外科学总论 课件 8 麻醉学

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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
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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
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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
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Preoperative assessment
(Physical examination)
* Vital signs * Airway * Heart * Lungs * Extremities * Neurologic examination
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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.
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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
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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
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Preoperative assessment
(Review of organ systems)
* Neurologic * Endocrine * Psychiatric * Orthopedic * Dermatologic
II A patient with mild systemic disease – no functional limitations.
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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
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Preoperative assessment
Routine preoperative anaesthetic evaluation
* History - Current problem - Other known problems - Medication history
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Preoperative assessment
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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
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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%
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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”.
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American Society of Anaesthesiologists classification and perioperative mortality rates
Managing and teaching of cardiac and pulmonary resuscitation
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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
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Preoperative assessment
Teaching, supervising, and evaluating the performance of medical and paramedical personnel involved in anaesthesia, respiratory care, and critical care