1、眼科手术麻醉英语教学课件眼科手术麻醉英语教学课件2021/4/2722021/4/273 Pro Demandsfine procedure demands intraocular pressure(IOP)airwayoculocardiac reflex(OCR)2021/4/274Preoperative Evaluation and Preparation psychological preparation treatment of the original diseases treatment of the co-existing diseases2021/4/275Premedic
2、ation anticholinegics(抗胆碱药抗胆碱药):given intramuscularly,have no significant effects on IOP.However,applied topically to the eye may cause mydriasis(瞳孔散大瞳孔散大)and may increase IOP.sedatives(镇静药镇静药)analgesics(镇痛药镇痛药)antiemetics(止吐药止吐药)2021/4/276Anesthetic Techniques.local anesthesia.general anesthesia202
3、1/4/277complications of retrobulbar block(将局将局麻药注入睫状长、短神经及眼球筋膜囊麻药注入睫状长、短神经及眼球筋膜囊内内)Important Points in Local Anesthesiaapplication of Adrenalinapplication of sedativesOCRToxicitty of local anesthetics2021/4/278Important Points in General Anesthesia careful monitoring smooth anesthesia application of
4、 muscle relaxants prevention of OCR N2O on IOP anesthetics and IOP2021/4/279Questions Whats the main cause of Whats the main cause of exorbitantexorbitant IOP during ophthalmic operations?IOP during ophthalmic operations?Whats OCR and how to treat it?Whats OCR and how to treat it?青光眼青光眼(glaucoma)(gl
5、aucoma)病人的术前用药、局麻用病人的术前用药、局麻用药及全麻肌松药应用注意事项？药及全麻肌松药应用注意事项？视网膜脱离修补术中视网膜脱离修补术中,手术需要往玻璃体内手术需要往玻璃体内注气，应用吸入全麻药应注意些什么？为什注气，应用吸入全麻药应注意些什么？为什么？么？2021/4/2710THANK THANK youyou2021/4/2711Demands patients cooperation and immobility perfect sedation and analgesia should be availablle.fixation of the eyeball rela
6、xation of the orbicularis oculi muscle(眼轮匝肌眼轮匝肌)and extraocular muscles(眼外肌眼外肌)is necessary.2021/4/2712IOP(眼内压眼内压)1、IOP：the pressure on the eyeball wall exerted by the intraocular contents.3、The main determinant of IOP is the dynamic balance between the production of aqueous humor and its eventual e
7、limination.2、aqueous humor circulation4、the main cause of exorbitant IOP is the obstruction of the aqueous humor(房水房水)circulation.2021/4/27132021/4/27142021/4/2715Several impact facts on IOP Mydriatic drugs(扩瞳药扩瞳药)Maneuvers(动作行为动作行为)Hypercarbia(高碳酸血症高碳酸血症)and hypoxia(低低氧血症氧血症)Pressure on the eyeball
8、 Anesthetics:Most anesthetics reduce IOP.Only succinylcholine and ketamine may increase IOP.2021/4/2716Oculocardiac Reflex(OCR)眼心反射眼心反射The OCR is a trigeminovagal reflex(三叉三叉-迷走神迷走神经反射经反射)that may be induced by pressure on the eyeball,traction(牵拉牵拉)on the extraocular muscle(眼外肌眼外肌),orbital(眼眶内的眼眶内的)
9、hematoma(血血肿肿),ocular trauma(损伤损伤),and eye pain,manifested by cardiac arrhythmias(心律失常心律失常)such as bradycardia(心动过缓心动过缓),nodal rhythm(结结性节律性节律),ectopic beats(异位搏动异位搏动),ventricular fibrillation(心室纤维颤动心室纤维颤动),or asystole(心脏停搏心脏停搏).2021/4/2717Local Anesthesia topical anesthesia(表面麻醉表面麻醉)infiltration an
10、esthesia(浸润麻醉浸润麻醉)nerve block(神经阻滞神经阻滞)2021/4/2718General Anesthesia with endotracheal intubation without endotracheal intubation2021/4/27192021/4/2720Anesthetics and IOP Most general anesthetics are CNS depressants,they lower IOP.But succinylcholine causes a transient(46min)but significant increase
11、 in IOP of 10 to 20 mmHg.The effect of ketamine on IOP varies.Early studies reported an increase in IOP after intramuscular or intravenous administration of ketamine.Ketamine given after premedication with diazepam and meperidine(哌替啶哌替啶)does not affect IOP,and intramuscularly administered ketamine m
12、ay even lower IOP in children.2021/4/2721N2O on IOP Ophthalmologists sometimes inject a small bubble of gas(e.g.,SF6)into the vitreal(玻璃体的玻璃体的)cavity during reattachment(修补修补)of the retina(视网膜视网膜)so as to hold the retina in place under a long-acting bubble of stable size.N2O is more diffusible than SF6 and more soluble in water,and rapidly enters the gas bubble.Administrating N2O after the injection of SF6,the size of the injected gas bubble rapidly.And then both bubble size and IOP decrease along with the discontinuation of N2O.2021/4/2722
