耳鼻喉科手术麻醉课件

耳鼻喉科手术麻醉耳鼻喉科手术麻醉耳鼻喉科手术麻醉耳鼻喉科手术麻醉

ProDemands

difficultairway

cardiacarrhythmia：applicattionofEpinephrine,reflexofcarotidsinus,etc.

N2Oandmiddleearpressure耳鼻喉科手术麻醉耳鼻喉科手术麻醉耳鼻喉科手术麻醉PreoperativeEvaluation

andPreparationInterview(麻醉前访视)

Premedication(麻醉前用药)：

▲sedatives(镇静药)

▲anticholinegics(抗胆碱药)

耳鼻喉科手术麻醉Choiceofanesthesialocalanestehsia：tothosecooperativeonesundergoingshort-termandsimpleoperationsgeneralanesthesia：tothoseonescan’tbeundertakenoperationsunderlocalanesthesia耳鼻喉科手术麻醉SeveralcommonENToperations*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)耳鼻喉科手术麻醉PS：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耳鼻喉科手术麻醉

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？耳鼻喉科手术麻醉THANKYOU！耳鼻喉科手术麻醉Difficultairway

*1>Difficultintubation*2>compromisedairway耳鼻喉科手术麻醉N2OandmiddleearpressureThemiddleearandparanasalsinus(鼻旁窦)arenormalbodyaircavitiesthatconsistofopen,nonventilatedspaces.Theblood/gascoefficient(系数)is0.013fornitrogenversus0.46forN2O.Wheninhaledinhighconcentrations,N2Oenterstheaircavitiesfasterthannitrogencanleave.Inafixedcavitysuchasthemiddleear,theresultisanincreaseinpressure.AfterdiscontinuationofN2O,thegasisrapidlyreabsorbed,marked,negativemiddleearpressuremaydevelop.

耳鼻喉科手术麻醉Difficultintubation①anatomicabnormalities：

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)

耳鼻喉科手术麻醉CompromisedairwayPathologicconditionsabovetheglottismaypreventaclearviewoftheglotticopening,whereassubglotticlesionspermitagoodviewofthevocalcords,buttheyrequirecarefulplacementofasmallendotrachealtubeorbronchoscope.

耳鼻喉科手术麻醉Operationsofearsoperationsofearconcha(耳廓)andconchatract(外耳道)

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

耳鼻喉科手术麻醉Operationofnasalcavityandnasalsinuslocalanesthesiageneralanesthesia耳鼻喉科手术麻醉耳鼻喉科手术麻醉Tonsillectomyattention：topicalanesthesiaandcoughreflexgeneralanesthesiaandthemanagementofairwayemergentsurgeryforbleedingaftertonsillectomyandtheanestheticmanagement耳鼻喉科手术麻醉bleedingafteronsillectomy

problems:hypo-volemia,fullstomach,andairwayobstruction.

inductionofanesthesia:

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

耳鼻喉科手术麻醉Totalthroatresectionprotheoperation：widerange，deepreach，airwayobstructionofsomeextentanestheticmangement：generalanesthesiawithendotrachealintubationthroughtracheotomyattention：

*

reflexofcarotidsinus(颈动脉窦反射)*split(破裂)ofmainline(大静脉)→气栓(gasembolism)*evaluationofrespirationfunctionandcorrespondingtreatment耳鼻喉科手术麻醉EndoscopyandendoscopicsurgeryProfile：

interactionofanestheticandsurgicalmanagementwiththecompromisedairwayinconsistency(矛盾)betweentheoperationandanestheticrecovery耳鼻喉科手术麻醉Anesthesiaselectionforendoscopyandendoscopicsurgery*localanesthesia：trytoperformlocalanesthesiatothecooperativeadultpatientsespeciallytothosewithsomeextentofairwayobstructionduringshort-termoperations*generalanesthesia：mainlyfitschildrenpatients耳鼻喉科手术麻醉Generalanesthesiaforendoscopyandendoscopicsurgerywithendotrachealintubation：thintubewithoutendotrachealintubation

1>intensiveinhalationanesthesiainductioncompaniedbytopicalanesthesia

2>withathinplastictubeabovethecarina(隆突)to