1、颅内压麻醉对脑血流、脑代谢和颅内压麻醉对脑血流、脑代谢和颅内压的影响的影响 麻醉药和肌松药 颅内高压的常见原因和处理颅内高压的常见原因和处理颅内高压的症状颅内高压的处理 Depth of Inhalation AnesthesiaCirculation引起颅内压升高的因素可分为两大类,一类与颅内正常内容物有关,主要包括脑组织、脑脊液及脑直流量;The blood/gas coefficient is 1.0%Nitrous oxide 105%地氟烷 Desfluranedegradation by baralyme and soda lime麻醉意外和并发症(1)第一期(镇痛期)麻醉开始-神
2、志消失-皮层抑制引起颅内压升高的因素可分为两大类,一类与颅内正常内容物有关,主要包括脑组织、脑脊液及脑直流量;125mg/kg,适应症:心血管手术、颅内手术、门诊小手术、各种诊治操作。颅内占位性病变 如颅内血肿、肿瘤、脓肿等。苯环己哌啶类氯胺酮根据用药种类:单一、复合。5 percent nitrous oxide 0.resistant to degradation by soda limeMAC in 100 percent oxygen is 0.second gas effect(back)后颅凹病变使颅内压升高时,可出现心动过复、呼吸变慢等;Essential Concepts Ab
3、out Inhalation Anesthesia 全身麻醉的概念吸入麻醉71 and in 63.Maintenance of anesthesia1-2.coronary artery steal syndrome.FGF at least two liters per minute导管粗细(喉头水肿,梗阻);适用于心内直视手术、胸内手术、大血管手术。颅内占位性病变 如颅内血肿、肿瘤、脓肿等。Depth of Inhalation Anesthesia并发症:血压升高、颅内压眼压增高、呼吸抑制、喉痉挛、噩梦精神症状、暂时失明、恶心呕吐。Pharmacokinetics of Inhaled
4、 AnestheticsThe blood/gas coefficient is 1.3mg/kg,持续3-5分钟,点滴0.Halothane 0.下呼吸道梗阻:气管、支气管分泌物引起;68mg/kg15分钟,然后0.After Surface Anesthesia,sedation agents were administrated,intubation.increase intracranial pressuresusceptible to decomposition.increase intracranial pressure后颅凹病变使颅内压升高时,可出现心动过复、呼吸变慢等;七氟醚
5、Sevoflurane颅腔内容物由神经组织(86)、脑脊液(10)及血液(4)三部分组成。Pharmacokinetics of Inhaled Anesthetics吸入麻醉药的药效学常用吸入麻醉药氧化亚氮nitrous oxide乙醚 Ether氟烷 Halothane安氟醚enflurane异氟醚 Isoflurane,forane七氟烷 Sevoflurane地氟烷 Desflurane吸入麻醉安氟醚enflurane74 and in 70 percent nitrous oxide 0.Pharmacokinetics of Inhaled AnestheticsCirculati
6、on平衡麻醉:镇静+镇痛+肌松。降低颅内压的措施很多,首先必须针对原发病因进行处理。注意事项:呼吸抑制明显严重,抑制循环,注射部位疼痛,用药后有时精神错乱,体表异感、幻觉、女性有多情表现Induction of anesthesia 6-10%清醒插管后再作静脉快速诱导125mg/kg,适应症:心血管手术、颅内手术、门诊小手术、各种诊治操作。General anesthesia provides loss of consciousness and loss of sensation.RespiratoryFGF at least two liters per minute5 percent n
7、itrous oxide 0.静脉全麻的概念和优缺点地氟醚 Desflurane芬太尼静脉麻醉fentanyl起效快,作用时间短,无镇痛作用。Maintenance of anesthesia1-2.导管粗细(喉头水肿,梗阻);其正常值为70200mmH2O(0.地氟烷 DesfluraneIntroduction麻醉药品和设备麻醉药品和设备Introveinus high speed introduction Inhalation introduction22Slowly Introduction气管插管术气管内插管术Maintenance of Inhalation Anesthesiai
8、ntubationMaintenanceWash-outrecoveryMonitoringRespiratoryPetCO2ZoomloopParameter of RespiratoryDepth of AnesthesiaBISCirculation麻醉期间生理指标监测125mg/kg,适应症:心血管手术、颅内手术、门诊小手术、各种诊治操作。15 and in 70 percent nitrous oxide 0.并发症:血压升高、颅内压眼压增高、呼吸抑制、喉痉挛、噩梦精神症状、暂时失明、恶心呕吐。方法分类明视插管术;Fulminant hepatic necrosis第一期(镇痛期)麻
9、醉开始-神志消失-皮层抑制Maintenance of anesthesia1-2.5 percent nitrous oxide 0.Without muscle relaxantGeneral anesthesia provides loss of consciousness and loss of sensation.Introduction 麻醉诱导used low flow or closed system anesthesia.N2O+O2,plus Inhalation Anesthesticscardiac output5 percent nitrous oxide 0.cor
10、onary artery steal syndrome.After Surface Anesthesia,sedation agents were administrated,intubation.便于清除呼吸道内分泌物和异物;increase intracranial pressureMaintenance注意事项:可使促皮质激素效应消失,免疫抑制、脓毒血症、器官移植慎用;正常人平卧时,脑穿刺测得脑脊液压可正确反映颅内压的变化。Depth of Inhalation Anesthesia麻醉意外和并发症(1)麻醉意外和并发症(2)麻醉意外和并发症(3)麻醉后苏醒期的护理术后恢复室Propof
11、olThe blood/gas coefficient is 0.treatment of asthma注意事项:呼吸抑制明显严重,抑制循环,注射部位疼痛,用药后有时精神错乱,体表异感、幻觉、女性有多情表现概念:麻醉药系经呼吸道吸入而产生麻醉。概念:麻醉药系经呼吸道吸入而产生麻醉。其他:procaine,酒精当脑血流自动调节功能受损时,此类药物可明显增加脑血流量,使颅内压升高。The blood/gas coefficient is 0.任何一部分发生变化将影响到其他两部分,若超过了生理限度,其间失去相互调节,将产生颅内压升高。颅腔内容物由神经组织(86)、脑脊液(10)及血液(4)三部分组成
12、。74%Enflurane 1.Sevoflurane 2.Halothane 0.后颅凹病变使颅内压升高时,可出现心动过复、呼吸变慢等;FGF at least two liters per minute颅腔内容物由神经组织(86)、脑脊液(10)及血液(4)三部分组成。Pharmacokinetics of Inhaled AnestheticsFGF at least two liters per minutenot use for obstetric anesthesiaused low flow or closed system anesthesia.resistant to deg
13、radation by the absorber可乐宁抑制突触前去甲肾上腺素的释放产生受体激动效应,并可通过其他机制降低脑血流量。thiopental氯胺酮氯胺酮 ketamineetomidatefentanylmidazolam静脉麻醉静脉全麻的概念和优缺点分类和麻醉原则麻醉药分类麻醉方法颅内压氟烷 Halothane当脑血流自动调节功能受损时,此类药物可明显增加脑血流量,使颅内压升高。Brainstem auditory evoked potential BAEP依托咪酯麻醉etomidate0 and in 60 percent nitrous oxide 2.15 and in 70
14、 percent nitrous oxide 0.5 percent nitrous oxide 0.注意事项:可使促皮质激素效应消失,免疫抑制、脓毒血症、器官移植慎用;注意事项:心率增快、无镇痛作用,呼吸抑制作用,半衰期2.异丙酚Halothane 0.麻醉意外和并发症(3)3 MAC will prevent movement in about 95 percent of the patients.68mg/kg15分钟,然后0.甾类安泰酮68mg/kg15分钟,然后0.Depth of Inhalation Anesthesia0 and in 60 percent nitrous ox
15、ide 2.125mg/kg,适应症:心血管手术、颅内手术、门诊小手术、各种诊治操作。氟烷 Halothanecardiac output下呼吸道梗阻:气管、支气管分泌物引起;Induction of anesthesia 6-10%安氟醚enflurane麻醉药品和设备Maintenance of Inhalation AnesthesiaintubationMaintenanceWash-outrecovery术后恢复室fentanylThe main target of inhalation anesthetics(or so-called volatile anesthetics)is
16、 the brain.The blood/gas coefficient is 0.优点:起效快,对呼吸道无刺激;blood/gas coefficient is 0.not use for obstetric anesthesiaPharmacokinetics of Inhaled Anesthetics颅腔狭小如狭颅症、颅底陷入症。125mg/kg,适应症:心血管手术、颅内手术、门诊小手术、各种诊治操作。弱短效催眠药,诱导0.诱导thiopental 3mg/kg,芬太尼10-20mcg/kg,维持50-100mcg/kg,点滴1.resistant to degradation by
17、soda lime68 and in 70 percent nitrous oxide 0.not exceed 70 percent.地氟醚 Desflurane注意事项:可使促皮质激素效应消失,免疫抑制、脓毒血症、器官移植慎用;blood/gas coefficient is 1.注意事项:呼吸抑制明显严重,抑制循环,注射部位疼痛,用药后有时精神错乱,体表异感、幻觉、女性有多情表现第一期(镇痛期)麻醉开始-神志消失-皮层抑制68 and in 70 percent nitrous oxide 0.引起颅内压升高的因素可分为两大类,一类与颅内正常内容物有关,主要包括脑组织、脑脊液及脑直流量;
18、引起颅内压升高的因素可分为两大类,一类与颅内正常内容物有关,主要包括脑组织、脑脊液及脑直流量;5-3mg/kg,总量1克,可单次、分次、连续滴入;颅内占位性病变 如颅内血肿、肿瘤、脓肿等。作用保持呼吸道通畅;sensitize the myocardium to the action of epinephrine and norepinephrine注意事项:心率增快、无镇痛作用,呼吸抑制作用,半衰期2.42 and the MAC in 100 percent oxygen is 6.导管粗细(喉头水肿,梗阻);Recovery 麻醉清醒Fulminant hepatic necrosis地
19、氟烷 Desflurane可乐宁抑制突触前去甲肾上腺素的释放产生受体激动效应,并可通过其他机制降低脑血流量。concentration effectInduction of anesthesia1-3%此外,某些越药物亦可直接扩张脑血管、增加脑血流,从而使颅内压升高羟丁酸盐类-OHEssential Concepts About Inhalation Anesthesiaminute ventilation概念:麻醉药系经呼吸道吸入而产生麻醉。8 and the MAC in 100 percent oxygen is 1.Depth of Anesthesia125mg/kg,适应症:心血管
20、手术、颅内手术、门诊小手术、各种诊治操作。Maintenance 麻醉维持起效快,作用时间短,无镇痛作用。麻醉对脑血流、脑代谢和颅内压的影响Brainstem auditory evoked potential BAEP另一类为颅内病变使颅内空间或颅腔容积变小。芬太尼静脉麻醉fentanyl注意事项:心率增快、无镇痛作用,呼吸抑制作用,半衰期2.5mg/kg,儿童5-6mg/kg,婴幼儿7-8mg/kg。咪唑类ETOMIDATE可乐宁抑制突触前去甲肾上腺素的释放产生受体激动效应,并可通过其他机制降低脑血流量。其正常值为70200mmH2O(0.概念将特制的气管导管,通过口腔或鼻腔插入病人气管内
21、,是一种抢救病人和气管内麻醉的必要技术。second gas effect(back)sensitize the myocardium to the action of epinephrine and norepinephrine地氟醚 Desfluranetreatment of asthmaHalothane 0.优点:起效快,对呼吸道无刺激;单胺类血管活性药物:一般不透过血脑屏障,对脑代谢和脑血流量无明显影响,但在血脑屏障受损或大剂量应用时,可对脑血流产生明显影响。平衡麻醉:镇静+镇痛+肌松。罂粟碱可直接降低脑血管阻力,伴随着血压下降,脑血流量相应减少。Pharmacokinetics of Inhaled Anesthetics麻醉意外和并发症(3)优点:起效快,对呼吸道无刺激;麻醉方法