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1、.,1,Introduction of Clinical Anesthesia,王昌文 2014.01.09,.,2,Concept,Using Drugs or other methods Central Nerve System or peripheral nerve system Losing sense, painless and comfortable, temporarily,.,3,What can you do for your future?,expertise in resuscitation fluid replacement airway management oxyg
2、en transport operative stress reduction postoperative pain control ICU,.,4,Archaic anesthesia,Stone Age: spicula analgesia Acupuncture Traditional medicine Pressure Cryotherapy And others,.,5,History of anesthesiology,1846 public demonstration of ether anesthesia by William T. G. Morton,.,6,Mortons
3、ether inhaler (1846),.,7,John Snow, the first anesthesiologist（1846）,.,8,Machine of Inhalational anesthesia in 1847,Face mask(1847),.,10,History of inhalation,.,11,Anesthesia machine (1930),.,14,.,15,.,16,Intravenous anesthetics,1934: thiopental 1959: diazepam 1960: hydroxybutyrate, r-OH 1970: ketam
4、ine 1972: etomidate 1976: midazolam 1983: propofol,.,17,Others,Opioids Morphine, fentanyl, sufentanil, alfentanil, remifentanil Relaxants Curare, succinylcholine, pancuronium, vecuronium, atracurium, rocuronium, mivacurium, at al.,.,18,Local anesthetics,1884：Cocaine as ophthalmic anesthesia, nerve b
5、lock 1885：Epidural anesthesia 1898: Spinal anesthesia 1901：Caudal anesthesia 1905：Procaine 1930：Dibucaine 1932：Dicaine 1943：Lidocaine 1996: Ropivacaine,.,19,Developing of Clinical Anesthesiology,80年代 90年代 21世纪,BP,Pulse,ABP,CVP,S-G catheter,ECG,Temp.,ABP、 CVP,PETCO2 Anesthesia-gases,ECG,No-invasive B
6、P,SPO2,TEE,BIS,TOF,CCO,Work station,.,20,How about our department of anesthesiology?,1956：surgeon 1957：anesthesia group 60-70：epidural, spinal, nerve block 70-80：CPB, intravenous anesthesia, and inhalational anesthesia 80-85: intravenous anesthesia, inhalational anesthesia, ECG, arterial blood press
7、ure, CVP, S-G 80-90：inhalational anesthesia with timing injection of volatile anesthetics 90-prsent：depth of anesthesia, balance anesthesia PETCO2 work-station, BIS, TOF, PiCCO 21 century Key dept. & key lab. of province, pain clinical ward,.,21,Popular anesthesia words,ASA physical status classific
8、ation system TOF: train of four BIS: bispectral index SG: Swan Ganz catheter MAC: minimum alveolar concentration TEE: transesophageal echocardiography,.,22,The working field of Anesthesiologists,Clinic anesthesia Operating room, PACU, outpatient, CPCR (cardiopulmonary cerebral resuscitation) CCM (cr
9、itical care medicine) Analgesia Pain clinic, postoperative analgesia, others Others Research, education, training,.,23,How can you become a real anesthesiologist,purpose Basic knowledge Profile of whole body systems Using your potential Renew and update, uninterruptedly Communication,.,24,.,25,Anest
10、hesia methods,general,local,inhalation,intravenous,mucosa,muscle,spinal,epidural,Nerve block,Local infiltration,topical,balance,.,26,Subspecialty of anesthesiology,Cardiac surgery Vascular surgery Thoracic surgery Neurosurgical anesthesia Organ transplantation Pediatric surgery Obstetric anesthesia
11、And others,.,27,Preoperational evaluation for patient status,.,28,Procedure of clinical anesthesia,Pre-ope,preparation,introduction,Special monitoring,Maintain,PACU,.,29,Preope. Physical assessment,To visit patient in preoperation What is anesthesiologist to visit Checking whole body and assessing f
12、unctions of main organs To confirm the risk factor ASA classification,.,30,ASA Physical Status Classification System,A normal healthy patient A patient with mild systemic disease A patient with severe systemic disease A patient with severe systemic disease that is a constant threat to life A moribun
13、d patient who is not expected to survive without the operation A declared brain-dead patient whose organs are being removed for donor purposes,.,31,visiting with the patient preoperative,To receive the patient history data To relieve patients worrying status Review of current drug therapy Physical e
14、xamination, interpretation of laboratory data Find out risk factor Preposed anesthesia method,.,32,问诊表,麻醉史（全、椎管内、局），术中异常反应 既往史 过敏、哮喘、呼吸疾病、高血压、心脏病，肝脏、肾脏病，糖尿病，神经、肌肉疾病，出血倾向，癫痫，其他特殊情况 日常活动 药物史 个人嗜好：吸烟（量）、饮酒（量） 家族史 恶性高热、过敏、哮喘、高血压、糖尿病、肝病,.,33,.,34,Physical exam.,General status：发育、营养、精神状态等 血压、脉搏、体温 头部：眼、鼻、
15、口腔、下颌，中枢神经系统情况 颈部：活动度、长短、甲状腺大小等，颈静脉 胸部：望、触、叩、听，心电、血气、1秒率 腹部：望、触、叩、听，肝、肾、脾、胃肠功能 四肢：活动情况、感觉情况，动脉、静脉情况 背部：椎管内麻醉或其他麻醉方法要求的,35,.,实验室检查,末梢血 胸部X线 生化指标 血离子 尿常规 血型、凝血、出血时间 心电图 肺功能检查 腹部X线 感染症,36,.,全身情况的检查,发育、营养、体重 体重指数（BMI） 体重（kg）身高(m)2 基础代谢率（BMR） 0.75（脉率0.74 脉压）72,.,37,高血压标准(舒张压),轻度：90100 mmHg 中度：100110 mmHg
16、 重度：110 mmHg,.,38,头部,眼部：结膜、巩膜、瞳孔、眼球运动、眼睑 鼻腔：鼻孔大小 、通畅程度，有无出血倾向 口腔：张口度、牙齿、舌、咽腔、扁桃体 发音：有无异常,.,39,气道检查,.,40,颈部,长短、粗细 活动度、后仰 有无异常隆起或异常搏动 血管情况 气管是否居中 淋巴结有无肿大,.,41,胸部检查,望：对称、呼吸运动 触：皮下气肿、细震颤 叩：心界、肺区、肝区，胸水 听：心音、呼吸音，摩擦音等 心电图：12导联，连续监测 -ray, CT, MRI,.,42,腹部检查,望：外形，运动 触：紧张度、压痛，肝脾大小 叩：浊音 听：肠音，血流 B超 CT,.,43,脊柱,有无感染灶，出血点等 有无侧弯，异常突出 活动度 压痛、叩击痛,.,44,四肢检查,皮肤感觉 活动 温度 指(趾)甲颜色及血流充盈情况 动脉搏动情况，侧支循环情况 病理反射,脊神经的体表标志,.,46,实验室检查,血气分析 心电图 心功能 生化检查 肝功能 肾 内分泌 水、电解质和酸碱平衡,.,47,动脉正常血
