近代麻醉学发展的三个重要阶段【共享精品-ppt】

全身情况
Hb＞80g/L Hb exorbitance Hematocrit: 30%-35% acute inflammation BMR(basal metabolic rate):
Reed formula： BMR%=0.75×（PR+0.74×PP）－72 normal value：-10%~+10%
are being removed for donor purposes ➢ The addition of an 'E' indicates emergency
surgery.
Physical exam.
General status：发育、营养、精神状态等 血压、脉搏、体温 头部：眼、鼻、口腔、下颌，中枢神经系统情况 颈部：活动度、长短、甲状腺大小等，颈静脉 胸部：望、触、叩、听，心电、血气、1秒率 腹部：望、触、叩、听，肝、肾、脾、胃肠功能 四肢：活动情况、感觉情况，动脉、静脉情况 背部：椎管内麻醉或其他麻醉方法要求的
法国、日本等——麻醉复苏科（department of anesthesiology and resuscitation）；
美国等——麻醉与危重病医学科（department of anesthesiology and critical care medicine）。
Archaic anesthesia
inhalational anesthesia 80-85: intravenous anesthesia, inhalational
anesthesia, ECG, arterial blood pressure, CVP 80-90：inhalational anesthesia with timing injection
How about our department of anesthesiology?
～1956：surgeon
1957：anesthesia group 60-70：epidural, spinal, nerve block 70-80：CPB, intravenous anesthesia, and
Anesthesia machine (1930)
Intravenous anesthetics
1934: thiopental 1959: diazepam 1960: hydroxybutyrates, r-OH 1970: ketamine 1972: etomidate 1976: midazolam 1983: propofol
Local anesthetics
1884：Cocaine as ophthalmic anesthesia, nerve block 1885：Epidural anesthesia 1898: Spinal anesthesia 1901：Caudal anesthesia 1905：Procaine 1930：Dibucaine 1932：Dicaine 1943：Lidocaine 1963: bupivacaine 1996: ropivacaine More new: levobupivacaine
To receive the patient history data To relieve patient’s worrying status Review of current drug therapy Physical examination, interpretation of
laboratory data Find out risk factor Propose anesthesia method
Stone Age: spicula analgesia Acupuncture Traditional medicine Pressure Cryotherapy And others
History of anesthesiology
1846 public demonstration of ether anesthesia by William T. G. Morton
<50%: 低肺功能 <30%: 手术禁忌
床旁测试病人肺功能的方法
摒弃试验 吹气试验 吹火柴试验
气道评估 (airway evaluation)
Purpose: difficult intubation, difficult mask ventilation
Morton's ether inhaler (1846)
John Snow, the first anesthesiologist （1846）
Machine of Inhalational anesthesia in 1847
Face mask (1847)
History of inhalation
Procedure of clinical anesthesia
Pre-ope prepare
introduction
PACU
Maintain Special monitoring
Preope. Physical assessment
Purpose of Preope. Physical assessment
The working field of Anesthesiologists
Clinic anesthesia
– Operating room, PACU, outpatient,
CPCR (cardiopulmonary cerebral resuscitation)
CCM (critical care medicine) Analgesia
a constant threat to life ➢ V. A moribund patient who is not expected to
survive without the operation ➢ VI. A declared brain-dead patient whose organs
– Pain clinic, postoperative analgesia, others
Others
– Research, education, training
How can you become a real anesthesiologist
purpose Basic knowledge Profile of whole body systems Using your potential Renew and update, uninterruptedly Communication
of volatile anesthetics 90-present：depth of anesthesia, balance
anesthesia
Popular anesthesia words
ASA physical status classification system TOF: train of four BIS: bispectral index CVP neurostimulator SG: Swan Ganz catheter MAC: minimum alveolar concentration TEE: transesophageal echocardiography
全身情况和各器官系统的检诊
全身情况
growth，nutrition ，body weight ，et al BMI (body mass index)
=body weight (kg)×body height (m)2 Male : about 22kg/m2; Female: 20kg/m2 ; 25-29kg/m2: over weight; ≥30kg/m2: obesity BW＞100% standard BW: pae. Physical assessment
To receive the patient history data Physical examination, interpretation of
laboratory data ASA classification Propose anesthesia method
近代麻醉学发展的三个重要阶段
麻醉：19世纪40年代算起，近100年的发展历程。 临床麻醉学（clinical anesthesiology）：初步形成临
床麻醉学的五大组成。 麻醉与危重病医学（anesthesiology and critical care
medicine）： 从20世纪50年代末至今，一次作用要的飞跃，特别 是近30余年的发展
Others
Opioids
– Morphine, fentanyl, sufentanil, alfentanil, remifentanil
Relaxants
– Curare(1942), succinylcholine, pancuronium, vecuronium, atracurium, rocuronium, mivacurium, at al.
Cardiac surgery Vascular surgery Thoracic surgery Neurosurgical anesthesia Organ transplantation Pediatric surgery Obstetric anesthesia And others
nerve system Losing sense, painless and
comfortable, temporarily
What can you do for your future?
expertise in resuscitation fluid replacement airway management oxygen transport operative stress reduction postoperative pain control ICU
ASA physical status
➢ I. A normal healthy patient ➢ II. A patient with mild systemic disease ➢ III. A patient with severe systemic disease ➢ IV. A patient with severe systemic disease that is
呼吸系统
呼吸系统感染：择期手术，急症手术，肺结
核，慢性肺脓肿，重症支气管扩张症
COPD (chronic obstructive pulmonary disease): 功能因素比解 剖因素更重要
Asthma: 控制感染、停止吸烟、降低 气管和支气管的反应性
肺功能的评估
肺活量：<60% 通气储量百分比：<70% FEV1.0/FVC%：<60% or 50% FVC<15ml/kg MVV: 40L or 50%~60% of prediction value
Anesthesia methods
general
inhalation intravenous mucosa muscle
local balance
spinal
epidural Nerve block
Local infiltration
topical
Subspecialty of anesthesiology
Introduction of Clinical Anesthesia
Department of Anesthesiology Cui Xiao Guang
Concept
Using Drugs or other methods Central Nerve System or peripheral