耳鼻喉科手术麻醉.ppt

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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 PreparationInterview(麻醉前访视)Premed

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

3、eration 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病 情情：急急(urgent)、重重(severe)、危危(dangerous)麻麻醉醉：全全麻麻，配配合合充充分分表表麻麻,要要求求麻麻醉醉既既不不加加重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管理：管理：*术术前前:准准备备应应迅迅

4、速速、利利索索，呼呼吸吸困困难难(dyspnea)的应急处理的应急处理 *术术中中:积积极极防防治治喉喉、气气管管、支支气气管管痉痉挛挛、缺缺氧氧、气气 道道 内内 出出 血血、气气 管管 破破 裂裂(split)或或 气气 胸胸(pneumothorax)、喉喉头头水水肿肿(laryngeal edema)等等 *术术毕毕:充充分分供供氧氧，待待患患者者清清醒醒良良好好、呼呼吸吸通通畅畅，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 QuestionsTry to describe the factors causing arrhythmia during ENT sur

5、gery.“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 paranasal sinus(鼻旁窦鼻旁窦)are normal body air cavities that cons

6、ist 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 middle ear,the result is an increase in pressure.After discontinuatio

7、n of N2O,the gas is rapidly reabsorbed,marked,negative middle ear pressure may develop.Difficult intubationanatomic abnormalities：micrognathia(小颌小颌),limited jaw motion,or congenital syndromes(craniofacial dysostoses)etc.Other causes：obesity,acromegaly(肢端肥肢端肥大症大症),cervical spine problems,rheumatoid a

8、rthritis(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 vocal cords,but they require careful placement of a small endotracheal tube or bronchosco

9、pe.Operations of earsoperations of ear concha(耳廓)and concha tract(外耳道)：local anesthesia(to cooperative patients)operations inside earsoperations inside ears：general anesthesiaMicrosurgery(显微外科手术)：controlled hypotension(控制性低血压)is sometimes neededN N2 2O and middle ear pressureO and middle ear pressur

10、e Operation of nasal cavity and nasal sinuslocal anesthesiageneral anesthesiaTonsillectomyTonsillectomyattention：topical anesthesia and cough reflexgeneral anesthesia and the management of airwayemergent surgery for bleeding after tonsillectomy and the anesthetic managementbleeding after onsillectom

11、ybleeding 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 trachea and glottis f

12、rom 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 throat resectionprofile of the operation：wide range，deep reach，airway obstruction of some extentanesthetic mangement

13、：general anesthesia with endotracheal intubation through tracheotomyattention：*reflex of carotid sinus(颈动脉窦反射颈动脉窦反射)*split(破破裂裂)of main line(大大静静脉脉)气气栓栓(gas embolism)*evaluation of respiration function and corresponding treatmentEndoscopy and endoscopic surgeryProfile：interaction of anesthetic and s

14、urgical management with the compromised airway inconsistency(矛盾)between the operation and anesthetic recoveryAnesthesia selection for endoscopy and endoscopic surgery*local anesthesia：try to perform local anesthesia to the cooperative adult patients especially to those with some extent of airway obs

15、truction during short-term operations*general anesthesia：mainly fits children patientsGeneral anesthesia for endoscopy and endoscopic surgerywith with endotracheal intubation：thin tubewithout 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)