昆医大临床麻醉学课件02临床麻醉简介及麻醉前病人身体评估

Introduction of Clinical AnesthesiaDepartment of AnesthesiologyConceptn nUsingDrugsorothermethodsn nCentralNerveSystemorperipheralnervesystemn nLosingsense,painlessandcomfortable,temporarilyWhat can you do for your future?n nexpertiseinresuscitationn nfluidreplacementn nairwaymanagementn noxygentransportn noperativestressreductionn npostoperativepaincontroln nICU近代麻醉学发展的三个重要阶段近代麻醉学发展的三个重要阶段l l麻醉麻醉麻醉麻醉：1919世纪世纪世纪世纪4040年代算起，近年代算起，近年代算起，近年代算起，近100100年的发展历程。年的发展历程。年的发展历程。年的发展历程。l l临床麻醉学临床麻醉学临床麻醉学临床麻醉学（clinical anesthesiologyclinical anesthesiology）：初步形成临）：初步形成临）：初步形成临）：初步形成临 床麻醉学的五大组成。床麻醉学的五大组成。床麻醉学的五大组成。床麻醉学的五大组成。l l麻醉与危重病医学麻醉与危重病医学麻醉与危重病医学麻醉与危重病医学（anesthesiology and critical care anesthesiology and critical care medicinemedicine）：）：）：）：从从从从2020世纪世纪世纪世纪5050年代末至今，一次作用要的飞跃，特别年代末至今，一次作用要的飞跃，特别年代末至今，一次作用要的飞跃，特别年代末至今，一次作用要的飞跃，特别是近是近是近是近3030余年的发展余年的发展余年的发展余年的发展法国、日本等法国、日本等法国、日本等法国、日本等麻醉复苏科麻醉复苏科麻醉复苏科麻醉复苏科（department of department of anesthesiology and resuscitationanesthesiology and resuscitation）；）；）；）；美国等美国等美国等美国等麻醉与危重病医学科麻醉与危重病医学科麻醉与危重病医学科麻醉与危重病医学科（department of department of anesthesiology and critical care medicineanesthesiology and critical care medicine）。）。）。）。Archaic anesthesian nStoneAge:spiculaanalgesian nAcupuncturen nTraditionalmedicinen nPressuren nCryotherapyn nAndothersHistory of anesthesiologyn n1846publicdemonstrationofetheranesthesiabyWilliamT.G.MortonMortons ether inhaler(1846)John Snow,the first anesthesiologist（1846）Machine of Inhalational anesthesia in 1847Face mask(1847)History of inhalationAnesthesia machine(1930)Intravenous anestheticsn n1934:thiopentaln n1959:diazepamn n1960:hydroxybutyrates,r-OHn n1970:ketaminen n1972:etomidaten n1976:midazolamn n1983:propofolOthersn nOpioidsMorphine,fentanyl,sufentanil,alfentanil,Morphine,fentanyl,sufentanil,alfentanil,remifentanilremifentaniln nRelaxantsCurare(1942),succinylcholine,Curare(1942),succinylcholine,pancuronium,vecuronium,atracurium,pancuronium,vecuronium,atracurium,rocuronium,mivacurium,atal.rocuronium,mivacurium,atal.Local anestheticsn n18841884：Cocaineasophthalmicanesthesia,nerveblockCocaineasophthalmicanesthesia,nerveblockn n18851885：EpiduralanesthesiaEpiduralanesthesian n1898:Spinalanesthesia1898:Spinalanesthesian n19011901：CaudalanesthesiaCaudalanesthesian n19051905：ProcaineProcainen n19301930：DibucaineDibucainen n19321932：DicaineDicainen n19431943：LidocaineLidocainen n1963:bupivacaine1963:bupivacainen n1996:ropivacaine1996:ropivacainen nMorenew:levobupivacaineMorenew:levobupivacaineHow about our department of anesthesiology?n n19561956：surgeonsurgeonn n19571957：anesthesiagroupanesthesiagroupn n60-7060-70：epidural,spinal,nerveblockepidural,spinal,nerveblockn n70-8070-80：CPB,intravenousanesthesia,andCPB,intravenousanesthesia,andinhalationalanesthesiainhalationalanesthesian n80-85:intravenousanesthesia,inhalational80-85:intravenousanesthesia,inhalationalanesthesia,ECG,arterialbloodpressure,CVPanesthesia,ECG,arterialbloodpressure,CVPn n80-9080-90：inhalationalanesthesiawithtiminginjectioninhalationalanesthesiawithtiminginjectionofvolatileanestheticsofvolatileanestheticsn n90-present90-present：depthofanesthesia,balancedepthofanesthesia,balanceanesthesiaanesthesiaPopular anesthesia wordsn nASAphysicalstatusclassificationsystemASAphysicalstatusclassificationsystemn nTOF:trainoffourTOF:trainoffourn nBIS:bispectralindexBIS:bispectralindexn nCVPCVPn nneurostimulatorneurostimulatorn nSG:SwanGanzcatheterSG:SwanGanzcathetern nMAC:minimumalveolarconcentrationMAC:minimumalveolarconcentrationn nTEE:transesophagealechocardiographyTEE:transesophagealechocardiographyThe working field of Anesthesiologistsn nClinicanesthesiaClinicanesthesia Operatingroom,PACU,outpatient,Operatingroom,PACU,outpatient,n nCPCR(cardiopulmonarycerebralCPCR(cardiopulmonarycerebralresuscitation)resuscitation)n nCCM(criticalcaremedicine)CCM(criticalcaremedicine)n nAnalgesiaAnalgesia Painclinic,postoperativeanalgesia,othersPainclinic,postoperativeanalgesia,othersn nOthersOthers Research,education,trainingResearch,education,trainingHow can you become a real anesthesiologistn npurposen nBasicknowledgen nProfileofwholebodysystemsn nUsingyourpotentialn nRenewandupdate,uninterruptedlyn nCommunicationAnesthesia methodsgenerallocal inhalationintravenousmucosamusclespinalepiduralNerve blockLocal infiltration topicalbalanceSubspecialty of anesthesiologyn nCardiacsurgeryCardiacsurgeryn nVascularsurgeryVascularsurgeryn nThoracicsurgeryThoracicsurgeryn nNeurosurgicalanesthesiaNeurosurgicalanesthesian nOrgantransplantationOrgantransplantationn nPediatricsurgeryPediatricsurgeryn nObstetricanesthesiaObstetricanesthesian nAndothersAndothersProcedure of clinical anesthesiaPre-opeprepareintroductionSpecial monitoringMaintainPACUPreope.Physical assessmentPurpose of Preope.Physical assessmentn nToreceivethepatienthistorydatan nTorelievepatientsworryingstatusn nReviewofcurrentdrugtherapyn nPhysicalexamination,interpretationoflaboratorydatan nFindoutriskfactorn nProposeanesthesiamethodContent of Preope.Phy