耳鼻喉科手术麻醉-课件

AnesthesiaForEar，NoseandThroatSurgery耳鼻喉科手术麻醉byXuLiAnesthesiaForEar，NoseandTh1耳鼻喉科手术麻醉-课件2

ProfileandDemands

difficultairway

cardiacarrhythmia：applicattionofEpinephrine,reflexofcarotidsinus,etc.

N2OandmiddleearpressureProfileandDemandsdifficult3耳鼻喉科手术麻醉-课件4耳鼻喉科手术麻醉-课件5PreoperativeEvaluation

andPreparationInterview(麻醉前访视)

Premedication(麻醉前用药)：

▲sedatives(镇静药)

▲anticholinegics(抗胆碱药)

PreoperativeEvaluation

andP6Choiceofanesthesialocalanestehsia：tothosecooperativeonesundergoingshort-termandsimpleoperationsgeneralanesthesia：tothoseonescan’tbeundertakenoperationsunderlocalanesthesiaChoiceofanesthesialocalanes7SeveralcommonENToperations*operationofear*operationofnasalcavity(鼻腔)andnasalsinus(鼻窦)*tonsillectomy(扁桃体摘除术)*totalthroatresection(全喉截除术)*Endoscopy(内镜检查)andendoscopicsurgery(内镜手术)SeveralcommonENToperations*8PS：婴幼儿气管、支气管异物取出术病情：急(urgent)

、重(severe)

、危(dangerous)

麻醉：全麻，配合充分表麻,要求麻醉既不加重缺氧又能迅速诱导至足够深度管理：*术前:准备应迅速、利索，呼吸困难(dyspnea)的应急处理*术中:积极防治喉、气管、支气管痉挛、缺氧、气道内出血、气管破裂(split)或气胸(pneumothorax)

、喉头水肿(laryngealedema)等*术毕:充分供氧，待患者清醒良好、呼吸通畅，吸空气SPO2基本正常后方可出手术室PS：婴幼儿气管、支气管异物取出术病情：急(urgent)9

QuestionsTrytodescribethefactorscausingarrhythmiaduringENTsurgery.

“全喉截除术”中，发生颈外静脉破裂，除了紧急止血外还应警惕什么情况的发生？如何处理？中耳手术时，吸入全麻的使用应注意什么？QuestionsTrytodescribethe10THANKYOU！THANKYOU！11Difficultairway

*1>Difficultintubation*2>compromisedairwayDifficultairway*1>Difficult12N2OandmiddleearpressureThemiddleearandparanasalsinus(鼻旁窦)arenormalbodyaircavitiesthatconsistofopen,nonventilatedspaces.Theblood/gascoefficient(系数)is0.013fornitrogenversus0.46forN2O.Wheninhaledinhighconcentrations,N2Oenterstheaircavitiesfasterthannitrogencanleave.Inafixedcavitysuchasthemiddleear,theresultisanincreaseinpressure.AfterdiscontinuationofN2O,thegasisrapidlyreabsorbed,marked,negativemiddleearpressuremaydevelop.

N2OandmiddleearpressureThe13Difficultintubation①anatomicabnormalities：micrognathia(小颌),limitedjawmotion,orcongenitalsyndromes(craniofacialdysostoses<颅面骨发育不全>)etc..

②Othercauses：obesity,acromegaly(肢端肥大症),cervicalspineproblems,rheumatoidarthritis(风湿性关节炎),andevengastricreflux(返流)

Difficultintubation①anatomic14CompromisedairwayPathologicconditionsabovetheglottismaypreventaclearviewoftheglotticopening,whereassubglotticlesionspermitagoodviewofthevocalcords,buttheyrequirecarefulplacementofasmallendotrachealtubeorbronchoscope.

CompromisedairwayPathologicc15Operationsofearsoperationsofearconcha(耳廓)andconchatract(外耳道)

：localanesthesia(tocooperativepatients)operationsinsideears：generalanesthesiaMicrosurgery(显微外科手术)：controlledhypotension(控制性低血压)issometimesneededN2Oandmiddleearpressure

Operationsofearsoperationso16OperationofnasalcavityandnasalsinuslocalanesthesiageneralanesthesiaOperationofnasalcavityand17耳鼻喉科手术麻醉-课件18Tonsillectomyattention：topicalanesthesiaandcoughreflexgeneralanesthesiaandthemanagementofairwayemergentsurgeryforbleedingaftertonsillectomyandtheanestheticmanagementTonsillectomyattention：19bleedingafteronsillectomy

problems:hypo-volemia,fullstomach,andairwayobstruction.

inductionofanesthesia:

goodsuctioningofblood、arapid-sequenceinductionofanesthesiawithapplicationofcricoidpressureandslighthead-downpositioningofthepatientwillprotectthetracheaandglottisfromaspirationofblood.afterinduction,anasogastric(鼻胃的)tubemaybeplacedandremoved.extubation:aswithelectivetonsillectomy,extubationissafestwiththepatientawake.

bleedingafteronsillectomypr20Totalthroatresectionprofileoftheoperation：widerange，deepreach，airwayobstructionofsomeextentanestheticmangement：generalanesthesiawithendotrachealintubationthroughtracheotomyattention：

*

reflexofcarotidsinus(颈动脉窦反射)*split(破裂)ofmainline(大静脉)→气栓(gasembolism)*evaluationofrespirationfunctionandcorrespondingtreatmentTotalthroatresectionprofile21EndoscopyandendoscopicsurgeryProfile：

interactionofanestheticandsurgicalmanagementwiththecompromisedairwayinconsistency(矛盾)betweentheoperationandanestheticrecoveryEndoscopyandendoscopicsurge22Anesthesiaselectionforendoscopyandendoscopicsurgery*localanesthesia：trytoperformlocalanesthesiatothecooperativeadultpatientsespeciallytothosewithsomeextentofairwayobstructionduringshort-termoperations*generalanesthesia：mainlyfitschildrenpatientsAnesthesiaselectionforendos23Generalanesthesiaforendoscopyandendoscopicsurgerywithendotrachealintubation：thintubewithoutendotrachealintubation

1>intensiveinhalationanesthesiainductioncompaniedbytopicalanesthesia

2>withathinplastictubeabovethecarina(隆突)tosupplyoxygenortoventilatebyconnectingahighfrequencyjetventilator(高频喷射通气机)，performashort-termoperationundertheusageofscoline(琥珀胆碱)

3>supplyoxygenviathelateraltubeofthebronchoscope(气管镜的侧管)Generalanesthesiaforendosco24AnesthesiaForEar，NoseandThroatSurgery耳鼻喉科手术麻醉byXuLiAnesthesiaForEar，NoseandTh25耳鼻喉科手术麻醉-课件26

ProfileandDemands

difficultairway

cardiacarrhythmia：applicattionofEpinephrine,reflexofcarotidsinus,etc.

N2OandmiddleearpressureProfileandDemandsdifficult27耳鼻喉科手术麻醉-课件28耳鼻喉科手术麻醉-课件29PreoperativeEvaluation

andPreparationInterview(麻醉前访视)

Premedication(麻醉前用药)：

▲sedatives(镇静药)

▲anticholinegics(抗胆碱药)

PreoperativeEvaluation

andP30Choiceofanesthesialocalanestehsia：tothosecooperativeonesundergoingshort-termandsimpleoperationsgeneralanesthesia：tothoseonescan’tbeundertakenoperationsunderlocalanesthesiaChoiceofanesthesialocalanes31SeveralcommonENToperations*operationofear*operationofnasalcavity(鼻腔)andnasalsinus(鼻窦)*tonsillectomy(扁桃体摘除术)*totalthroatresection(全喉截除术)*Endoscopy(内镜检查)andendoscopicsurgery(内镜手术)SeveralcommonENToperations*32PS：婴幼儿气管、支气管异物取出术病情：急(urgent)

、重(severe)

、危(dangerous)

麻醉：全麻，配合充分表麻,要求麻醉既不加重缺氧又能迅速诱导至足够深度管理：*术前:准备应迅速、利索，呼吸困难(dyspnea)的应急处理*术中:积极防治喉、气管、支气管痉挛、缺氧、气道内出血、气管破裂(split)或气胸(pneumothorax)

、喉头水肿(laryngealedema)等*术毕:充分供氧，待患者清醒良好、呼吸通畅，吸空气SPO2基本正常后方可出手术室PS：婴幼儿气管、支气管异物取出术病情：急(urgent)33

QuestionsTrytodescribethefactorscausingarrhythmiaduringENTsurgery.

“全喉截除术”中，发生颈外静脉破裂，除了紧急止血外还应警惕什么情况的发生？如何处理？中耳手术时，吸入全麻的使用应注意什么？QuestionsTrytodescribethe34THANKYOU！THANKYOU！35Difficultairway

*1>Difficultintubation*2>compromisedairwayDifficultairway*1>Difficult36N2OandmiddleearpressureThemiddleearandparanasalsinus(鼻旁窦)arenormalbodyaircavitiesthatconsistofopen,nonventilatedspaces.Theblood/gascoefficient(系数)is0.013fornitrogenversus0.46forN2O.Wheninhaledinhighconcentrations,N2Oenterstheaircavitiesfasterthannitrogencanleave.Inafixedcavitysuchasthemiddleear,theresultisanincreaseinpressure.AfterdiscontinuationofN2O,thegasisrapidlyreabsorbed,marked,negativemiddleearpressuremaydevelop.

N2OandmiddleearpressureThe37Difficultintubation①anatomicabnormalities：micrognathia(小颌),limitedjawmotion,orcongenitalsyndromes(craniofacialdysostoses<颅面骨发育不全>)etc..

②Othercauses：obesity,acromegaly(肢端肥大症),cervicalspineproblems,rheumatoidarthritis(风湿性关节炎),andevengastricreflux(返流)

Difficultintubation①anatomic38CompromisedairwayPathologicconditionsabovetheglottismaypreventaclearviewoftheglotticopening,whereassubglotticlesionspermitagoodviewofthevocalcords,buttheyrequirecarefulplacementofasmallendotrachealtubeorbronchoscope.

CompromisedairwayPathologicc39Operationsofearsoperationsofearconcha(耳廓)andconchatract(外耳道)

：localanesthesia(tocooperativepatients)operationsinsideears：generalanesthesiaMicrosurgery(显微外科手术)：controlledhypotension(控制性低血压)issometimesneededN2Oandmiddleearpressure

Operationsofearsoperationso40OperationofnasalcavityandnasalsinuslocalanesthesiageneralanesthesiaOperationofnasalcavityand41耳鼻喉科手术麻醉-课件42Tonsillectomyattention：topicalanesthesiaandcoughreflexgeneralanesthesiaandthemanagementofairwayemergentsurgeryforbleedingaftertonsillectomyandtheanestheticmanagementTonsillectomyattention：43bleedingafteronsillectomy

problems:hypo-volemia,fullstomach,andairwayobstruction.

inductionofanesthesia:

goodsuctioningofblood、arapid-sequenceinductionofanesthesiawithapplicationofcricoidpressureandslighthead-downpositioningofthepatientwillprotectthetracheaandglottisfromaspirationofblood.afterinduction,anasogastric(鼻胃的)tubemaybeplacedandremoved.extubation:aswithelectivetonsillectomy,extubationissafestwiththepatientawake.

bleedingafteronsillectomypr44Totalthroatresectionprofileoftheoperation：widerange，deepreach，airwayobstructionofsomeextentanestheticmangement：generalanesthesiawithendotrachealintubationthroughtracheotomyattention：

*

reflexofcarotidsinus(颈动脉窦反射)*split(破裂)ofmainline(大静脉)→气栓(gasembolism)*evaluationofrespirationfunctionandcorrespondingtreatmentTotalthroatresectio