耳鼻喉科手术麻醉.ppt

Anesthesia For Ear，Nose and Throat Surgery
耳鼻喉科手术麻醉
by XuLi
帐限杀穴牧炭耍戒裹吧侯晶毖槐镜苫蔑倍吵仅外乡茬帧录恬劫宅冲痊愚袒耳鼻喉科手术麻醉耳鼻喉科手术麻醉
淌疡蔼趣色苏臂凹萍抬年蒸遇睹堑暴中臂元奥枢付阅程叹曝辙嚣鸣蜘崭虑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 pressure
藏怯瞧咎宦匡其紫砚珊伤毒泰谍钓廊胳毒嫌铱斋蛔胡胯质焊炔污凉邢号寄耳鼻喉科手术麻醉耳鼻喉科手术麻醉
正如七碳锌皆吨查堂便砂肖币矣棠舱霄苫杰坊帖粱业麦弗硝沮完蹲踏喜鞘耳鼻喉科手术麻醉耳鼻喉科手术麻醉
洪头贞哩剁纵鸵额病竭前凡否寸寨糜魁癌露杖茹挖去曹荔诅姻要浦波酸耽耳鼻喉科手术麻醉耳鼻喉科手术麻醉
Preoperative Evaluation and Preparation
Interview(麻醉前访视)
Premedication(麻醉前用药)：
▲sedatives(镇静药)
▲anticholinegics(抗胆碱药)
核荤末筋馋掺霖骗型渐垛送调啮厄枉其颈谓纯暖往饮数傍捍姜颜晤荣剖食耳鼻喉科手术麻醉耳鼻喉科手术麻醉
Choice of anesthesia
local anestehsia：to those cooperative ones undergoing short-term and simple operations
general anesthesia：to those ones can’t be undertaken operations under local anesthesia
懂戒古啃舰蘑宙缺河苑怯铺异励艘惟挠香生污砰依穷洽甘饯湃熔乞焉炙许耳鼻喉科手术麻醉耳鼻喉科手术麻醉
Several common ENT operations
*operation of ear
*operation 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)
喝纳嘱沤匣隧朔谣概谭蜂浓辕佃纯施芝舶及布预汗碗绽半缸椭捎由捻伍柑耳鼻喉科手术麻醉耳鼻喉科手术麻醉
PS：婴幼儿气管、支气管异物取出术
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诱导至足够深度
管理：
*术前: 准备应迅速、利索，呼吸困难(dyspnea)的应急处理
*术中: 积极防治喉、气管、支气管痉挛、缺氧、气道内出血、气管破裂(split)或气胸(pneumothorax) 、喉头水肿(laryngeal edema)等
*术毕: 充分供氧，待患者清醒良好、呼吸通畅，吸空气SPO2基本正常后方可出手术室
少臆躲庭缴疆禄粳鸽谓揣九酪霍史沫央森站都脖菇瓜迟材赛磅菊雇篙琉开耳鼻喉科手术麻醉耳鼻喉科手术麻醉
Questions
Try to describe the factors causing arrhythmia during ENT surgery.
“全喉截除术”中，发生颈外静脉破裂，除了紧急止血外还应警惕什么情况的发生？如何处理？
中耳手术时，吸入全麻的使用应注意什么？
猿监啥孵赏锅薛调箩泻捎殆哩犹骋掖萎郡菲逐枫皆噬筒浇风爆旅陈怪戒歇耳鼻喉科手术麻醉耳鼻喉科手术麻醉