麻醉概述英文.ppt

ANESTHESIOLOGYContents1.The history of anesthesiology 2.The scope of anesthesiology3.Classification of Anesthesia4.Definition of Anesthesia5.Preparing for anesthesiaThe History of Anesthesiology Anesthetic practices date from ancient timesThe History of Anesthesiology Modern anesthesiology began in 1846-Ether was used as an anesthetic agent in humans.William T.G.Morton (1819-1868)The History of Anesthesiology Modern inhalation anesthetics were developed from 1950s to 1960s Intravenous anesthesia first began in 1872-Use of choral hydrate.From then,many other intravenous agents were developed.Muscle relaxants resulted in evolution of anesthesiology-Curare(箭毒)was firstly used in 1942The History of Anesthesiology The original of modern local anesthesia was credited to use of cocaine in 1884.Subarachnoid anesthesia-1898.Caudal epidural anesthesia-1901.lumbar epidural anesthesia-1921The Scope of Anesthesiology 1.Clinical anesthesia 2.Pain management 3.First-aid and resuscitation 4.Intensive care8术前给药麻醉诱导麻醉维持呼吸管理呼吸管理气管插管气管插管控制呼吸控制呼吸辅助呼吸辅助呼吸循环管理循环管理麻醉深度麻醉深度容量容量血管活性药血管活性药苏醒麻醉恢复静脉诱导静脉诱导全凭静脉麻醉全凭静脉麻醉（TIVATIVA）拔管术后疼痛管理全身麻醉过程全身麻醉过程吸入诱导吸入诱导吸入麻醉吸入麻醉静吸静吸复合麻醉复合麻醉Definition of Anesthesia Anesthesia is always defined by drug-induced changes in behavior or perception.The components of general anesthetic state include unconsciousness,amnesia(健忘),analgesia(镇痛),immobility,and attenuation of autonomic nervous system responses to noxious stimulation.Course of Anesthesia Anesthesia induction Anesthesia maintenance Anesthesia recoveryClassification of Anesthesia General anesthesia Inhalation anesthesia Intravenous anesthesiaCombined anesthesiaIntravenous Venous-inhalationIntrathecal block-general anesthesia Local anesthesia Topical anesthesia Infiltration anesthesia Nerve block Nerve plexus block Intrathecal block:Subarachnoid block,epidural block and caudal blockMonitoring During Anesthesia The Cardiovascular System The Respiratory System Liver and kidney function Central nerve system Coagulation functionPain Management Postoperative analgesia Delivery analgesia Acute and chronic pain cure Cancer analgesiaPreparing For Anesthesia Preoperative visit Preoperative evaluation:History,physical examination,laboratory evaluation Preoperative fasting Coexisting disease therapy Equipment preparation Preoperative medicationPurposes of the preoperative visit1.Establish rapport with the patient 2.Obtain a history and perform a physical examinations3.Order a special investigations4.Assess the risks of anesthesia and surgery 5.Institute preoperative managementRoutine Preoperative Anesthetic Evaluation History Review of organ system clinical examination Laboratory EvaluationASA Physical Status ClassificationClassDefinition1A normal healthy patient.2A patient with mild systemic disease and no functional limitation3A patient with moderate to severe systemic disease that results in some functional limitation4A patient with severe systemic disease that is a constant threat to life and functionally incapacitating5A moribund patient who is not expected to survive 24 hours with or without surgeryEIf the procedure is an emergency,the physical status is followed by“E”Preoperative Fasting The time of fasting solid is more than 12 hours,and fluid is more than 4 hours.The time of fasting breast milk is 8 hours in baby.If necessary,baby should be transfused.Coexisting Disease Therapy Coexisting disease may affect outcome adversely if not under optimum control.The coexisting disease must be treated properly before any nonurgent surgery.Coexisting disease and drug treatment may interact with anesthesia and surgery in several waysCoexisting Disease Therapy 1.The course of the disease may be modified by anesthesia or surgery.2.Influence the effects of anesthesia.3.Both disease and drug treatment may influence choice of anesthetic technique.4.Drug treatment may modify the normal compensatory physiological responsesChoice of AnesthesiaFactors to choice a anesthetic technique 1.Patient condition 2.Surgery category 3.The technical and theoretic level of anesthetist 4.Anesthetics 5.Anesthesia and monitor equipmentEquipment and drug PreparationAnesthetic machine1.Electrical supply2.All essential equipment is present and correctly assembled3.Medical gas supply4.Vaporizers5.Breathing system:VentilatorsEquipment and drug PreparationAncillary Equipment 1.laryngoscopes,intubation aids 2.Face masks,airways,tracheal tubes and connectors 3.Suction apparatusEquipment and drug PreparationMonitoring equipment and drug 1.NIBP,SpO2,ECG,etc.2.Ephedrine,Atropine,etc 3.AnestheticsPreoperative MedicationGoals for pharmacologic premedication 1.Sedation and hypnosis2.Analgesia3.Reduce secretions 4.Attenuate autonomic nervous system responses