胸腹主动脉瘤手术的麻醉处理.pptVIP

Procedures performed before surgery starts: 1.A suitable vein or veins are cannulated with at least one 14-gauge cannula for infusion of warmed fluids. 2.Cannulation of a radial artery. 3.Central venous catheterization for measure- ment of right atrial pressure. 4.An oesophageal or tympanic membrane temperature probe is inserted for measure- ment of temperature. 5.The bladder is catheterized for monitoring of urine output. * Key points during anesthesia and operation procedure. 1.Tracheal intubation To maintain systemic arterial pressure stable. (Dopamine or Noradrenalin) The double lumen tubes are necessary for some thoracic approach operations * * * 2.Crossclamping of the aorta ★a sudden increase in systemic vascular resistance (afterload): cardiac work increase myocardial ischaemia ★the large bowel and lower limbs suffer variable degrees of hypoxia: inflammatory mediators released oxygen radicals neutrophil proteases platelets activating factor cyclo-oxygenase products cytokines * 3.Aoric declamping ★a sudden decrease in afterload with reperfusion of the bowel, pelvis and lower limbs. vasodilatation metabolic acidosis capillary permeability increased blood cells sequestrated in the lungs * 4.The large heat loss Many patients undergoing this operation are elderly and have a low metabolic rate. All possible measures must be taken to minimize heat loss. (1)Warming of infusion fluids (2)Warming and humidification of anesthetic gases (3)Use a warming blanket (4)Wrapping the bowel in a clear plastic bag (5)The operating theatre * Organ protection Vascular dis