外科学总论 课件 8 麻醉学
合集下载
- 1、下载文档前请自行甄别文档内容的完整性，平台不提供额外的编辑、内容补充、找答案等附加服务。
- 2、"仅部分预览"的文档,不可在线预览部分如存在完整性等问题,可反馈申请退款(可完整预览的文档不适用该条件!)。
- 3、如文档侵犯您的权益，请联系客服反馈,我们会尽快为您处理(人工客服工作时间：9:00-18:30)。
36
Clinical Anaesthesiology
(General Anaesthesia)
内容（教学大纲）
全身麻醉的方法 常用吸入、静脉、肌松药 全身麻醉深度判断 气管插管的方法、临床应用、并发症 全身麻醉并发症的防治 麻醉监测和管理原则
Contents
Methods of General Anaesthesia Clinical Pharmacology General Anaesthesia Tracheal Intubation Complications of General Anaesthesia Monitoring During Anaesthesia
Blood/Gas Partition 0.47 2.4 1.9 1.4 0.42 0.65
Clinical Pharmacology
13
Definition of the practice of anaesthesiology
Monitoring and restoring homeostasis in perioperative and critically patients
Diagnosing and treating painful syndromes
medical students, and assuming administrative and leadership positions on the medical staffs of many hospitals and ambulatory care facilities
10
Classification of Anaesthesia Methods General anaesthesia
Inhalational Anaesthetic Agents
Agent
MAC%
Nitrous oxide 105
Halothane
0.74
Enflurane
1.68
Isoflurane
1.15
Desflurane
6.0
Sevoflurane 2.0
Vapor Pressure 243 175 240 681 160
24
Preoperative assessment
(Physical examination)
* Vital signs * Airway * Heart * Lungs * Extremities * Neurologic examination
25
ASA classification
I A normal healthy patient other than surgical pathology without systemic disease.
IV A patient with severe systemic disturbance which poses a constant threat to life and is incapacitating.
27
ASA classification
V A moribund patient not expected to survive 24 hours with or without surgery.
* Inhalation anaesthesia * Intravenous anaesthesia * Intramuscularly * Rectally * Orally * Balanced anaesthesia
11
Classification of Anaesthesia Methods
Questions
* What is the physical classification of the ASA?
* Describe some key features of the airway examination. Outline the Mallampati classification.
* General * Respiratory * Cardiovascular * Renal * Gastrointestinal * Hematologic
23
Preoperative assessment
(Review of organ systems)
* Neurologic * Endocrine * Psychiatric * Orthopedic * Dermatologic
II A patient with mild systemic disease – no functional limitations.
27
ASA classification
III A patient with moderate to severe systemic disturbance due to medical or surgical disease- some functional limitation but not incapacitating.
Regional Anaesthesia
Contraindications of Regional
Anaesthesia
Sepsis Bacteremia Skin infection at injection site Hypovolemia Coagulopathy Therapeutic anticoagulation Demyelinating central nerve system disease Increased intracranial pressure Psychosis or dementia Lack of consent
16
Preoperative assessment
Routine preoperative anaesthetic evaluation
* History - Current problem - Other known problems - Medication history
20
Preoperative assessment
12
Definition of the practice of anaesthesiology
Assessing, consulting, and preparing patients for anaesthesia
Rendering patients insensible to pain during surgical obstetric, therapeutic, and diagnostic procedures
* Previous anaesthetics, surgery, and obstetric deliverries
* Family history * Review of organ systems * Last oral intake
22
Preoperative assessment
(Review of organ systems)
Class I II III IV V
Mortality Rate 0.06-0.08% 0.27-0.4% 1.8-4.3% 7.8-23% 9.4-51%
28
General Anaesthesia
* Airway
Airway
Mallampati classification咽喉分级 Thyromental distance 甲頦间距 Neck extension 颈屈曲伸展活动度 Tissue compliance 组织顺应性 Temporomandibular joint mobility
VI Brain-dead organ donor E If the case is an emergency,
the physical status is followed by the letter “E”-, “IIE”.
27
American Society of Anaesthesiologists classification and perioperative mortality rates
Managing and teaching of cardiac and pulmonary resuscitation
14
Definition of the practice of anaesthesiology
Evaluating respiratory function and applying respiratory therapy
Regional Anaesthesia
* Intrathecal anaesthesia * Subarachnoid block * Epidural anaesthesia * Caudal block * Nerve plexus block * Ganglion block * Nerve block * Field block
(Medication history)
* Allergies * Drug intolerances * Present Prescription,
Nonprescription * Nontherapeutic: Alcohol, Tobacco * Illicit
21
Preoperative assessment
Teaching, supervising, and evaluating the performance of medical and paramedical personnel involved in anaesthesia, respiratory care, and critical care
15
Definition of the practice of anaesthesiology
Involvement in the administration of hospitals, medical schools, and outpatient facilities as necessary to implement these responsibilities
* Intensive care units * Respiratory therapy departments * Recovery room
9
Scope of Anaesthesia
* Cardiopulmonary resuscitation * Postoperative pain relief * Anaesthetic research, teaching
颞下颌关节活动度
Mallampati classification of the oropharynx
Class I: Soft palate, fauces, uvula, anterior and posterior tonsillar pillars
Class II: Soft palate, fauces, uvula Class III: Soft palate, base of uvula Class IV: Soft palate only
麻醉概论
内容(教学大纲)
麻醉学的概念 麻醉学的工作范畴 麻醉方法的分类 麻醉前病人的访视 各种麻醉方法访视重点
Scope of Anaesthesia
* Providing general or regional anaesthesia inside and outside the operating room
Methods of General Anaesthesia
Inhalation anaesthesia Intravenous anaesthesia Intramuscularly Rectally Orally Balanced anaesthesia
Clinical Pharmacology
Clinical Anaesthesiology
(General Anaesthesia)
内容（教学大纲）
全身麻醉的方法 常用吸入、静脉、肌松药 全身麻醉深度判断 气管插管的方法、临床应用、并发症 全身麻醉并发症的防治 麻醉监测和管理原则
Contents
Methods of General Anaesthesia Clinical Pharmacology General Anaesthesia Tracheal Intubation Complications of General Anaesthesia Monitoring During Anaesthesia
Blood/Gas Partition 0.47 2.4 1.9 1.4 0.42 0.65
Clinical Pharmacology
13
Definition of the practice of anaesthesiology
Monitoring and restoring homeostasis in perioperative and critically patients
Diagnosing and treating painful syndromes
medical students, and assuming administrative and leadership positions on the medical staffs of many hospitals and ambulatory care facilities
10
Classification of Anaesthesia Methods General anaesthesia
Inhalational Anaesthetic Agents
Agent
MAC%
Nitrous oxide 105
Halothane
0.74
Enflurane
1.68
Isoflurane
1.15
Desflurane
6.0
Sevoflurane 2.0
Vapor Pressure 243 175 240 681 160
24
Preoperative assessment
(Physical examination)
* Vital signs * Airway * Heart * Lungs * Extremities * Neurologic examination
25
ASA classification
I A normal healthy patient other than surgical pathology without systemic disease.
IV A patient with severe systemic disturbance which poses a constant threat to life and is incapacitating.
27
ASA classification
V A moribund patient not expected to survive 24 hours with or without surgery.
* Inhalation anaesthesia * Intravenous anaesthesia * Intramuscularly * Rectally * Orally * Balanced anaesthesia
11
Classification of Anaesthesia Methods
Questions
* What is the physical classification of the ASA?
* Describe some key features of the airway examination. Outline the Mallampati classification.
* General * Respiratory * Cardiovascular * Renal * Gastrointestinal * Hematologic
23
Preoperative assessment
(Review of organ systems)
* Neurologic * Endocrine * Psychiatric * Orthopedic * Dermatologic
II A patient with mild systemic disease – no functional limitations.
27
ASA classification
III A patient with moderate to severe systemic disturbance due to medical or surgical disease- some functional limitation but not incapacitating.
Regional Anaesthesia
Contraindications of Regional
Anaesthesia
Sepsis Bacteremia Skin infection at injection site Hypovolemia Coagulopathy Therapeutic anticoagulation Demyelinating central nerve system disease Increased intracranial pressure Psychosis or dementia Lack of consent
16
Preoperative assessment
Routine preoperative anaesthetic evaluation
* History - Current problem - Other known problems - Medication history
20
Preoperative assessment
12
Definition of the practice of anaesthesiology
Assessing, consulting, and preparing patients for anaesthesia
Rendering patients insensible to pain during surgical obstetric, therapeutic, and diagnostic procedures
* Previous anaesthetics, surgery, and obstetric deliverries
* Family history * Review of organ systems * Last oral intake
22
Preoperative assessment
(Review of organ systems)
Class I II III IV V
Mortality Rate 0.06-0.08% 0.27-0.4% 1.8-4.3% 7.8-23% 9.4-51%
28
General Anaesthesia
* Airway
Airway
Mallampati classification咽喉分级 Thyromental distance 甲頦间距 Neck extension 颈屈曲伸展活动度 Tissue compliance 组织顺应性 Temporomandibular joint mobility
VI Brain-dead organ donor E If the case is an emergency,
the physical status is followed by the letter “E”-, “IIE”.
27
American Society of Anaesthesiologists classification and perioperative mortality rates
Managing and teaching of cardiac and pulmonary resuscitation
14
Definition of the practice of anaesthesiology
Evaluating respiratory function and applying respiratory therapy
Regional Anaesthesia
* Intrathecal anaesthesia * Subarachnoid block * Epidural anaesthesia * Caudal block * Nerve plexus block * Ganglion block * Nerve block * Field block
(Medication history)
* Allergies * Drug intolerances * Present Prescription,
Nonprescription * Nontherapeutic: Alcohol, Tobacco * Illicit
21
Preoperative assessment
Teaching, supervising, and evaluating the performance of medical and paramedical personnel involved in anaesthesia, respiratory care, and critical care
15
Definition of the practice of anaesthesiology
Involvement in the administration of hospitals, medical schools, and outpatient facilities as necessary to implement these responsibilities
* Intensive care units * Respiratory therapy departments * Recovery room
9
Scope of Anaesthesia
* Cardiopulmonary resuscitation * Postoperative pain relief * Anaesthetic research, teaching
颞下颌关节活动度
Mallampati classification of the oropharynx
Class I: Soft palate, fauces, uvula, anterior and posterior tonsillar pillars
Class II: Soft palate, fauces, uvula Class III: Soft palate, base of uvula Class IV: Soft palate only
麻醉概论
内容(教学大纲)
麻醉学的概念 麻醉学的工作范畴 麻醉方法的分类 麻醉前病人的访视 各种麻醉方法访视重点
Scope of Anaesthesia
* Providing general or regional anaesthesia inside and outside the operating room
Methods of General Anaesthesia
Inhalation anaesthesia Intravenous anaesthesia Intramuscularly Rectally Orally Balanced anaesthesia
Clinical Pharmacology