耳鼻喉科手術(shù)麻醉.ppt

1、Anesthesia For Ear，Nose and Throat Surgery,耳鼻喉科手術(shù)麻醉,by XuLi,Profile and Demands,difficult airway,cardiac arrhythmia：applicattion of Epinephrine, reflex of carotid sinus, etc.,N2O and middle ear pressure,Preoperative Evaluation and Preparation,Interview(麻醉前訪視) Premedication(麻醉前用藥)： sedatives(鎮(zhèn)靜藥) ant

2、icholinegics(抗膽堿藥),Choice of anesthesia,local anestehsia：to those cooperative ones undergoing short-term and simple operations general anesthesia：to those ones cant be undertaken operations under local anesthesia,Several common ENT operations,*operation of ear,*operation of nasal cavity(鼻腔) and nasa

3、l sinus(鼻竇),*tonsillectomy(扁桃體摘除術(shù)),*total throat resection(全喉截除術(shù)),*Endoscopy(內(nèi)鏡檢查)and endoscopic surgery(內(nèi)鏡手術(shù)),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

4、頭水腫(laryngeal edema)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,Questions,Try to describe the factors causing arrhythmia during ENT surgery. “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(shí)，吸入全麻的使用應(yīng)注意什么？,THANK YOU！,Difficult airway,*1Difficult intubation,*2compromised airway,N2O and middle ear press

5、ure,The middle ear and paranasal sinus(鼻旁竇) are normal body air cavities that consist of open, nonventilated spaces. The blood/gas coefficient(系數(shù)) 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 ca

6、vity such as the 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(小頜), limited jaw motion, or congenital syndromes (craniofacial

7、dysostoses) etc. Other causes：obesity, acromegaly(肢端肥大癥), cervical spine problems, rheumatoid arthritis(風(fēng)濕性關(guān)節(jié)炎), and even gastric reflux(返流),Compromised airway,Pathologic conditions above the glottis may prevent a clear view of the glottic opening, whereas subglottic lesions permit a good view of th

8、e vocal 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 ears：general anesthesia Microsurgery(顯微外科手術(shù))：controlled hypotension(控制性低血

9、壓) is sometimes needed N2O and middle ear pressure,Operation of nasal cavity and nasal sinus,local anesthesia general anesthesia,Tonsillectomy,attention： topical anesthesia and cough reflex general anesthesia and the management of airway emergent surgery for bleeding after tonsillectomy and the anes

10、thetic management,bleeding 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 of cricoid pressure and slight head-down positioning of the patient will protect the

11、 trachea and glottis from aspiration of blood. after induction, a nasogastric(鼻胃的) tube may be placed and removed. extubation: as with elective tonsillectomy, extubation is safest with the patient awake.,Total throat resection,profile of the operation：wide range，deep reach，airway obstruction of some

12、 extent anesthetic mangement：general anesthesia with endotracheal intubation through tracheotomy attention： * reflex of carotid sinus(頸動(dòng)脈竇反射) *split(破裂) of main line(大靜脈)氣栓(gas embolism) *evaluation of respiration function and corresponding treatment,Endoscopy and endoscopic surgery,Profile： interac

13、tion of anesthetic and surgical management with the compromised airway inconsistency(矛盾) between the operation and anesthetic recovery,Anesthesia selection for endoscopy and endoscopic surgery,*local anesthesia：try to perform local anesthesia to the cooperative adult patients especially to those wit

14、h some extent of airway obstruction during short-term operations,*general anesthesia：mainly fits children patients,General anesthesia for endoscopy and endoscopic surgery,with endotracheal intubation：thin tube without endotracheal intubation 1intensive inhalation anesthesia induction companied by topical anesthesia 2 with a thin plastic tube above the cari