6.administration of general anesthesia全身麻醉应用.ppt

what do you see in the picture? An anesthesia machine A beautiful and smart anesthetist Administration of General Anesthesia Xiao Ying （肖颖） The First Affiliated Hospital of Sun Yat-sen University Mar 2010 Overview What is general anesthesia? Preoperative preparation Induction: going off to sleep Maintenance: keeping pt asleep Emergence: waking up Transport What is general anesthesia Primary goals Safety is top priority Amnesia: no memory of the event Hypnosis: unconcious Analgesia: free of pain Block certain autonomic reflexes Optimal surgical conditions: immobolity What is general anesthesia Secondary goals Medical condition Surgical procedures Surgical settings Examples for secondary goals Patients with CAD: Oxygen supply-demand balance Neurosugery: ICP control, brain relaxation and CPP maintenance Obstetrics: anesthetics and fetal depression, difficult airway Day surgery vs Inpatient: which kind of analgesic you should choose to minimize postoperative pain and decrease PONV? Preoperative preparation Preoperative evaluations Airway examination Interim changes in pt’s condition Medications Laboratory data Consultant notes Last oral intake Preoperative preparation Intravascular volume Dehydration: adequately hydrate the pt before induction Intravenous access Preoperative medications Anxiety Benzodiazepine: Midazolam Opioid: Morphine or Fentanyl Neutralize gastric acid and decrease gastric volume Which kind of pt is at increased risk of aspiration of gastric content? Recent meal Trauma Bowel obstruction Pregnancy History of gastric surgery Increased intra-abdominal pressure History of active reflux Monitoring Induction Let the pt go off to sleep Induction techniques Intravenous: the most common method Inhalation: for special pt (pt with difficult airway, pediatric pt) Intramuscular :rarely used,only used in uncooperative pts and young children Airway management ASA Closed Claims St