临床麻醉学_第22章_口腔颌面外科手术的麻醉_.pptVIP

第二节　麻醉选择及常用麻醉方法The anesthetic choices and common anesthetic methods 凡手术创伤大、手术出血多、手术时 间长、儿童及不合作的成年人、术者在术 中难以保持呼吸道通畅、以及有可能发生 反流误吸的病人，均选用全身麻醉 麻醉前访视 了解手术部位 了解病变累及气道的情况 了解鼻、口腔和头颈部情况 有无合并症 确定插管途经及方式 麻醉前用药 镇静药(sedatives) 抗胆碱药( anticholinegics） 麻醉选择及注意事项 局部麻醉 全身麻醉 全身麻醉与外周神经阻滞联合 第三节　麻醉管理与麻醉后处理 Management during and after anesthesia 一) 麻醉管理 During anesthesia (1)气道 Ensure the airway Causes of airway obstructions are: Tongue falling down, laryngo spasm, bronchiospasm ,secretions、blood、debris drain into larynx, tracheal tube kinking 整容术中死亡，原因？ (2) 术中监测 较大手术，需增加特殊监测（如中心静脉 压、有创血压、颅内压、心输出量等）  20bpm The criteria of satisfied ventilation: 　　Spo2 98-100% PEt CO2 30-45mmHg 　　 　　Blood-gas analysis 　　TV 8-10ml/kg (Neonate 6-7ml/kg) 　　Rf 12/min (Neonate Rf ) 二 ) 麻醉后管理 Management after anesthesia 气管导管拔出与否？（拔管后气道能否通畅？有无外科禁忌及气道结构改变？） 拔管前准备好困难气道处理措施 拔管后喉痉挛的预防与处理 拔管指征： ①患者完全清醒 ②潮气量和分钟通气量基本正常 ③SPO295% ④无肌松残余 术后恶心呕吐 （post-operative nausea and vomit,PONV) 术后镇静和镇痛 急性喉痉挛的处理 为拔管后严重的气道并发症，多见于小儿。 处理：争分夺秒 立即吸出声门和会厌附近分泌物；纯氧行持续 气道正压；排除机械性梗阻；小剂量异丙酚加深麻醉；甚至短效肌松药改善氧和或插管 知识回顾Knowledge Review * Pelvic girdle pain From Wikipedia, the free encyclopedia Jump to:navigation, search This articles tone or style may not be appropriate for Wikipedia. Specific concerns may be found on the talk page. See Wikipedias guide to writing better articles for suggestions. (January 2010) Pregnancy related Pelvic Girdle Pain (PGP) causes pain, instability and limitation of mobility and functioning in any of the three pelvic joints. PGP has a long history of recognition, mentioned by Hippocrates.[1] and later described in medical literature by Snelling.[2] The affection appears to consist of relaxation of the pelvic articulations, becoming apparent suddenly after parturition or gradually during pregnancy and pe