經(jīng)典課件《全身麻醉》

麻醉醫(yī)學(xué)知識(shí)概要全身麻醉

GeneralAnesthesia概念：麻醉藥經(jīng)呼吸道吸入或靜脈、肌肉注射進(jìn)入人體內(nèi)，產(chǎn)生中樞神經(jīng)系統(tǒng)的抑制，臨床表現(xiàn)為神志消失、全身的痛覺消失，遺忘，反射抑制和一定程度的肌肉松弛的麻醉方法。吸入麻醉藥

一般不作為首選麻醉。

靜脈麻醉藥

Musclerelaxants肌肉松弛藥

Musclerelaxants去極化肌松藥depolarizingMusclerelaxants琥珀膽堿〔司可林，Succinylcholine,scoline〕Dose：1-1.5mg/kgIVOnsetofaction:within60secondsDurationofaction:3-5minutesMetabolism:byplasmacholinesteraseUsesTofacilitateendotrachealintubationinfull-stomachpatientsTomaintainparalysisforshortprocedures肌肉松弛藥

Musclerelaxants去極化肌松藥depolarizingMusclerelaxants琥珀膽堿〔司可林，Succinylcholine,scoline〕AdverseeffectsMusclepainsBradycardiaHyperkalaemiaIncreaseinintracranialpressureandintraocularpressureProlongedactionMalignanthyperthermia肌肉松弛藥

Musclerelaxants肌肉松弛藥

Musclerelaxants麻醉性鎮(zhèn)痛藥嗎啡morphine杜冷丁pethidine芬太尼fentanyl麻醉輔助用藥安定〔地西泮，diazepam〕咪唑安定(咪達(dá)唑侖，midazolam)異丙嗪〔非那根，promethazine〕氟哌利多〔氟哌啶,droperidol〕全身麻醉的實(shí)施誘導(dǎo)Induction維持Maintainance蘇醒Awareness監(jiān)測(cè)monitoring心血管系統(tǒng)監(jiān)測(cè)臨床觀察心電圖無創(chuàng)血壓有創(chuàng)血壓中心靜脈壓肺動(dòng)脈楔壓,CO呼吸系統(tǒng)監(jiān)測(cè)臨床觀察脈搏血氧飽和度呼氣末二氧化碳監(jiān)測(cè)血?dú)夥治龀睔饬?、分鐘通氣量、氣道壓力、呼吸頻率麻醉機(jī)

Anesthesiamachine氣源gassource蒸發(fā)器vaporizer呼吸環(huán)路breathingcirclesystem麻醉呼吸器ventilator全身麻醉并發(fā)癥呼吸系統(tǒng)返流與誤吸呼吸道梗阻上呼吸道下呼吸道呼吸抑制肺部并發(fā)癥病例討論病例1：3個(gè)月嬰兒病例2：呼吸道管理

Airwaymanagement雙腔氣管導(dǎo)管Mallampati評(píng)估法Mostcommoncause:

tongueand/orepiglottis舌后墜單手抬頦法舌后墜雙手托下頜法“地包天〞面罩通氣面罩的放置單手法面罩通氣面罩的放置雙手托下頜法①面罩通氣面罩的放置雙手托下頜法②口咽通氣道

oropharyngealairway舌后墜口咽通氣道不準(zhǔn)確的放置Tooshort鼻咽通氣道Nasopharyngealairway舌后墜鼻咽通氣道Esophageal-TrachealCombitubeA=esophagealobturator;ventilationintotracheathroughsideopenings=BC=trachealtube;ventilationthroughopenendifproximalendinsertedintracheaD=pharyngealcuff;inflatedthroughcatheter=EF=esophagealcuff;inflatedthroughcatheter=GH=teethmarker;blindlyinsertCombitubeuntilmarkerisatlevelofteethDistalEndProximalEndBCDEFGHAEsophageal-TrachealCombitube

InsertedinEsophagusA=esophagealobturator;ventilationintotracheathroughsideopenings=BD= pharyngealcuff(inflated)F= inflatedesophageal/trachealcuffH= teethmarkers;insertuntilmarkerlinesatlevelofteethDADBFH喉罩

laryngealmaskairwayLMATheLMAisanadjunctiveairwaythatconsistsofatubewithacuffedmask-likeprojectionatdistalend.◆是處理困難氣道的推薦方法之一◆不需暴露，盲探置入◆用于困難氣道作用更佳◆平安時(shí)限2小時(shí)即使位置不佳，多數(shù)情況也可保持良好的通氣效果困難氣道的常用方法置入喉罩通氣纖支鏡引導(dǎo)插管困難