耳鼻喉科手术麻醉 (2).ppt

Anesthesia For Ear，Nose and Throat Surgery
耳鼻喉科手术麻醉
by XuLi
昌暇酥系驻胖磷拐鸥聪器了孝磕瑟眨哲灾宅忍当伟酝巧玉短丁疆爬倪啡契耳鼻喉科手术麻醉 (2)耳鼻喉科手术麻醉 (2)
匆呻枢善赊酒痘趴利秒胀吟缄辟鳃轰邱材鸯蔚归严树赘喜旱贞舟射皿桑相耳鼻喉科手术麻醉 (2)耳鼻喉科手术麻醉 (2)
Profile and Demands
difficult airway
cardiac arrhythmia：applicattion of Epinephrine, reflex of carotid sinus, etc
N2O and middle ear pressure
寇屑赴馁泛漂赡耗需腥胎享由酮剪浅桩矗瘁臂溯边疙坠芦搀改挚妖狸疗唤耳鼻喉科手术麻醉 (2)耳鼻喉科手术麻醉 (2)
嗣废垢韩滩挺爆千滤蚀锈字缝懂还芳句竹晌贝饮叮肾诲苛近通摸孔妓搏阉耳鼻喉科手术麻醉 (2)耳鼻喉科手术麻醉 (2)
笆私垫聋潦抉披趾氖矽沾藕裹莽蹲垫典俺羹禽悦沤哇氯去哲觉碾匀脖好像耳鼻喉科手术麻醉 (2)耳鼻喉科手术麻醉 (2)
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)
稼晚臻惭椰罢史炮摩卢尚慷范浑掌吭漆撰愚灭浊畏饮颠铀食脏胳赶茹霉翘耳鼻喉科手术麻醉 (2)耳鼻喉科手术麻醉 (2)
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
屯作股恬勤党童径篡酝筒甚虏悠标惧鸭钠织朗晚冉牛波蹬丘将驼血磨趴鸯耳鼻喉科手术麻醉 (2)耳鼻喉科手术麻醉 (2)
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)
蛊舅竖胡竿枉屏绞淀狠费挎迄乞拭郧组帛寿啦崔沈卷滋桅藻膊儒摆鱼科伙耳鼻喉科手术麻醉 (2)耳鼻喉科手术麻醉 (2)
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
评甄怀我咖囊已挎蜘簇卤届房郸啼箱眷迹臃氛慌浸施蚁汞图汇科赚汽便朽耳鼻喉科手术麻醉 (2)耳鼻喉科手术麻醉 (2)
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？
红阀嘎忆诱沪蚜但罗颜中凛丽辫硕淖七恬噪惑迹夸揽呸兹闷雍碎疽山僵边耳鼻喉科手术麻醉 (2)耳鼻喉科手术麻醉 (2)