经典课件《全身麻醉》

麻醉医学知识概要全身麻醉

GeneralAnesthesia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

Musclerelaxants肌肉松弛药

Musclerelaxants去极化肌松药depolarizingMusclerelaxants琥珀胆碱〔司可林，Succinylcholine,scoline〕Dose：1-1.5mg/kgIVOnsetofaction:within60secondsDurationofaction:3-5minutesMetabolism:byplasmacholinesteraseUsesTofacilitateendotrachealintubationinfull-stomachpatientsTomaintainparalysisforshortprocedures肌肉松弛药

Musclerelaxants去极化肌松药depolarizingMusclerelaxants琥珀胆碱〔司可林，Succinylcholine,scoline〕AdverseeffectsMusclepainsBradycardiaHyperkalaemiaIncreaseinintracranialpressureandintraocularpressureProlongedactionMalignanthyperthermia肌肉松弛药

Musclerelaxants肌肉松弛药

Musclerelaxants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

Anesthesiamachine气源gassource蒸发器vaporizer呼吸环路breathingcirclesystem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病例讨论病例1：3个月婴儿病例2：呼吸道管理

Airwaymanagement双腔气管导管Mallampati评估法Mostcommoncause:

tongueand/orepiglottis舌后坠单手抬颏法舌后坠双手托下颌法“地包天〞面罩通气面罩的放置单手法面罩通气面罩的放置双手托下颌法①面罩通气面罩的放置双手托下颌法②口咽通气道

oropharyngealairway舌后坠口咽通气道不准确的放置Tooshort鼻咽通气道Nasopharyngealairway舌后坠鼻咽通气道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纤支镜引导插管困难