Anesthesia For Ear,Nose and Throat Surgery.ppt

Anesthesia For Ear，Nose and Throat Surgery 耳鼻喉科手术麻醉 Profile and Demands 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 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 Several common ENT operations 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 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？ Difficult airway *1 Difficult intubation N2O and middle ear pressure The middle ear and paranasal sinus 鼻旁窦 are normal body air cavities that consist of open, nonventilated spaces. The blood/gas coefficient 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 discontinuation of N2O, the gas is rapidly reabsorbed, marked, negative middle ear pressure may develop. Difficult intubation ①anatomic abnormalities： micrognathia 小颌 , limited jaw motion, or congenital syndromes craniofacial dysostoses etc.. ②Other causes：obesity, acromegaly 肢端肥大症 , cervical spine problems, rheumatoid arthritis 风湿性关节炎 , and even gastric reflux 返流 Compromised airway Pathologic 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 bronchoscope.  Operations of ears operations of ear concha 耳廓 and concha tract 外耳道 ：local anesthesia to cooperative pat