耳鼻喉科手術麻醉耳鼻喉科手術麻醉耳鼻喉科手術麻醉耳鼻喉科手術麻醉

ProDemands

difficultairway

cardiacarrhythmia：applicattionofEpinephrine,reflexofcarotidsinus,etc.

N2Oandmiddleearpressure耳鼻喉科手術麻醉耳鼻喉科手術麻醉耳鼻喉科手術麻醉PreoperativeEvaluation

andPreparationInterview(麻醉前訪視)

Premedication(麻醉前用藥)：

▲sedatives(鎮靜藥)

▲anticholinegics(抗膽堿藥)

耳鼻喉科手術麻醉Choiceofanesthesialocalanestehsia：tothosecooperativeonesundergoingshort-termandsimpleoperationsgeneralanesthesia：tothoseonescan’tbeundertakenoperationsunderlocalanesthesia耳鼻喉科手術麻醉SeveralcommonENToperations*operationofear*operationofnasalcavity(鼻腔)andnasalsinus(鼻竇)*tonsillectomy(扁桃體摘除術)*totalthroatresection(全喉截除術)*Endoscopy(內鏡檢查)andendoscopicsurgery(內鏡手術)耳鼻喉科手術麻醉PS：嬰幼兒氣管、支氣管異物取出術病情：急(urgent)

、重(severe)

、危(dangerous)

麻醉：全麻，配合充分表麻,要求麻醉既不加重缺氧又能迅速誘導至足夠深度管理：*術前:準備應迅速、利索，呼吸困難(dyspnea)的應急處理*術中:積極防治喉、氣管、支氣管痙攣、缺氧、氣道內出血、氣管破裂(split)或氣胸(pneumothorax)

、喉頭水腫(laryngealedema)等*術畢:充分供氧，待患者清醒良好、呼吸通暢，吸空氣SPO2基本正常后方可出手術室耳鼻喉科手術麻醉

QuestionsTrytodescribethefactorscausingarrhythmiaduringENTsurgery.

“全喉截除術”中，發生頸外靜脈破裂，除了緊急止血外還應警惕什么情況的發生？如何處理？中耳手術時，吸入全麻的使用應注意什么？耳鼻喉科手術麻醉THANKYOU！耳鼻喉科手術麻醉Difficultairway

*1>Difficultintubation*2>compromisedairway耳鼻喉科手術麻醉N2OandmiddleearpressureThemiddleearandparanasalsinus(鼻旁竇)arenormalbodyaircavitiesthatconsistofopen,nonventilatedspaces.Theblood/gascoefficient(系數)is0.013fornitrogenversus0.46forN2O.Wheninhaledinhighconcentrations,N2Oenterstheaircavitiesfasterthannitrogencanleave.Inafixedcavitysuchasthemiddleear,theresultisanincreaseinpressure.AfterdiscontinuationofN2O,thegasisrapidlyreabsorbed,marked,negativemiddleearpressuremaydevelop.

耳鼻喉科手術麻醉Difficultintubation①anatomicabnormalities：

micrognathia(小頜),limitedjawmotion,orcongenitalsyndromes(craniofacialdysostoses<顱面骨發育不全>)etc..

②Othercauses：obesity,acromegaly(肢端肥大癥),cervicalspineproblems,rheumatoidarthritis(風濕性關節炎),andevengastricreflux(返流)

耳鼻喉科手術麻醉CompromisedairwayPathologicconditionsabovetheglottismaypreventaclearviewoftheglotticopening,whereassubglotticlesionspermitagoodviewofthevocalcords,buttheyrequirecarefulplacementofasmallendotrachealtubeorbronchoscope.

耳鼻喉科手術麻醉Operationsofearsoperationsofearconcha(耳廓)andconchatract(外耳道)

：localanesthesia(tocooperativepatients)operationsinsideears：generalanesthesiaMicrosurgery(顯微外科手術)：controlledhypotension(控制性低血壓)issometimesneededN2Oandmiddleearpressure

耳鼻喉科手術麻醉Operationofnasalcavityandnasalsinuslocalanesthesiageneralanesthesia耳鼻喉科手術麻醉耳鼻喉科手術麻醉Tonsillectomyattention：topicalanesthesiaandcoughreflexgeneralanesthesiaandthemanagementofairwayemergentsurgeryforbleedingaftertonsillectomyandtheanestheticmanagement耳鼻喉科手術麻醉bleedingafteronsillectomy

problems:hypo-volemia,fullstomach,andairwayobstruction.

inductionofanesthesia:

goodsuctioningofblood、arapid-sequenceinductionofanesthesiawithapplicationofcricoidpressureandslighthead-downpositioningofthepatientwillprotectthetracheaandglottisfromaspirationofblood.afterinduction,anasogastric(鼻胃的)tubemaybeplacedandremoved.extubation:aswithelectivetonsillectomy,extubationissafestwiththepatientawake.

耳鼻喉科手術麻醉Totalthroatresectionprotheoperation：widerange，deepreach，airwayobstructionofsomeextentanestheticmangement：generalanesthesiawithendotrachealintubationthroughtracheotomyattention：

*

reflexofcarotidsinus(頸動脈竇反射)*split(破裂)ofmainline(大靜脈)→氣栓(gasembolism)*evaluationofrespirationfunctionandcorrespondingtreatment耳鼻喉科手術麻醉EndoscopyandendoscopicsurgeryProfile：

interactionofanestheticandsurgicalmanagementwiththecompromisedairwayinconsistency(矛盾)betweentheoperationandanestheticrecovery耳鼻喉科手術麻醉Anesthesiaselectionforendoscopyandendoscopicsurgery*localanesthesia：trytoperformlocalanesthesiatothecooperativeadultpatientsespeciallytothosewithsomeextentofairwayobstructionduringshort-termoperations*generalanesthesia：mainlyfitschildrenpatients耳鼻喉科手術麻醉Generalanesthesiaforendoscopyandendoscopicsurgerywithendotrachealintubation：thintubewithoutendotrachealintubation

1>intensiveinhalationanesthesiainductioncompaniedbytopicalanesthesia

2>withathinplastictubeabovethecarina(隆突)to