静脉全麻.ppt
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1、第八章 静脉全身麻醉 Intravenous anesthesia,1. Introduction,Definition General anesthesia maybe produced by many drugs which are administered via intravenous injection and depress the central nervous system., Rapid induction of anesthesia Non-irritant to the respiratory tract No environmental pollution Making
2、 patient comfortable Rapid recovery Simply to use,Advantages, No muscle relaxation Poor control Poor analgesia,Disadvantages, Intravenous basal anesthesia Intravenous induction of anesthesia Intravenous maintenance of anesthesia,Classifications, Bolus induction of anesthesia, minor operation Intermi
3、ttent injection Continuous infusion Target-controlled infusion(TCI),Methods,2. Intravenous Anesthesia of Thiopentone Sodium,Methods, Bolus(2-2.5%) short procedures or induction of anesthesia adults: 2.54.5 mg/kg young children: 5-6 mg/kg elder: 2.5-3 mg/kg Basal anesthesia for children : 2.5%, 15-20
4、 mg/kg, i.m - induce sleep in 5 min 5-10%, 44 mg/kg, rectal administration - induce sleep in 10-15 min, intermittent injection,首次3-5ml,递增5-10ml,意识消失,睫毛反射消失,疼痛刺激无反应,开始手术 每2-3分钟,注药1-2ml 成人总量0.5g,最大剂量0.75-1.0g, Continuous infusion, 辅助麻醉,解痉、控制惊厥 0.1%-0.5%,20-100滴/分钟滴注 蓄积、中毒,Indications, Induction Mainte
5、nance Basal narcosis Treatment of status epilepticus and convulsion Assistant of other anesthesia Reduction of intracranial pressure,Absolute Contraindications, Airway obstruction Porphyria Previous hypersensitiving reaction,Precautions, Cardiovascular disease (hypovolaemia, myocardial disease, card
6、iac valvular stenosis ) Severe hepatic disease Renal disease Muscle disease Reduced metabolic rate,Precautions, Obstetrics Outpatient anesthesia Adrenocortical insufficiency Extremes of age(neonate, infant) Asthma,Complications, Phlebitis Tissue necrosis Intra-artery injection: endarteritis Severe c
7、ardiovascular and respiratory depression Allergic reaction Laryngeal spasm Bronchospasm Coughing and hiccups,3. Intravenous Anesthesia of Ketamine,Methods,肌肉注射法(intramuscular injection ) Children 4-6 mg/kg,1year increased to 10mg/kg 1-5min起效,维持15-25分钟 追加首量1/21/3 静脉注射法(intravenous injection) 首量 1-2mg
8、/kg,1-2min起效,维持5-10min 追加:首量的1/2或全量 总量 6mg/kg,连续静脉输注法 (continuous intravenous injection) 1-2mg/kg induction,0.1% ketamine,iv by drip,maintenance of anesthesia, 氯胺酮亚分离麻醉 (analgesia without loss of consciousness ) 0.5(0.25-0.5)mg/kg,iv 50 ng/kg/min,Indications, Superficial operation with minor and sho
9、rt procedure Basal narcosis in children for regional anesthesia (pediatric anesthesia) Induction of anesthesia for children, shock or hypovolemia patient Assistant of epidural anesthesia or nerve block(analgesia and sedation) Elderly or high-risk patient: may stable circulatory and respiratory syste
10、m function Anesthesia for asthmatic patients,Absolute Contraindications, Airway obstruction Raised intracranial pressure,Precautions,Hypertension Cardiovascular disease,cardiac failure and angina Prolonged operations Hyperthyroid and chromaffinoma epilepticus and mental confusion,Complications,Blood
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