麻醉ANESTHESIOLOGY.ppt

1、,ANESTHESIOLOGYPeng Zhanglong Department of Anesthesiology Rui Jin HospitalShanghai Second Medical University,1,1,Contents,The history of anesthesiology The scope of anesthesiology Classification of Anesthesia Definition of Anesthesia Preparing for anesthesia Premedication,2,2,The History of Anesthe

2、siology,Anesthetic practices date from ancient times Modern anesthesiology began in 1842 - Ether was used as an anesthetic agent in humans. Modern anesthesiology only became firmly established less than six decades ago,3,Modern inhalation anesthetics were developed from 1950s to 1960s Intravenous an

3、esthesia first began in 1872- Use of choral hydrate. 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,The original of modern local anesthe

4、sia was credited to use of cocaine in 1884. Subarachnoid anesthesia - 1898. Caudal epidural anesthesia- 1901. lumbar epidural anesthesia - 1921,5,Clinical anesthesia Pain management First-aid and resuscitation Intensive care,6,The Scope of Anesthesiology,Definition of Anesthesia,Anesthesia is always

5、 defined by drug-induced changes in behavior or perception(感觉). The components of general anesthetic state include unconsciousness, amnesia(健忘), analgesia(镇痛), immobility, and attenuation of autonomic nervous system responses to noxious stimulation.,7,Course of Anesthesia,Anesthesia induction Anesth

6、esia maintenance Anesthesia recovery,8,Classification of Anesthesia,General anesthesia Inhalation anesthesia Intravenous anesthesia Combined anesthesia Intravenous Venous-inhalation Intrathecal block- general anesthesia,Local anesthesia Topical anesthesia Infiltration anesthesia Nerve block Nerve pl

7、exus block Intrathecal block: Subarachnoid block, epidural block and caudal block,9,Some special measures during anesthesia,Deliberate hypotension(控制性低血压) Deliberate hypothermia(控制性低温) Acute isovolumic hemodilution(急性等容量血液稀释) Acute hypervolumic hemodilution(急性高容量血液稀释) Cardiac pulmonary bypass(心肺转流),

8、10,Monitoring During Anesthesia,The Cardiovascular System The Respiratory System Liver and kidney function Central nerve system Coagulation function,11,Pain Management,Postoperative analgesia Delivery analgesia Acute and chronic pain cure Cancer analgesia,12,Preoperative visit Preoperative evaluatio

9、n: History, physical examination, laboratory evaluation Preoperative fasting Coexisting disease therapy Equipment preparation Preoperative medication,13,Preparing For Anesthesia,Purposes of the preoperative visit,Establish rapport with the patient Obtain a history and perform a physical examinations

10、 Order a special investigations Assess the risks of anesthesia and surgery Institute preoperative management,14,History Review of organ system clinical examination Laboratory Evaluation,15,Routine Preoperative Anesthetic Evaluation,ASA Physical Status Classification,16,Preoperative Fasting,The time

11、of fasting solid is more than 6 hours, and fluid is 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. The coexisting disease must

12、be treated properly before any nonurgent surgery . Coexisting disease and drug treatment may interact with anesthesia and surgery in several ways,18,Coexisting Disease Therapy,The course of the disease may be modified by anesthesia or surgery. Influence the effects of anesthesia. Both disease and dr

13、ug treatment may influence choice of anesthetic technique. Drug treatment may modify the normal compensatory physiological responses,19,Choice of Anesthesia,Factors to choice a anesthetic technique Patient condition Surgery category The technical and theoretic level of anesthetist Anesthetics Anesth

14、esia and monitor equipment,20,Anesthetic machine Electrical supply All essential equipment is present and correctly assembled Medical gas supply Vaporizers Breathing system: Ventilators,21,Equipment and drug Preparation,Ancillary Equipment laryngoscopes, intubation aids Face masks, airways, tracheal

15、 tubes and connectors Suction apparatus,22,Equipment and drug Preparation,Equipment and drug Preparation,Monitoring equipment and drug NIBP, SpO2, ECG, etc. Ephedrine, Atropine, etc Anesthetics,23,Preoperative Medication,Sedation and hypnosis Analgesia Drying of airway secretions Attenuate vagal ref

16、lexes and sympathoadrenal responses,Goals for pharmacologic premedication,24,Preoperative Medication,Sedative Benzodiazepines(苯二氮): Diazepam, Lorazepam, Midazolam Phenothiazines(吩噻嗪)：Promethazine Hypnotics Barbiturates(巴比妥): Phenobarbital,Drugs used for pharmacologic premedication,25,Preoperative Medication,Butyrophenones(丁酰苯)：Droperidol, Halo