剖宫产的麻醉(英文版) PPT
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《剖宫产麻醉》幻灯片
由于高海拔地区以低氧为轴心的病理生理改 变影响着全身各系统器官和神经内分泌调 节, 当其受到平原所说的同等量级的创伤、 感染等打击时, 会使病理生理的变化更加剧 烈。
高原世居人群基因改变，适应缺氧环境
【2】 中华医学会高原医学分会推荐稿 (兰州会议 ). 高海拔地区多脏器功能障碍综合征评分诊断标 准. 高原医学杂志,2005 , 15(4): 1~ 3.7
)
T6 (子宫 左倾1 分钟)
T7 (子宫 左倾3 分钟)
T8 (子宫 左倾5 分钟)
T9 (切皮
前)
T10 (胎儿 娩出时
)
T11 (胎儿 娩出后 3分钟)
T12 (缩宫 素应用 后1分 钟)
T13 (缩宫 素应用 后3分 钟)
T14 (缩宫 素应用 后5分
钟)
T15 (胎盘 娩出时
)
T16 (手术 结束时
aortocaval compression--left 15 degree table tilt vs. uterine displacement by hand] 脊髓注射后，SL组患者转向左侧卧位15度，UD组用手推子宫位移。直至分娩最低的腿 部动脉收缩压UD组〔P<0.05〕显著降低。SL组麻黄碱要求显著少〔P<0.05〕。 Apgar评分没有差异。
90.00 85.00 80.00 75.00 70.00 65.00
T1 T2 T3 T4 T5 T6 T7 T8 T9 T10 T11 T12 T13 T14 T15 T16
TFC
血管阻力
34.50 34.00 33.50 33.00 32.50 32.00
T1 T2 T3 T4 T5 T6 T7 T8 T9 T10 T11 T12 T13 T14 T15 T16
高原世居人群基因改变，适应缺氧环境
【2】 中华医学会高原医学分会推荐稿 (兰州会议 ). 高海拔地区多脏器功能障碍综合征评分诊断标 准. 高原医学杂志,2005 , 15(4): 1~ 3.7
)
T6 (子宫 左倾1 分钟)
T7 (子宫 左倾3 分钟)
T8 (子宫 左倾5 分钟)
T9 (切皮
前)
T10 (胎儿 娩出时
)
T11 (胎儿 娩出后 3分钟)
T12 (缩宫 素应用 后1分 钟)
T13 (缩宫 素应用 后3分 钟)
T14 (缩宫 素应用 后5分
钟)
T15 (胎盘 娩出时
)
T16 (手术 结束时
aortocaval compression--left 15 degree table tilt vs. uterine displacement by hand] 脊髓注射后，SL组患者转向左侧卧位15度，UD组用手推子宫位移。直至分娩最低的腿 部动脉收缩压UD组〔P<0.05〕显著降低。SL组麻黄碱要求显著少〔P<0.05〕。 Apgar评分没有差异。
90.00 85.00 80.00 75.00 70.00 65.00
T1 T2 T3 T4 T5 T6 T7 T8 T9 T10 T11 T12 T13 T14 T15 T16
TFC
血管阻力
34.50 34.00 33.50 33.00 32.50 32.00
T1 T2 T3 T4 T5 T6 T7 T8 T9 T10 T11 T12 T13 T14 T15 T16
剖宫产麻醉ppt课件
7
麻醉方式的选择原则
麻醉方式应根据产妇和胎儿情况、麻醉医 师技术熟练程度及设备条件而定；
以保证母儿安全、减少手术创伤和术后并 发症为最终目的。
8
麻醉方法连续硬膜外麻醉健康产妇首选
优点：血压波动小，可减少仰卧位综合症 发生率，局麻药对胎儿影响小，不影响子 宫的收缩；
方法：选择L2 ～3 或L1 ～2 间隙穿刺，使 阻滞平面不高于T8 ；
20
★胎儿重度宫内窒息、产妇大出血或预计有 发生大出血可能者，全麻为最佳选择；
★母胎状态良好，出血少无低血容量者可选 锥管内麻醉；
★休克者可紧急采用局麻，辅以全麻；
★子宫破裂需切除子宫者可选全麻。
21
妊娠高血压综合征的麻醉
妊娠高血压综合征分为轻、中、重三度， 麻醉前应详细了解妊高症的程度，有无凝 血和肝肾功能异常，抗高血压药、硫酸镁 和镇静药使用情况，且需纠正低血容量和 电解质紊乱。
外穿刺，成功后经套针后孔置入25 号腰穿针，刺 破蛛网膜后至蛛网膜下腔，即2ml ，退出腰穿针， 然后自硬膜外穿刺套针向刻缓慢匀速注入0.5% 重比重布比卡因头端置入导管3cm 。 两点法：选择L1 ～2 或L2 ～3 间隙行硬膜外置管， 然后选择L3 ～4 间隙行蛛网膜下腔穿刺注药。两 种方法均经硬膜外导管适量追加局麻药
16
注意：
饱胃者术前务必上胃管以抽吸胃内容物， 减少返流误吸的危险，选用不易通过胎盘 的药物诱导插管，胎儿取出后可适当加深 麻醉。
17
局部浸润麻醉适用于母儿情况紧急，产 妇餐后和基层医院的剖宫产术
优点：简单、快速，对母儿安全，不受餐 后的限制；
方法：以安全有效剂量的局麻药，于产妇 下腹部手术切口范围行棱形或扇形的皮下、 筋膜以及腹膜的浸润麻醉，剖宫娩出胎头 后，给产妇加以其他麻醉方式以满足需要；
麻醉方式的选择原则
麻醉方式应根据产妇和胎儿情况、麻醉医 师技术熟练程度及设备条件而定；
以保证母儿安全、减少手术创伤和术后并 发症为最终目的。
8
麻醉方法连续硬膜外麻醉健康产妇首选
优点：血压波动小，可减少仰卧位综合症 发生率，局麻药对胎儿影响小，不影响子 宫的收缩；
方法：选择L2 ～3 或L1 ～2 间隙穿刺，使 阻滞平面不高于T8 ；
20
★胎儿重度宫内窒息、产妇大出血或预计有 发生大出血可能者，全麻为最佳选择；
★母胎状态良好，出血少无低血容量者可选 锥管内麻醉；
★休克者可紧急采用局麻，辅以全麻；
★子宫破裂需切除子宫者可选全麻。
21
妊娠高血压综合征的麻醉
妊娠高血压综合征分为轻、中、重三度， 麻醉前应详细了解妊高症的程度，有无凝 血和肝肾功能异常，抗高血压药、硫酸镁 和镇静药使用情况，且需纠正低血容量和 电解质紊乱。
外穿刺，成功后经套针后孔置入25 号腰穿针，刺 破蛛网膜后至蛛网膜下腔，即2ml ，退出腰穿针， 然后自硬膜外穿刺套针向刻缓慢匀速注入0.5% 重比重布比卡因头端置入导管3cm 。 两点法：选择L1 ～2 或L2 ～3 间隙行硬膜外置管， 然后选择L3 ～4 间隙行蛛网膜下腔穿刺注药。两 种方法均经硬膜外导管适量追加局麻药
16
注意：
饱胃者术前务必上胃管以抽吸胃内容物， 减少返流误吸的危险，选用不易通过胎盘 的药物诱导插管，胎儿取出后可适当加深 麻醉。
17
局部浸润麻醉适用于母儿情况紧急，产 妇餐后和基层医院的剖宫产术
优点：简单、快速，对母儿安全，不受餐 后的限制；
方法：以安全有效剂量的局麻药，于产妇 下腹部手术切口范围行棱形或扇形的皮下、 筋膜以及腹膜的浸润麻醉，剖宫娩出胎头 后，给产妇加以其他麻醉方式以满足需要；
英语学习-剖宫产用药指南ppt课件
cesarean adj. 剖腹产的； n. 剖腹产
Endometritis n. [妇产] 子宫内膜炎
malaise n. 不舒服；心神不安 速
lochia n. 恶露；产褥排泄物
Postpartum adj. 产后的 adv. 在产后 uterine adj. 子宫的；同母异父的 tachycardia n. [内科] 心动过速；心跳过
Postpartum infectious complications are common after cesarean delivery. Endometritis (infection of the uterine lining) is usually identified by fever, malaise, tachycardia, abdominal pain, uterine tenderness, and sometimes abnormal or foul-smelling lochia. Fever may also be the only symptom of endometritis.
Background
Endometritis has been reported to occur in up to 24% of patients in elective cesarean delivery and up to approximately 60% of patients undergoing nonelective or emergency section. Risk factors for endometritis include cesarean delivery, prolonged rupture of membranes, prolonged labor with multiple vaginal examinations, intrapartum fever, and low socioeconomic status. Patients with low socioeconomic status may have received inadequate prenatal care.
剖宫产的麻醉(英文幻灯)
Pregnancy - CV
z Decreased
peripheral vascular resistance (estrogens) leads to increased CO while BP remains the same z Large uterus and dorsal recumbency can decrease venous return, CO, and uterine and renal blood flow
Anesthetic Techniques
z Epidural z Systemic
medications z Line block z Inhalant
Neonatal Resucitation
z Clear
head/oropharynx of fluid
– Suction – Swinging/flinging
z Rub
with towel and stimulate z Keep warm z Doxapram z Intubate and ventilate PRN
Pregnancy - Pulmonary
z Oxygen
consumption increases by 20% because of fetus, placenta, uterine muscle and mammary tissue z FRC of lung decreases by anterior displacement of diaphragm and abdominal organs by gravid uterus z So hypoventilation induces hypoxemia and hypercapnia more readily
急诊剖宫产的麻醉选择和术中处理PPT课件
• anaesthetist informed – delivery
第7页/共53页
Perianesthetic Evaluation
• A directed history and physical examination
• platelet count • An intrapartum blood type and screen
第12页/共53页
Perianesthetic– Maternal Position
• Avoid aortocaval compression
Kinsella SM. Editorial. Lateral tilt for pregnant women: why 15 degrees? Anaesthesia 2003; 58: 835–7.
• Transverse lie
• Hemorrhage
• Breech
• Placenta previa
• Multiple gestation
• Placental abruption
第3页/共530% unplanned
• More extensive peripartum monitoring • Lower threshold for surgical intervention
第10页/共53页
Aspiration Prophylaxis
• clear liquids up to 2h before induction of anesthesia
• A fasting period for solids 6–8 h(fat content?)
• Further restriction
Risk of high spinal
第7页/共53页
Perianesthetic Evaluation
• A directed history and physical examination
• platelet count • An intrapartum blood type and screen
第12页/共53页
Perianesthetic– Maternal Position
• Avoid aortocaval compression
Kinsella SM. Editorial. Lateral tilt for pregnant women: why 15 degrees? Anaesthesia 2003; 58: 835–7.
• Transverse lie
• Hemorrhage
• Breech
• Placenta previa
• Multiple gestation
• Placental abruption
第3页/共530% unplanned
• More extensive peripartum monitoring • Lower threshold for surgical intervention
第10页/共53页
Aspiration Prophylaxis
• clear liquids up to 2h before induction of anesthesia
• A fasting period for solids 6–8 h(fat content?)
• Further restriction
Risk of high spinal
产科麻醉英文版 ppt课件
0.075 mg/kg – no problem
0.15 mg/kg – different degree
Droperidol
Pregnant woman: 慎用 Apgar score ↓
Thiopental sodium
Neonatus sleep: little Premature and intrauterine embarrass: carefully using
PCEA: low dose of fentanyl and 0.1%-
0.3% ropivacaine
Tramadol
Placental transfer
No inhibiting uterine contraction
No Respiratory depression
Diazepam
20-30s before of first stage of labor: 50% O 2 and 50% N 2 O, maximum<70%
Readily cross the placenta Half-lives: 48 hours
Problems: sedation, hypotonia,
cyanosis, impaired metabolic responses to stress.
Midazolam
Plasma protein binding: 94% Respiratory depression: depended on dose
morphine pethidine fentanyl alfentanil
General anesthetics propofol
麻醉(英文版) PPT
6
Mandate and scope of anesthesiology
1、Clinical anesthesia 2、First aid and resuscitation 3、Monitoring and treatment of severe patients 4、Pain Management 5、others：MODS、Discontinuation
Loss feeling or awareness reversibly by using certain drugs on the central or peripheral nervous system, to alleviate the pain of patients, and create conditions for operation.
7
The basic content of Clinical Anesthesia
➢ Analgesia ➢ Create conditions for operation
Muscle relaxant Breathing Control Regulation of blood pressure Regulation of body temperature
5
Morton WTG successfully showed ether anesthesia in Massachusetts General Hospital in October 16, 1846 , which opened up a new era of modern anesthesia.
➢ Cardiopulmonary bypass ➢ Maintain homeostasis stability
Mandate and scope of anesthesiology
1、Clinical anesthesia 2、First aid and resuscitation 3、Monitoring and treatment of severe patients 4、Pain Management 5、others：MODS、Discontinuation
Loss feeling or awareness reversibly by using certain drugs on the central or peripheral nervous system, to alleviate the pain of patients, and create conditions for operation.
7
The basic content of Clinical Anesthesia
➢ Analgesia ➢ Create conditions for operation
Muscle relaxant Breathing Control Regulation of blood pressure Regulation of body temperature
5
Morton WTG successfully showed ether anesthesia in Massachusetts General Hospital in October 16, 1846 , which opened up a new era of modern anesthesia.
➢ Cardiopulmonary bypass ➢ Maintain homeostasis stability
胎盘早剥麻醉英文版ppt课件
A Case of Placental Abruption Anesthesia
Name
Basic Information
Pregnant female 27y/o 75kg
normal pregnancy for 38 weeks Medical history : After CEA L4-5 for clinical painless labour about 3 h in the ward, the obstetric doctors found a significant increase in vaginal bleeding Chief complaint: Severe abdominal pain with no relief after CEA Past history :The patient was healthy before
3
Pre-evaluation
• ASA:Ш • Mallampati:Ⅱ • Clear , pale • Hypotention : BP 80/40 mmHg, • FHR: 110-120 bpm • a moderate and a severe variation of the deceleration occurred about every 20 minutes • to OR •
• 3.Fetal distress
7
Evaluation and Analysis
1. Timely termination of pregnancy to ensure the safety of mother and infant 2. Timely expansion of volume, to prevent the occurrence of shock and coagulation disorders 3. Maintain intraoperative BIS in 40-60, adjusted the anesthetic drug̓s concentration timely to prevent the deep anesthesia or intraoperative awareness
Name
Basic Information
Pregnant female 27y/o 75kg
normal pregnancy for 38 weeks Medical history : After CEA L4-5 for clinical painless labour about 3 h in the ward, the obstetric doctors found a significant increase in vaginal bleeding Chief complaint: Severe abdominal pain with no relief after CEA Past history :The patient was healthy before
3
Pre-evaluation
• ASA:Ш • Mallampati:Ⅱ • Clear , pale • Hypotention : BP 80/40 mmHg, • FHR: 110-120 bpm • a moderate and a severe variation of the deceleration occurred about every 20 minutes • to OR •
• 3.Fetal distress
7
Evaluation and Analysis
1. Timely termination of pregnancy to ensure the safety of mother and infant 2. Timely expansion of volume, to prevent the occurrence of shock and coagulation disorders 3. Maintain intraoperative BIS in 40-60, adjusted the anesthetic drug̓s concentration timely to prevent the deep anesthesia or intraoperative awareness
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been fed
Pregnancy- Hepatic/Renal
Overall liver function generally well maintained
GFR increases by as much as 60%, so BUN and Cr should be lower than normal
So hypoventilation induces hypoxemia and hypercapnia more readily
Pregnancy - GI
LES tone decreased, more risk of regurgitation
Therefore, also more risk of aspiration Since it is an emergency-patient may have
Pregnancy - CV
Decreased peripheral vascular resistance (estrogens) leads to increased CO while BP remains the same
Large uterus and dorsal recumbency can decrease venous return, CO, and uterine and renal blood flow
– Physical condition of mother usually less than optimal
Drugs should be chosen to minimize fetal depression
Decrease time fry
– Decreases fetal exposure to drugs – Decreases maternal cardio/pul depression
Anesthesia for C-sections
Cesarean Section
Ideal protocol
– Ample analgesia, muscle relaxation and sedation for surgery without endangering mother or fetus
Neonatal Resucitation
Clear head/oropharynx of fluid
– Suction – Swinging/flinging
Rub with towel and stimulate Keep warm Doxapram Intubate and ventilate PRN
Anesthetics, analgesics, sedatives, tranquilizers
– Cross blood-brain barrier – Also cross placenta
Cesarean Section
C-sections are usually emergencies
Pregnancy - Pulmonary
Oxygen consumption increases by 20% because of fetus, placenta, uterine muscle and mammary tissue
FRC of lung decreases by anterior displacement of diaphragm and abdominal organs by gravid uterus
Increases in BUN and Cr may indicate significant renal pathology
Anesthetic Techniques
Regional
– Less neonatal depression – Aspiration and airway problems
General
– Speed and ease of induction – Controllability – Control of airway
Anesthetic Techniques
Epidural Systemic medications Line block Inhalant
Pregnancy- Hepatic/Renal
Overall liver function generally well maintained
GFR increases by as much as 60%, so BUN and Cr should be lower than normal
So hypoventilation induces hypoxemia and hypercapnia more readily
Pregnancy - GI
LES tone decreased, more risk of regurgitation
Therefore, also more risk of aspiration Since it is an emergency-patient may have
Pregnancy - CV
Decreased peripheral vascular resistance (estrogens) leads to increased CO while BP remains the same
Large uterus and dorsal recumbency can decrease venous return, CO, and uterine and renal blood flow
– Physical condition of mother usually less than optimal
Drugs should be chosen to minimize fetal depression
Decrease time fry
– Decreases fetal exposure to drugs – Decreases maternal cardio/pul depression
Anesthesia for C-sections
Cesarean Section
Ideal protocol
– Ample analgesia, muscle relaxation and sedation for surgery without endangering mother or fetus
Neonatal Resucitation
Clear head/oropharynx of fluid
– Suction – Swinging/flinging
Rub with towel and stimulate Keep warm Doxapram Intubate and ventilate PRN
Anesthetics, analgesics, sedatives, tranquilizers
– Cross blood-brain barrier – Also cross placenta
Cesarean Section
C-sections are usually emergencies
Pregnancy - Pulmonary
Oxygen consumption increases by 20% because of fetus, placenta, uterine muscle and mammary tissue
FRC of lung decreases by anterior displacement of diaphragm and abdominal organs by gravid uterus
Increases in BUN and Cr may indicate significant renal pathology
Anesthetic Techniques
Regional
– Less neonatal depression – Aspiration and airway problems
General
– Speed and ease of induction – Controllability – Control of airway
Anesthetic Techniques
Epidural Systemic medications Line block Inhalant