腹盆腔手术麻醉.ppt

第二十一章腹、盆腔手术的麻醉 Chapter 21 Anesthesia for operations in abdominal and pelvic cavities 第一节、腹、盆腔手术麻醉的特点 The features of anesthesia for operations in abdominal and pelvic cavities 1、腹、盆腔脏器的主要生理功能和围术期病理生理变化ans in abdominal and pelvic cavities include digestive system and genitourinary system. The main physiological functions are digestion, absorption,metabolism, elimination, immune function and secretion. The adequate preoperative preparation should be done to avoid anesthetic complications. 2、腹、盆腔手术围术期液体管理Severe bleeding(massive hemorrhage), massive loss of body fluid,internal redistribution of fluids — often called “third space ” can cause severe intravascular depletion. The fluids infusion rate is 10ml/kg/h and the crystalloid and colloid solutions should be administered properly. When the danger of anemia outweighs the risks of transfusion, further blood loss should be replaced with transfusion of red blood cells to maintain hemoglobin concentration or hematocrit . 3、手术体位(Patient ’s position in operation )对生理功能的影响截石位( Lithotomy position ) 头低位( Trendelenburg position ) Lithotomy position and Trendelenburg tilt would result in changes in pulmonary blood volume, a decrease in pliance, a cephalad shift of the diaphragm, and a decrease in lung volume parameters. Cardiac preload may increase. Nerve injuries to mon peroneal , sciatic, and femoral nerves are likely. 4、腹压对生理功能的影响Increased abdominal pressure and elevation of diaphragm lead to dyspnea . Anesthetic agents,anesthetic techniques and rapid pression exacerbate vasodilatation, decreased venous return to heart and cardiac output. The measures should be taken: Administration of IV fluids. Modulate the position. Administration of ephedrine. Avoid rapid pression. 5、腹、plete neuromuscular blocking is required in operations. 6、腹、盆腔手术中的内脏牵拉反应 Distension of viscera or traction on peritoneum may induce bradycardia , reducing of arterial