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1、1,General Anesthesia in oral and maxillofacial surgery,Wenguo Fan(范文国：)Department of Anesthesiology, The Affiliated Hospital of Stomatology, Sun Yat-sen University,2,What is general anesthesia(GA)?,GA is anesthetics-induced reversible suppression on CNS.,3,What is general anesthesia(GA)?,GA has the
2、following manifestations : Essential Components of Anesthesia A. pain relief (analgesia) B. blocking memory of the procedure (amnesia) C. producing unconsciousness (Hypnosis) D. inhibiting normal body reflexes to make surgery safe and easier to perform E. relaxing the muscles of the body,General Ane
3、sthesia, Sleep, and Coma. N Engl J Med. 2010 December 30; 363(27): 26382650,4,What is general anesthesia(GA)?,GA was absent until the mid-1800s William Morton administered ether to a patient having a neck tumor removed at the Massachusetts General Hospital, Boston, in October 1846. The discovery of
4、the diethyl ether as GA was the result of a search for means of eliminating a patients pain perception and responses to painful stimuli.,(CH3CH2)2O,What is general anesthesia(GA)?,Leg amputation prior to introduction of GA,5,What is general anesthesia(GA)?,Safety of GA Perioperative Mortality (2010
5、to 2014) : 2,866,141 cases and 944 deaths (33 per 100,000). Anesthesia-related Mortality: 1/13881/857081/50000 (in China),6,(Whitlock, Feiner et al. 2015),7,What is general anesthesia(GA)?,Development of Anesthesia First noteworthy step in modern anesthesia: 19th century Medical Milestones - The Pas
6、t 500 Years The New England Journal of Medicine (2008),8,GA in oral and maxillofacial surgery,9,Indications of oral and maxillofacial surgery Extractions of decayed teeth that cannot be restored Surgical removal of impacted teeth Extraction of nonvital teeth Preprosthetic surgery to smooth and conto
7、ur the alveolar ridge Removal of teeth for orthodontic treatment Removal of root fragments,GA in oral and maxillofacial surgery,10,Indications of oral and maxillofacial surgery Removal of cysts and tumors Biopsy Treatment of fractures of the mandible or maxilla Surgery to alter the size or shape of
8、the facial bones Surgery of the temporomandibular joint Reconstructive surgery Cleft lip and cleft palate repairs Salivary gland surgery Surgical implant procedures,GA in oral and maxillofacial surgery,11,GA in oral and maxillofacial surgery,Characteristic 1： Anesthesia and performing surgery interf
9、ere with each other.,12,GA in oral and maxillofacial surgery,Characteristic 1： Anesthesia and performing surgery interfere with each other.,13,Anesthesia for oral and maxillofacial surgery,Characteristic 2：Its difficult to keep airway unobstructed. The patientsOperative site （aspiration pneumonia）Op
10、erator,14,Anesthesia for oral and maxillofacial surgery,Characteristic 2： .,15,Anesthesia for oral and maxillofacial surgery,Characteristic 2： Difficult airway ASA: when sign of inadequate ventilation could not be reversed by mask ventilation or oxygen saturation could not be maintained above 90% or
11、if a trained Anaesthetist usinig conventional larangoscope takes more than 3 attempts or more than 10 minutes are required to complete tracheal intubation.,16,GA in oral and maxillofacial surgery,Characteristic 3： The high proportion of pediatric and old patientsCharacteristic 4： Be associated with
12、more surgical bleeding,17,18,GA in oral and maxillofacial surgery,Characteristic 4： Bleeding: 9500mlBlood TransfusionRBC34u， blood plasma 3200ml, Transfusion:8000ml Others,19,20,GA in oral and maxillofacial surgery,Characteristic 5： Respiratory complications are more common during anesthesia recover
13、y period.Monitoring of SpO2,ECG,Pet-CO2,BP,21,GA in oral and maxillofacial surgery,National Board Dental Examination,22,Methods of GA in oral and maxillofacial surgery,23,GA in oral and maxillofacial surgery,Anesthetics divide into 2 classes Inhalation Anesthetics Gasses Usually Halogenated Intraven
14、ous Anesthetics Injections Anesthetics or induction agents,24,GA in oral and maxillofacial surgery,Anaesthesias methods Inhalation anesthesia; Intravenous anesthesia Combined intravenous and inhaled anesthesia (CIIA) Total intravenous anesthesia (TIVA),25,Inhalation anesthesia,Through airway Mainten
15、ance (most); induction (some) Mechanism: interact with the brain cell membrane, details are not clear,26,Inhalation anesthesia,MAC (minimum alveolar concentration)The concentration (at 1atm) required to prevent movement in 50% of subjects following a surgical stimulus. (50%Effect Dose/ED50)Oil-gas p
16、artition coefficientAnesthetic potencyMACMAC is also an index for depth of anesthesia,27,How to determine its controllability?,Blood-gas partition coefficient (solubility)The lower the blood-gas partition coefficient the easier for the partial pressure in alveolar, blood and brain to get equilibriumthe easier to control its concentration in brain,28,Physicochemical property,(1) oil-gas partition coefficientanesthetic potency MAC(2) blood-gas partition coefficientcontrollability,
