上海交大外科學(xué)07-麻醉與復(fù)蘇2

1、,,,,ANESTHESIOLOGYPeng Zhanglong Department of Anesthesiology Rui Jin HospitalShanghai Second Medical University,1,1,Contents,The history of anesthesiology The scope of anesthesiologyClassification of AnesthesiaDe

2、finition of AnesthesiaPreparing for anesthesiaPremedication,2,2,The History of Anesthesiology,Anesthetic practices date from ancient timesModern anesthesiology began in 1842 --- Ether was used as an anesthetic agent i

3、n humans. Modern anesthesiology only became firmly established less than six decades ago,3,Modern inhalation anesthetics were developed from 1950s to 1960s Intravenous anesthesia first began in 1872--- Use of choral hy

4、drate. From then, many other intravenous agents were developed.Muscle relaxants resulted in evolution of anesthesiology---Curare(箭毒)was firstly used in 1942,4,The History of Anesthesiology,The History of Anesthesiology,

5、The original of modern local anesthesia was credited to use of cocaine in 1884.Subarachnoid anesthesia --- 1898. Caudal epidural anesthesia--- 1901. lumbar epidural anesthesia --- 1921,5,Clinical anesthesiaPain managem

6、entFirst-aid and resuscitationIntensive care,6,The Scope of Anesthesiology,Definition of Anesthesia,Anesthesia is always defined by drug-induced changes in behavior or perception(感覺). The components of general anesth

7、etic state include unconsciousness, amnesia(健忘), analgesia(鎮(zhèn)痛), immobility, and attenuation of autonomic nervous system responses to noxious stimulation.,7,Course of Anesthesia,Anesthesia inductionAnesthesia maintenance

8、Anesthesia recovery,8,Classification of Anesthesia,General anesthesiaInhalation anesthesiaIntravenous anesthesiaCombined anesthesiaIntravenous Venous-inhalationIntrathecal block- general anesthesia,Local anesthes

9、iaTopical anesthesiaInfiltration anesthesiaNerve blockNerve plexus blockIntrathecal block: Subarachnoid block, epidural block and caudal block,9,Some special measures during anesthesia,Deliberate hypotension(控制性低血壓

10、)Deliberate hypothermia(控制性低溫)Acute isovolumic hemodilution(急性等容量血液稀釋)Acute hypervolumic hemodilution(急性高容量血液稀釋)Cardiac pulmonary bypass(心肺轉(zhuǎn)流),10,Monitoring During Anesthesia,The Cardiovascular SystemThe Respiratory

11、 SystemLiver and kidney functionCentral nerve systemCoagulation function,11,Pain Management,Postoperative analgesiaDelivery analgesiaAcute and chronic pain cureCancer analgesia,12,Preoperative visitPreoperative ev

12、aluation: History, physical examination, laboratory evaluationPreoperative fastingCoexisting disease therapyEquipment preparationPreoperative medication,13,Preparing For Anesthesia,Purposes of the preoperative visit,

13、Establish rapport with the patient Obtain a history and perform a physical examinationsOrder a special investigationsAssess the risks of anesthesia and surgery Institute preoperative management,14,HistoryReview of

14、organ systemclinical examinationLaboratory Evaluation,15,Routine Preoperative Anesthetic Evaluation,ASA Physical Status Classification,16,Preoperative Fasting,The time of fasting solid is more than 6 hours, and fluid i

15、s more than 2 hours.The time of fasting breast milk is 4 hours in baby. If necessary, baby should be transfused.,17,Coexisting Disease Therapy,Coexisting disease may affect outcome adversely if not under optimum control

16、.The coexisting disease must be treated properly before any non–urgent surgery .Coexisting disease and drug treatment may interact with anesthesia and surgery in several ways,18,Coexisting Disease Therapy,The course of

17、 the disease may be modified by anesthesia or surgery.Influence the effects of anesthesia.Both disease and drug treatment may influence choice of anesthetic technique.Drug treatment may modify the normal compensatory

18、physiological responses,19,Choice of Anesthesia,Factors to choice a anesthetic techniquePatient condition Surgery categoryThe technical and theoretic level of anesthetistAnestheticsAnesthesia and monitor equipment,2

19、0,Anesthetic machineElectrical supplyAll essential equipment is present and correctly assembledMedical gas supplyVaporizersBreathing system: Ventilators,21,Equipment and drug Preparation,Ancillary Equipmentlaryngos

20、copes, intubation aidsFace masks, airways, tracheal tubes and connectorsSuction apparatus,22,Equipment and drug Preparation,Equipment and drug Preparation,Monitoring equipment and drugNIBP, SpO2, ECG, etc.Ephedrine,

21、Atropine, etcAnesthetics,23,Preoperative Medication,Sedation and hypnosisAnalgesiaDrying of airway secretionsAttenuate vagal reflexes and sympathoadrenal responses,Goals for pharmacologic premedication,24,Preoperativ

22、e Medication,SedativeBenzodiazepines(苯二氮): Diazepam, Lorazepam, MidazolamPhenothiazines(吩噻嗪)：PromethazineHypnoticsBarbiturates(巴比妥): Phenobarbital,Drugs used for pharmacologic premedication,25,Preoperative Medication

23、,Butyrophenones(丁酰苯)：Droperidol, Haloperidol AnalgesiaOpioid: Morphine, Meperidine, FentanylAnticholinergic agentsAtropine, ScopolamineOther special drugsβ-receptor blocker, Calcium channel blocker,26,Preoperative