Chapter 6 Basic Concept of General Anesthesia Department of Anesthesiology Xiangya hospital Central...
-
Upload
clifton-pierce -
Category
Documents
-
view
236 -
download
12
Transcript of Chapter 6 Basic Concept of General Anesthesia Department of Anesthesiology Xiangya hospital Central...
![Page 1: Chapter 6 Basic Concept of General Anesthesia Department of Anesthesiology Xiangya hospital Central South University.](https://reader035.fdocuments.in/reader035/viewer/2022062309/56649f2c5503460f94c4754a/html5/thumbnails/1.jpg)
Chapter 6
Basic Concept of General Anesthesia
Department of AnesthesiologyXiangya hospital
Central South University
![Page 2: Chapter 6 Basic Concept of General Anesthesia Department of Anesthesiology Xiangya hospital Central South University.](https://reader035.fdocuments.in/reader035/viewer/2022062309/56649f2c5503460f94c4754a/html5/thumbnails/2.jpg)
General anesthesia is an altered physiologic state characterized by reversible loss of consciousness, analgesia of the entire body, amnesia and some degree of muscle relaxation.
Induction → Maintenance → Recovery
Definition of General Anesthesia
![Page 3: Chapter 6 Basic Concept of General Anesthesia Department of Anesthesiology Xiangya hospital Central South University.](https://reader035.fdocuments.in/reader035/viewer/2022062309/56649f2c5503460f94c4754a/html5/thumbnails/3.jpg)
1.Induction of General Anesthesia
Definition
全麻诱导是指病人从清醒转为可以进行手术操作的麻醉状态的过程。
There are some complications or risks in this stage, e.g. reduction of blood pressure, arrhythmia, myocardial ischemia.
![Page 4: Chapter 6 Basic Concept of General Anesthesia Department of Anesthesiology Xiangya hospital Central South University.](https://reader035.fdocuments.in/reader035/viewer/2022062309/56649f2c5503460f94c4754a/html5/thumbnails/4.jpg)
Induction of General Anesthesia-- -- Methods ① Rapid-sequence Intravenous Induction
tracheal intubation
muscle relaxants
mask ventilation for 5 minclose-fitting face mask100% oxygen delivery
unc ons ci ousnes s
sedat i ves , hypnot i c s orI nt r avenous anest het i cs agent s
![Page 5: Chapter 6 Basic Concept of General Anesthesia Department of Anesthesiology Xiangya hospital Central South University.](https://reader035.fdocuments.in/reader035/viewer/2022062309/56649f2c5503460f94c4754a/html5/thumbnails/5.jpg)
Agent induction dose (mg/Kg)
Diazepam 0.2
Midazolam 0.1-0.2
Thiopental 3-5
Etomidate 0.3
ketamine 1-2
Propofol 1.5-2.5
Fentanyl 5-6 μg/kg
Intravenous induction agents
![Page 6: Chapter 6 Basic Concept of General Anesthesia Department of Anesthesiology Xiangya hospital Central South University.](https://reader035.fdocuments.in/reader035/viewer/2022062309/56649f2c5503460f94c4754a/html5/thumbnails/6.jpg)
Muscle Relaxants
depolarizing nondepolarizing dose (mg/kg)
Succinycholine 1-2
vecuronium 0.08-0.1
atracurium 0.3-0.6
pancuronium 0.08-0.1
Rocuronium 0.6-1
![Page 7: Chapter 6 Basic Concept of General Anesthesia Department of Anesthesiology Xiangya hospital Central South University.](https://reader035.fdocuments.in/reader035/viewer/2022062309/56649f2c5503460f94c4754a/html5/thumbnails/7.jpg)
Induction of General Anesthesia Induction of General Anesthesia ① Rapid-sequence Intravenous Induction
-- Disadvantage and Complications ● Regurgitation and Vomitting ● Cardiovascular depression ● Respiratory depression● Histamine release ● Pain on injection
● Hiccup and muscle movements
![Page 8: Chapter 6 Basic Concept of General Anesthesia Department of Anesthesiology Xiangya hospital Central South University.](https://reader035.fdocuments.in/reader035/viewer/2022062309/56649f2c5503460f94c4754a/html5/thumbnails/8.jpg)
Induction of General Anesthesia Induction of General Anesthesia ② Inhalational Induction-- Indications
● young children
● myasthenia gravies ● upper airway obstruction, e.g. Epiglottitis ● lower airway obstruction with foreign body
● bronchopleural fistula or empyema ● no accessible veins
![Page 9: Chapter 6 Basic Concept of General Anesthesia Department of Anesthesiology Xiangya hospital Central South University.](https://reader035.fdocuments.in/reader035/viewer/2022062309/56649f2c5503460f94c4754a/html5/thumbnails/9.jpg)
Induction of General Anesthesia Induction of General Anesthesia Inhalational Induction-- Methods
Initially, nitrous oxide 70% in oxygen is used and anesthesia is deepened by gradual introduction of increments of a volatile agent, e.g. Halothane 1-3%, Enflurane 1.5-2.5%, Isoflurane 1-2% .
![Page 10: Chapter 6 Basic Concept of General Anesthesia Department of Anesthesiology Xiangya hospital Central South University.](https://reader035.fdocuments.in/reader035/viewer/2022062309/56649f2c5503460f94c4754a/html5/thumbnails/10.jpg)
Induction of General Anesthesia Induction of General Anesthesia Inhalational Induction-- characteristics
● Spontaneous ventilation is to be maintained. ● the face mask is applied firmly as consciousness
is lost and the airway is supported manually. ● Insertion of an oropharyngeal airway , a laryngeal mask airway or a tracheal tube may be considered when anesthesia has been established.
![Page 11: Chapter 6 Basic Concept of General Anesthesia Department of Anesthesiology Xiangya hospital Central South University.](https://reader035.fdocuments.in/reader035/viewer/2022062309/56649f2c5503460f94c4754a/html5/thumbnails/11.jpg)
Induction of General Anesthesia Induction of General Anesthesia Inhalational Induction
Disadvantage and Complications
● Slow induction of anesthesia
● Airway obstruction , bronchospasm ● Laryngeal spasm , hiccups ● Environmental pollution
![Page 12: Chapter 6 Basic Concept of General Anesthesia Department of Anesthesiology Xiangya hospital Central South University.](https://reader035.fdocuments.in/reader035/viewer/2022062309/56649f2c5503460f94c4754a/html5/thumbnails/12.jpg)
Induction of General Anesthesia Induction of General Anesthesia ③ Induction with spontaneous ventilation -- Indications
● Airway obstruction
● anticipant difficult intubation
![Page 13: Chapter 6 Basic Concept of General Anesthesia Department of Anesthesiology Xiangya hospital Central South University.](https://reader035.fdocuments.in/reader035/viewer/2022062309/56649f2c5503460f94c4754a/html5/thumbnails/13.jpg)
Induction of General Anesthesia Induction of General Anesthesia Induction With Spontaneous Ventilation
-- Characteristics
● Maintaining spontaneous ventilation
throughout the procedure
● Sufficient surface anesthesia
![Page 14: Chapter 6 Basic Concept of General Anesthesia Department of Anesthesiology Xiangya hospital Central South University.](https://reader035.fdocuments.in/reader035/viewer/2022062309/56649f2c5503460f94c4754a/html5/thumbnails/14.jpg)
Induction of General Anesthesia Induction of General Anesthesia
④ Intravenous induction following conscious intubation -- Indications
● Patient with the risk of regurgitation
● Patient with postural hypotension
following anesthesia (e.g. paraplegia)
![Page 15: Chapter 6 Basic Concept of General Anesthesia Department of Anesthesiology Xiangya hospital Central South University.](https://reader035.fdocuments.in/reader035/viewer/2022062309/56649f2c5503460f94c4754a/html5/thumbnails/15.jpg)
Induction of General Anesthesia Induction of General Anesthesia
⑤ Other induction methods
● intramuscular injection of ketamine ● take midazolam orally
● administration of fentanyl via mucosa
![Page 16: Chapter 6 Basic Concept of General Anesthesia Department of Anesthesiology Xiangya hospital Central South University.](https://reader035.fdocuments.in/reader035/viewer/2022062309/56649f2c5503460f94c4754a/html5/thumbnails/16.jpg)
注意事项
• 保持呼吸道通畅 ---首要任务 • 保持一定麻醉深度,减轻插管应激反应• 静脉用药按 Kg体重计算、维持循环稳定• 诱导前,准备好麻醉机和插管用具,监测生命体征• 面罩加压给氧时, TV不宜过大,避免气体进入胃内→胃胀气、返流
![Page 17: Chapter 6 Basic Concept of General Anesthesia Department of Anesthesiology Xiangya hospital Central South University.](https://reader035.fdocuments.in/reader035/viewer/2022062309/56649f2c5503460f94c4754a/html5/thumbnails/17.jpg)
⒉Maintenance of general anesthesia
镇静 sedation
镇痛 analgesia
肌松 muscle relaxation
![Page 18: Chapter 6 Basic Concept of General Anesthesia Department of Anesthesiology Xiangya hospital Central South University.](https://reader035.fdocuments.in/reader035/viewer/2022062309/56649f2c5503460f94c4754a/html5/thumbnails/18.jpg)
⒉Maintenance of general anesthesia
Inhalational agents
Intravenous anesthetics
Opioids
Muscle relaxants
![Page 19: Chapter 6 Basic Concept of General Anesthesia Department of Anesthesiology Xiangya hospital Central South University.](https://reader035.fdocuments.in/reader035/viewer/2022062309/56649f2c5503460f94c4754a/html5/thumbnails/19.jpg)
全麻维持与诱导紧密衔接了解手术进程,麻醉深度与手术刺激相适应做好呼吸管理,保持气道通畅,人工通气监 测 PETCO2 、 SPO2 及血气分析 :
颅脑手术 PaCO2 维持 30-35mmHg
冠心病病人 PaCO2 不宜太低,以免冠脉痉挛
注意事项
![Page 20: Chapter 6 Basic Concept of General Anesthesia Department of Anesthesiology Xiangya hospital Central South University.](https://reader035.fdocuments.in/reader035/viewer/2022062309/56649f2c5503460f94c4754a/html5/thumbnails/20.jpg)
注意事项 ■ 使用肌松监测仪指导肌松剂的使用
■ 充分镇静、避免术中知晓■ 维持生命体征和内环境平稳,及时
处理术中失血性休克、过敏性休克、 心律失常等异常情况
![Page 21: Chapter 6 Basic Concept of General Anesthesia Department of Anesthesiology Xiangya hospital Central South University.](https://reader035.fdocuments.in/reader035/viewer/2022062309/56649f2c5503460f94c4754a/html5/thumbnails/21.jpg)
⒊ Recovery
Antagonizing residual neuromuscular blockade
Extubation
Airway supporting
Recovery position is benefit to avoid airway obstruction
![Page 22: Chapter 6 Basic Concept of General Anesthesia Department of Anesthesiology Xiangya hospital Central South University.](https://reader035.fdocuments.in/reader035/viewer/2022062309/56649f2c5503460f94c4754a/html5/thumbnails/22.jpg)
![Page 23: Chapter 6 Basic Concept of General Anesthesia Department of Anesthesiology Xiangya hospital Central South University.](https://reader035.fdocuments.in/reader035/viewer/2022062309/56649f2c5503460f94c4754a/html5/thumbnails/23.jpg)
⒊ Recovery
• 严格掌握拔管指征,过早、过晚拔管均会造成严重后果
• 自然苏醒,必要时使用催醒药• MACawake: 肺泡气内吸入麻醉药浓度降至
0.4MAC ( 0.5 或 0.58MAC )时, 95% 病人能按指令睁眼
![Page 24: Chapter 6 Basic Concept of General Anesthesia Department of Anesthesiology Xiangya hospital Central South University.](https://reader035.fdocuments.in/reader035/viewer/2022062309/56649f2c5503460f94c4754a/html5/thumbnails/24.jpg)
4.Monitoring depth of anesthesia
Stages of anesthesia
![Page 25: Chapter 6 Basic Concept of General Anesthesia Department of Anesthesiology Xiangya hospital Central South University.](https://reader035.fdocuments.in/reader035/viewer/2022062309/56649f2c5503460f94c4754a/html5/thumbnails/25.jpg)
![Page 26: Chapter 6 Basic Concept of General Anesthesia Department of Anesthesiology Xiangya hospital Central South University.](https://reader035.fdocuments.in/reader035/viewer/2022062309/56649f2c5503460f94c4754a/html5/thumbnails/26.jpg)
麻醉深度监测技术
• 食道下端肌肉收缩波形和振幅的测定• 脑电双频谱指数( Bispectral Index , BI
S ) 清醒 : 80-100
外科麻醉期 : 40
• 体感诱发电位• 脑干听觉诱发电位