王保国神经外科麻醉研究进展课件.ppt

神经外科麻醉研究进展 首都医科大学附属北京天坛医院麻醉科 王保国 Neurosurgical Anesthesia Anesthetic Techniques Intraoperative Monitoring Induced Hypothermia Deliberated hypotension Blood Conservation Postoperative analgesia Anesthetic Techniques General Anesthesia: 90% Inhalation: 20% TIVA: 20% Inhalation + intravenous: 50% No N2O Local block + analgesia: 8% Acupuncture assisted analgesia: 2% Premedication Premedicants: Midazolam 0.06 mg/kg, iv. Famotidine 20mg or Losec 40mg, iv. Time: 15-30 min before anesthesia. Atropine 0.5 mg, iv, as needed. 长托宁经粘膜给药 神经外科手术前长托宁粘膜给药的临床研究 扈大为 王保国 采用随机、双盲、平行对照设计，对比观察不同剂量长托宁麻醉前粘膜给药对血流动力学、肌松、镇静及术中和术后腺体分泌的影响。 随机分组 C组（对照组，注射用水1ml） P1组（长托宁0.5mg） P2组(长托宁1mg) 口干程度VAS评分 术中和术后呼吸道分泌物的量 Ⅰ级：口腔干，吸引无唾液。 Ⅱ级：无唾液自口角流出，口腔吸引唾液较少。 Ⅲ级：唾液唾液较多，自口角流出，湿润床单。 肌松恢复程度比较 手术结束后气管拔管、呼之睁眼、握手、定向力恢复时间比较 长托宁术前经口、鼻粘膜给药，无明显心血管系统兴奋作用、对唾液分泌的抑制作用明显、可延长肌松剂维持时间、对其它麻醉镇静药无明显协同作用，可作为神经外科手术前用药。 全身麻醉诱导和维持 镇静催眠 镇痛 肌松 应激反应调控 内环境的调控 Induction of general anesthesia Rapid induction and tracheal intubation: Sedative and hypnotic: sodium thiopental propofol midazolam or etomidate Muscular relaxants vecuronium, pipecuronium, atracurium, pancuronium, or succinylcholine. Fentanyl, 4~8 ug/kg, Laryngeal and tracheal local spray: 1% dicaine (tetracaine) Induction of General Anesthesia Intubation with spontaneous breathing under neuroleptanalgesia +local anesthesia Sedative and hypnotic: midazolam 2~5mg iv Sodium hydroxybutyrate (?-OH) 80~100 mg/kg, iv Fentanyl, 4~6 ug/kg, iv Droperidol 5mg, iv Laryngeal and tracheal local spray: 1% dicaine (tetracaine) Indications: Full stomach Surgery on brain stem needed spontaneous breathing. Maintenance of general anesthesia Inhalation: Isoflurane, sevoflurane. 1.0 MAC is suitable. Low flow or closed circuit anesthesia. Narcotic is needed before stronger stimulation. Enflurane is not recommended. Maintenance of general anesthesia Total Intravenous Anesthesia (TIVA) Propofol, 6-8mg/kg/h Opioids before stronger surgical stimulation Nicardipine a