肥胖门诊麻醉幻灯片课件.pptVIP

Airway Management Because BMI alone is not a predictor of difficult intubation（由于BMI并 不能单独作为困难插管的指标）, ‘awake’ tracheal intubation may not always be necessary（清醒插管不总是必须的）. Nevertheless, OSA has been reported to be a predictor of difficult airway （OSA是作为困难气道的指标之一） Predictors of difficult tracheal intubation include high Mallampati score (III or IV), neck circumference（颈 围） ≥40 cm, limited mandibular protrusion（短下颌）, and severe OSA \ (AHI ≥40). Airway Management The availability of videolaryngoscopes has increased the success of tracheal intubation（可视喉镜可以提高插管的成功率）. A recent study in morbidly obese reported that the awake videolaryngoscopy after topical anesthesia can be considered as an alternate to awake fiberoptic tracheal intubation （局部麻醉下后清醒可视喉镜插管 可以作为清醒纤支镜插管的替代品之一） Induction of General Anesthesia Recent studies, in morbidly obese patients, have shown that the barrier pressure (lower esophageal pressure – gastric pressure) remains positive throughout induction of anesthesia屏障压力（食道下段压力-胃内压）在麻醉诱导的过程中仍然维持作用）. This suggests that the risk of gastric regurgitation in the morbidly obese is similar to that in the non-obese patients（提示病态肥胖病人的返流风险并 没有比其他病人更高）. Most anesthesia drugs including intravenous anesthetic drugs and opioids should be dosed according to lean body weight (not actual body weight)（包 括静脉麻醉药和阿片类在内的大多数麻醉药应该依据去脂体重计算）, except for neuromuscular blocking drugs, which should be dosed according ideal body weight（除了依据理想体重计算的肌松药）. 全麻诱导 Maintenance of General Anesthesia Several studies have reported that in the morbidly obese, Compared with sevoflurane, desflurane allows earlier ability to swallow water without coughing or drooling（和七氟醚相比，地氟醚允许病人出现更早的吞咽动 作）, suggesting an earlier return of protective airway reflexes（提示病人更 早恢复气道保护反射）. A recent study used anesthesia information management system as well as metaanalysis of 29 randomized controlled trials comparing desflurane and sevoflurane to de