口腔颌面外科手术的麻醉

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Delayed extubation: ① Pharyngeal damage due to tracheal
intubation ② The involved operation range is large ③ Restrictive dressings（敷料） applied after
由于口、鼻腔相通，致使吸吮、进食障碍，患 儿常有不同程度的营养不良和贫血。此类患儿还常 并发先天性心脏病，心功能也较差。
2) 双侧颞颌关节强直 Bilateral temporomandibular joints rigidity
可因长期不能开口或开口困难，造成进食障碍， 使全身营养状态低下。
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3) 口腔肿瘤 Oral tumor 如肿瘤侵袭到咽、软腭、口底和翼腭韧带，不
surgery ④ Narrowed pharyngeal cavity due to trauma
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(2) Prevent postoperative nausea and vomiting
(3) Prevent the complications related to anesthesia
第二十二章 口腔颌面外科手术的麻醉
Oral and maxillofacial surgery anesthesia
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口腔颌面外科包括除眼科、耳鼻喉科以外的颌面 部及口腔内需要用手术治疗的全部疾病，其中主要为 先天性畸形整形术、肿瘤切除术及外伤修复术
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教学大纲
掌握：口腔颌面外科手术的麻醉后评估及处理 熟悉：麻醉后病人的处理 了解：口腔颌面外科手术的特点
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第二节 麻醉选择及常用麻醉方法
The anesthetic choices and common anesthetic methods
凡手术创伤大、手术出血多、手术时间长 、儿童及不合作的成年人、术者在术中难以保持 呼吸道通畅、以及有可能发生反流误吸的病人， 均选用全身麻醉
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第三节 麻醉管理与麻醉后处理
此外，为防止导管在弯曲时管腔折屈或压偏 Байду номын сангаас最好采用管壁带细金属丝或尼龙丝做管壁支 架的导管
Choose an appropriate intubation route
nasal intubution
Oral intubution
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Hypotension technique
Use this technique in important procedure. The hypotensive duration should be short SBP>90mmHg, MBP>60mmHg
头颈部呈固定状态，使头部极度前屈，喉头 明显移位，气管也随粘连瘢痕移向左侧或右侧， 使病人不能仰头，也无法行气管造口
6) 口周瘢痕挛缩病人 scar formation and contractions around the mouth ，使口裂极度变小，病人根本 无法张口，喉镜与气管导管难以进入口腔
(2) Maintain statisfied ventilation
Inadequate ventilation may result in hypoxaemia, hypercapnia
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The criteria of satisfied ventilation: SpO2 98-100% PET CO2 30-45mmHg Blood-gas analysis TV 8-10ml/kg (Neonate 6-7ml/kg) Rf 12/min (Neonate Rf )
To fulfil respiration self-regulation, the postoperative resuscitation should be quick
Prevent postoperative nausea and vomitingrelated to pharyngeal stimulation, postoperative pain, anesthetic drugs etc
gases High-volume, low-pressure cuffs may be
preferred for long-term intubation
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Nasal-pharyngeal mucosal haemorrhage（鼻咽 粘膜出血）
Nasal-pharyngeal mucosal fall off Pharyngeal edema
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（4）Postoperative maxilla sinus（颌窦） inflammation
Choose appropriate size tracheal tube Use tracheal tube lubricant（滑润剂） Apply humidification（湿化） of inspired
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第一节 口腔 颌面外科病人与手 术特点及麻醉处理
Characteristics of the patients and the operation. Anesthesia management.
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一、常见口腔腭面外科病人的解剖及生 理改变
1) 先天性唇裂、腭裂 Congenital lip and palate cleft
仅张口困难，也阻塞咽部，使气管插管难以施行， 且常伴有低氧血症
4) 口腔及颌面部外伤 Trauma 如波及软腭、咽旁、舌根及舌底，不仅组织肿
胀使咽部变窄，也极易形成血肿阻塞咽部
上或下颌骨骨折的变形移位，可引起脱位性窒 息
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5) 颌－胸、颌－ 颈粘连 Mandible-thorax, mandibleneck adherence
7) 小下颌病人 Congenital maxillofacial deformity
舌体位于较小的下颌腔内，并且此类病人的 声门位置较高，使气管插管困难
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二、口腔颌面外科手术的特点
Characteristics of the surgery
1 麻醉医师与麻醉机远离手术部位 2 一部分病人有张口困难 3 一部分病人有呼吸道梗阻 4 一部分病人气管插管困难 5 手术后要保持气道通畅。 6 避免伤口不被呕吐物污染
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三、针对手术特点进行的麻醉处理
How to deal with the mentioned problems
For patients with airway obstruction, don’t use respiration suppressive drugs as premedications
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(二)Management after anesthesia
(1) Airway management Extubation conditions: ①Completely awake. ②normal ventilation,③ SPO2>96% (air inhalation) ④Normal muscle tonicity, smooth respiration Prevent laryngeal edema after extubation
To ensure the airway, we should administer tracheal intubation or tracheostomy（气管造 口术）
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To fix the tracheal tube and connecting tube in position, protect the anaesthetic tubing from dislodgement
Management during and after anesthesia
(一) During anesthesia
(1) Ensure the airway
Causes of airway obstructions : Tongue falling down, laryngo spasm, bronchiospasm ,secretions,blood and debris drain into larynx, tracheal tube kinking