾患者，如重症肌无力，禁用非去极化肌松 药。,有的肌松药有组胺释放作用，哮喘和过敏者慎用,麻醉性镇痛药,吗啡 morphine,杜冷丁 pethidine,芬太尼 fentanyl,麻醉辅助用药,安定地西泮，diazepam,咪唑安定(咪达唑仑，midazolam),异丙嗪非那根，promethazine,氟哌利多氟哌啶,droperidol,全身麻醉的实施,诱导 Induction,维持 Maintainance,苏醒 Awareness,监测monitoring,心血管系统监测,临床观察,心电图,无创血压,有创血压,中心静脉压,肺动脉楔压,CO,呼吸系统监测,临床观察,脉搏血氧饱和度,呼气末二氧化碳监测,血气分析,潮气量、分钟通气量、气道压力、呼吸频率,麻醉机Anesthesia machine,气源 gas source,蒸发器 vaporizer,呼吸环路 breathing circle system,麻醉呼吸器 ventilator,全身麻醉并发症,呼吸系统,返流与误吸,呼吸道梗阻,上呼吸道,下呼吸道,呼吸抑制,肺部并发症,循环系统,低血压与高血压,心律失常与心跳骤停,神经系统,术中知晓,苏醒延迟,其他：体温 胃肠道,病例讨论,病例1：3个月婴儿,病例2：,呼吸道管理Airway management,双腔气管导管,Mallampati评估法,Most common cause:tongue and/or epiglottis,舌 后 坠,单手抬颏法,舌 后 坠,双手托下颌法,“地包天,面罩通气,操作技术,面罩的放置,单 手 法,面罩通气,操作技术,面罩的放置,双手托下颌法,面罩通气,操作技术,面罩的放置,双手托下颌法,口咽通气道oropharyngeal airway,舌 后 坠,口咽通气道,不准确的放置,Too short,鼻咽通气道,Nasopharyngeal airway,舌 后 坠,鼻咽通气道,Esophageal-Tracheal Combitube,A=esophageal obturator;ventilation into trachea through side openings=B,C=tracheal tube;ventilation through open end if proximal end inserted in trachea,D=pharyngeal cuff;inflated through catheter=E,F=esophageal cuff;inflated through catheter=G,H=teeth marker;blindly insert Combitube until marker is at level of teeth,Distal End,Proximal End,B,C,D,E,F,G,H,A,Esophageal-Tracheal Combitube Inserted in Esophagus,A=esophageal obturator;ventilation into trachea through side openings=B,D=pharyngeal cuff(inflated),F=inflated esophageal/tracheal cuff,H=teeth markers;insert until marker lines at level of teeth,D,A,D,B,F,H,喉罩laryngeal mask airway LMA,The LMA is an adjunctive airway that consists of a tube with a cuffed mask-like projection at distal end.,是处理困难气道的推荐,方法之一,不需暴露，盲探置入,用于困难气道作用更佳,平安时限 2小时,即使位置不佳，多数情况也,可保持良好的通气效果,困难气道的常用方法,置入喉罩通气,经鼻或口置管,保存自主呼吸易成功,需要特殊的技术和设备,损伤较小,反复操作易致损伤,纤支镜引导插管,困难气道的常用方法,气管插管术器械,气管插管所需器械,气道的结构,喉,作用：发声及保护下气道,急诊加用silic手法,ThyroidCartilage,Cricoid,困难气道的常用方法,紧急环甲膜或气管切开,经气管喷射通气,困难气道的常用方法,困难气道的常用方法,逆行引导插管,