耳鼻喉科手術(shù)麻醉課件

耳鼻喉科手術(shù)麻醉耳鼻喉科手術(shù)麻醉耳鼻喉科手術(shù)麻醉耳鼻喉科手術(shù)麻醉

ProDemands

difficultairway

cardiacarrhythmia：applicattionofEpinephrine,reflexofcarotidsinus,etc.

N2Oandmiddleearpressure耳鼻喉科手術(shù)麻醉耳鼻喉科手術(shù)麻醉耳鼻喉科手術(shù)麻醉PreoperativeEvaluation

andPreparationInterview(麻醉前訪視)

Premedication(麻醉前用藥)：

▲sedatives(鎮(zhèn)靜藥)

▲anticholinegics(抗膽堿藥)

耳鼻喉科手術(shù)麻醉Choiceofanesthesialocalanestehsia：tothosecooperativeonesundergoingshort-termandsimpleoperationsgeneralanesthesia：tothoseonescan’tbeundertakenoperationsunderlocalanesthesia耳鼻喉科手術(shù)麻醉SeveralcommonENToperations*operationofear*operationofnasalcavity(鼻腔)andnasalsinus(鼻竇)*tonsillectomy(扁桃體摘除術(shù))*totalthroatresection(全喉截除術(shù))*Endoscopy(內(nèi)鏡檢查)andendoscopicsurgery(內(nèi)鏡手術(shù))耳鼻喉科手術(shù)麻醉PS：嬰幼兒氣管、支氣管異物取出術(shù)病情：急(urgent)

、重(severe)

、危(dangerous)

麻醉：全麻，配合充分表麻,要求麻醉既不加重缺氧又能迅速誘導(dǎo)至足夠深度管理：*術(shù)前:準(zhǔn)備應(yīng)迅速、利索，呼吸困難(dyspnea)的應(yīng)急處理*術(shù)中:積極防治喉、氣管、支氣管痙攣、缺氧、氣道內(nèi)出血、氣管破裂(split)或氣胸(pneumothorax)

、喉頭水腫(laryngealedema)等*術(shù)畢:充分供氧，待患者清醒良好、呼吸通暢，吸空氣SPO2基本正常后方可出手術(shù)室耳鼻喉科手術(shù)麻醉

QuestionsTrytodescribethefactorscausingarrhythmiaduringENTsurgery.

“全喉截除術(shù)”中，發(fā)生頸外靜脈破裂，除了緊急止血外還應(yīng)警惕什么情況的發(fā)生？如何處理？中耳手術(shù)時，吸入全麻的使用應(yīng)注意什么？耳鼻喉科手術(shù)麻醉THANKYOU！耳鼻喉科手術(shù)麻醉Difficultairway

*1>Difficultintubation*2>compromisedairway耳鼻喉科手術(shù)麻醉N2OandmiddleearpressureThemiddleearandparanasalsinus(鼻旁竇)arenormalbodyaircavitiesthatconsistofopen,nonventilatedspaces.Theblood/gascoefficient(系數(shù))is0.013fornitrogenversus0.46forN2O.Wheninhaledinhighconcentrations,N2Oenterstheaircavitiesfasterthannitrogencanleave.Inafixedcavitysuchasthemiddleear,theresultisanincreaseinpressure.AfterdiscontinuationofN2O,thegasisrapidlyreabsorbed,marked,negativemiddleearpressuremaydevelop.

耳鼻喉科手術(shù)麻醉Difficultintubation①anatomicabnormalities：

micrognathia(小頜),limitedjawmotion,orcongenitalsyndromes(craniofacialdysostoses<顱面骨發(fā)育不全>)etc..

②Othercauses：obesity,acromegaly(肢端肥大癥),cervicalspineproblems,rheumatoidarthritis(風(fēng)濕性關(guān)節(jié)炎),andevengastricreflux(返流)

耳鼻喉科手術(shù)麻醉CompromisedairwayPathologicconditionsabovetheglottismaypreventaclearviewoftheglotticopening,whereassubglotticlesionspermitagoodviewofthevocalcords,buttheyrequirecarefulplacementofasmallendotrachealtubeorbronchoscope.

耳鼻喉科手術(shù)麻醉Operationsofearsoperationsofearconcha(耳廓)andconchatract(外耳道)

：localanesthesia(tocooperativepatients)operationsinsideears：generalanesthesiaMicrosurgery(顯微外科手術(shù))：controlledhypotension(控制性低血壓)issometimesneededN2Oandmiddleearpressure

耳鼻喉科手術(shù)麻醉Operationofnasalcavityandnasalsinuslocalanesthesiageneralanesthesia耳鼻喉科手術(shù)麻醉耳鼻喉科手術(shù)麻醉Tonsillectomyattention：topicalanesthesiaandcoughreflexgeneralanesthesiaandthemanagementofairwayemergentsurgeryforbleedingaftertonsillectomyandtheanestheticmanagement耳鼻喉科手術(shù)麻醉bleedingafteronsillectomy

problems:hypo-volemia,fullstomach,andairwayobstruction.

inductionofanesthesia:

goodsuctioningofblood、arapid-sequenceinductionofanesthesiawithapplicationofcricoidpressureandslighthead-downpositioningofthepatientwillprotectthetracheaandglottisfromaspirationofblood.afterinduction,anasogastric(鼻胃的)tubemaybeplacedandremoved.extubation:aswithelectivetonsillectomy,extubationissafestwiththepatientawake.

耳鼻喉科手術(shù)麻醉Totalthroatresectionprotheoperation：widerange，deepreach，airwayobstructionofsomeextentanestheticmangement：generalanesthesiawithendotrachealintubationthroughtracheotomyattention：

*

reflexofcarotidsinus(頸動脈竇反射)*split(破裂)ofmainline(大靜脈)→氣栓(gasembolism)*evaluationofrespirationfunctionandcorrespondingtreatment耳鼻喉科手術(shù)麻醉EndoscopyandendoscopicsurgeryProfile：

interactionofanestheticandsurgicalmanagementwiththecompromisedairwayinconsistency(矛盾)betweentheoperationandanestheticrecovery耳鼻喉科手術(shù)麻醉Anesthesiaselectionforendoscopyandendoscopicsurgery*localanesthesia：trytoperformlocalanesthesiatothecooperativeadultpatientsespeciallytothosewithsomeextentofairwayobstructionduringshort-termoperations*generalanesthesia：mainlyfitschildrenpatients耳鼻喉科手術(shù)麻醉Generalanesthesiaforendoscopyandendoscopicsurgerywithendotrachealintubation：thintubewithoutendotrachealintubation

1>intensiveinhalationanesthesiainductioncompaniedbytopicalanesthesia

2>withathinplastictubeabovethecarina(隆突)to