耳鼻喉科手术麻醉-PPT课件.ppt

1、Anesthesia For EarAnesthesia For Ear，Nose Nose and Throat Surgeryand Throat Surgery耳鼻喉科手术麻醉耳鼻喉科手术麻醉 Profile and Demands difficult airway cardiac arrhythmia：applicattion of Epinephrine, reflex of carotid sinus, etc. N2O and middle ear pressurePreoperative Evaluation and Preparation Interview(麻醉前访视) P

2、remedication(麻醉前用药)： sedatives(镇静药) anticholinegics(抗胆碱药) Choice of anesthesia local anestehsia：to those cooperative ones undergoing short-term and simple operationsoperations general anesthesia：to those ones cant be undertaken operations under local anesthesiaSeveral common ENT operations*operation

3、 of ear*operation of nasal cavity(鼻腔) and nasal sinus(鼻窦)*tonsillectomy(扁桃体摘除术)*total throat resection(全喉截除术)*Endoscopy(内镜检查)and endoscopic surgery(内镜手术)PS：婴幼儿气管、支气管异物取出术：婴幼儿气管、支气管异物取出术 病情：急病情：急(urgent) 、重、重(severe) 、危、危(dangerous) 麻醉：全麻，配合充分表麻麻醉：全麻，配合充分表麻, 要求麻醉既不加重要求麻醉既不加重缺氧又能迅速诱导至足够深度缺氧又能迅速诱导至足够深度

4、 管理：管理： *术前术前: 准备应迅速、利索，呼吸困难准备应迅速、利索，呼吸困难(dyspnea)的应急处理的应急处理 *术中术中: 积极防治喉、气管、支气管痉挛、缺氧、积极防治喉、气管、支气管痉挛、缺氧、气 道 内 出 血 、 气 管 破 裂气 道 内 出 血 、 气 管 破 裂 ( s p l i t ) 或 气 胸或 气 胸(pneumothorax) 、喉头水肿、喉头水肿(laryngeal edema)等等 *术毕术毕: 充分供氧，待患者清醒良好、呼吸通畅，充分供氧，待患者清醒良好、呼吸通畅，吸空气吸空气SPO2基本正常后方可出手术室基本正常后方可出手术室 Questions Tr

5、y to describe the factors causing arrhythmia during ENT surgery. “全喉截除术全喉截除术”中，发生颈外静脉中，发生颈外静脉破裂，除了紧急止血外还应警惕什破裂，除了紧急止血外还应警惕什么情况的发生？如何处理？么情况的发生？如何处理？ 中耳手术时，吸入全麻的使用应注中耳手术时，吸入全麻的使用应注意什么？意什么？THANK YOU！Difficult airway *1Difficult intubation*2compromised airwayN2O and middle ear pressureThe middle ear and

6、 paranasal sinus(鼻旁窦鼻旁窦) are normal body air cavities that consist of open, nonventilated spaces. The blood/gas coefficient(系数系数) is 0.013 for nitrogen versus 0.46 for N2O. When inhaled in high concentrations, N2O enters the air cavities faster than nitrogen can leave. In a fixed cavity such as the

7、middle ear, the result is an increase in pressure. After discontinuation of N2O, the gas is rapidly reabsorbed, marked, negative middle ear pressure may develop. Difficult intubation anatomic abnormalities： micrognathia(小小颌颌), limited jaw motion, or congenital syndromes (craniofacial dysostoses) etc

8、. Other causes：obesity, acromegaly(肢端肥肢端肥大症大症), cervical spine problems, rheumatoid arthritis(风湿性关节炎风湿性关节炎), and even gastric reflux(返流返流) Compromised airwayPathologic conditions above the glottis may prevent a clear view of the glottic opening, whereas subglottic lesions permit a good view of the v

9、ocal cords, but they require careful placement of a small endotracheal tube or bronchoscope. Operations of ears operations of ear concha(耳廓) and concha tract(外耳道) ：local anesthesia(to cooperative patients) operations inside earsoperations inside ears：general anesthesia Microsurgery(显微外科手术)：controlle

10、d hypotension(控制性低血压) is sometimes needed N N2 2O and middle ear pressureO and middle ear pressure Operation of nasal cavity and nasal sinus local anesthesia general anesthesiaTonsillectomyTonsillectomyattention： topical anesthesia and cough reflex general anesthesia and the management of airway eme

11、rgent surgery for bleeding after tonsillectomy and the anesthetic managementbleeding after onsillectomybleeding after onsillectomy problems: hypo-volemia, full stomach, and airway obstruction. induction of anesthesia: good suctioning of blood、a rapid-sequence induction of anesthesia with application

12、 of cricoid pressure and slight head-down positioning of the patient will protect the trachea and glottis from aspiration of blood. after induction, a nasogastric(鼻胃的鼻胃的) tube may be placed and removed. extubation: as with elective tonsillectomy, extubation is safest with the patient awake. Total th

13、roat resection profile of the operation：wide range，deep reach，airway obstruction of some extent anesthetic mangement：general anesthesia with endotracheal intubation through tracheotomy attention： * reflex of carotid sinus(颈动脉窦反射颈动脉窦反射) *split(破裂破裂) of main line(大静脉大静脉)气栓气栓(gas embolism) *evaluation

14、of respiration function and corresponding treatmentEndoscopy and endoscopic surgeryProfile： interaction of anesthetic and surgical management with the compromised airway inconsistency(矛盾) between the operation and anesthetic recoveryAnesthesia selection for endoscopy and endoscopic surgery*local ane

15、sthesia：try to perform local anesthesia to the cooperative adult patients especially to those with some extent of airway obstruction during short-term operations*general anesthesia：mainly fits children patientsGeneral anesthesia for endoscopy and endoscopic surgery with with endotracheal intubation：

16、thin tube without without endotracheal intubation 1intensive inhalation anesthesia induction companied by topical anesthesia 2 with a thin plastic tube above the carina(隆突) to supply oxygen or to ventilate by connecting a high frequency jet ventilator(高频喷射通气机) ，perform a short-term operation under the usage of scoline(琥珀胆碱) 3supply oxygen via the lateral tube of the bronchoscope(气管镜的侧管)