administrationofgeneralanesthesia全身麻醉应用

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1、whatdoyouseeinthepicture?AnanesthesiamachineAbeautifulandsmartanesthetistAdministrationofGeneralAnesthesiaXiaoYing（肖颖）TheFirstAffiliatedHospitalofSunYat-senUniversityMar2010OverviewWhatisgeneralanesthesia?PreoperativepreparationInduction:goingofftosleepMaintenance:keepingp

2、tasleepEmergence:wakingupTransportWhatisgeneralanesthesiaPrimarygoalsSafetyistoppriorityAmnesia:nomemoryoftheeventHypnosis:unconciousAnalgesia:freeofpainBlockcertainautonomicreflexesOptimalsurgicalconditions:immobolityWhatisgeneralanesthesiaSecondarygoalsMedicalconditionSu

3、rgicalproceduresSurgicalsettingsExamplesforsecondarygoalsPatientswithCAD:Oxygensupply-demandbalanceNeurosugery:ICPcontrol,brainrelaxationandCPPmaintenanceObstetrics:anestheticsandfetaldepression,difficultairwayDaysurgeryvsInpatient:whichkindofanalgesicyoushouldchoosetomini

4、mizepostoperativepainanddecreasePONV?PreoperativepreparationPreoperativeevaluationsAirwayexaminationInterimchangesinpt’sconditionMedicationsLaboratorydataConsultantnotesLastoralintakePreoperativepreparationIntravascularvolumeDehydration:adequatelyhydratetheptbeforeinductio

5、nIntravenousaccessPreoperativemedicationsAnxietyBenzodiazepine:MidazolamOpioid:MorphineorFentanylNeutralizegastricacidanddecreasegastricvolumeWhichkindofptisatincreasedriskofaspirationofgastriccontent?RecentmealTraumaBowelobstructionPregnancyHistoryofgastricsurgeryIncrease

6、dintra-abdominalpressureHistoryofactiverefluxMonitoringStandardmonitoringforGAECGNBPPulseoximetryCapnographyOxygenanalyzerInductionLettheptgoofftosleepPreoxygenation8L~10L/minIVorInhalationalinductionAirwaymanagementInductiontechniquesIntravenous:themostcommonmethodInhalat

7、ion:forspecialpt(ptwithdifficultairway,pediatricpt)Intramuscular:rarelyused,onlyusedinuncooperativeptsandyoungchildrenAirwaymanagementASAClosedClaimsStudy(美国麻醉学会已结案的诉讼）35%ofclaimsareRESPIRATORYevents90%resultedinbraindamageordeath90%resultedfromDifficultyinINTUBATIONorEXTU

8、BATIONAirwaymanagementAirwaypatencyiscriticallyimportantOralairwayNasophryngealairwayLary