眼科手術麻醉英語教學課件2021/4/2722021/4/273ProDemandsfineproceduredemands

intraocularpressure(IOP)airwayoculocardiacreflex(OCR)2021/4/274PreoperativeEvaluation

andPreparationpsychologicalpreparationtreatmentoftheoriginaldiseasestreatmentoftheco-existingdiseases2021/4/275Premedicationanticholinegics(抗膽堿藥):givenintramuscularly,havenosignificanteffectsonIOP.However,appliedtopicallytotheeyemaycausemydriasis(瞳孔散大)andmayincreaseIOP.sedatives(鎮(zhèn)靜藥)analgesics(鎮(zhèn)痛藥)antiemetics(止吐藥)2021/4/276AnestheticTechniques.localanesthesia.generalanesthesia2021/4/277complicationsofretrobulbarblock(將局麻藥注入睫狀長、短神經(jīng)及眼球筋膜囊內(nèi))ImportantPointsinLocalAnesthesiaapplicationofAdrenalinapplicationofsedativesOCRToxicittyoflocalanesthetics2021/4/278ImportantPointsinGeneralAnesthesiacarefulmonitoringsmoothanesthesiaapplicationofmusclerelaxantspreventionofOCRN2OonIOPanestheticsandIOP2021/4/279QuestionsWhat’sthemaincauseofexorbitant

IOPduringophthalmicoperations?What’sOCRandhowtotreatit?青光眼(glaucoma)病人的術前用藥、局麻用藥及全麻肌松藥應用注意事項？視網(wǎng)膜脫離修補術中,手術需要往玻璃體內(nèi)注氣，應用吸入全麻藥應注意些什么？為什么？2021/4/2710THANKyou2021/4/2711Demandspatient’scooperationandimmobility

—>perfectsedationandanalgesiashouldbeavailablle.fixationoftheeyeball—>relaxationoftheorbicularisoculimuscle(眼輪匝肌)andextraocularmuscles(眼外肌)isnecessary.2021/4/2712IOP(眼內(nèi)壓)1、IOP：thepressureontheeyeballwallexertedbytheintraocularcontents.

3、ThemaindeterminantofIOPisthedynamicbalancebetweentheproductionofaqueoushumoranditseventualelimination.2、aqueoushumor

circulation4、themaincauseofexorbitantIOPistheobstructionoftheaqueoushumor(房水)circulation.

2021/4/27132021/4/27142021/4/2715SeveralimpactfactsonIOP

Mydriaticdrugs(擴瞳藥)

Maneuvers

(動作行為)

Hypercarbia(高碳酸血癥)andhypoxia(低氧血癥)

Pressureontheeyeball

Anesthetics:MostanestheticsreduceIOP.OnlysuccinylcholineandketaminemayincreaseIOP.2021/4/2716OculocardiacReflex(OCR)

眼心反射TheOCRisatrigeminovagalreflex(三叉-迷走神經(jīng)反射)thatmaybeinducedbypressureontheeyeball,traction(牽拉)ontheextraocularmuscle(眼外肌),orbital(眼眶內(nèi)的)hematoma(血腫),oculartrauma(損傷),andeyepain,manifestedbycardiacarrhythmias(心律失常)suchasbradycardia(心動過緩),nodalrhythm(結性節(jié)律),ectopicbeats(異位搏動),ventricularfibrillation(心室纖維顫動),orasystole(心臟停搏).2021/4/2717LocalAnesthesiatopicalanesthesia(表面麻醉)infiltrationanesthesia(浸潤麻醉)nerveblock(神經(jīng)阻滯)2021/4/2718GeneralAnesthesiawithendotrachealintubationwithoutendotrachealintubation2021/4/27192021/4/2720AnestheticsandIOP

MostgeneralanestheticsareCNSdepressants,theylowerIOP.

Butsuccinylcholinecausesatransient(4~6min)butsignificantincreaseinIOPof10to20mmHg.TheeffectofketamineonIOPvaries.EarlystudiesreportedanincreaseinIOPafterintramuscularorintravenousadministrationofketamine.Ketaminegivenafterpremedicationwithdiazepamandmeperidine(哌替啶)doesnotaffectIOP,andintramuscularlyadministeredketaminemayevenlowerIOPinchildren.2021/4/2721N2OonIOPOphthalmologistssometimesinjectasmallbubbleofgas(e.g.,SF6)intothevitreal(玻璃體的)cavityduringreattachment(修補)oftheretina(視網(wǎng)膜)soastoholdtheretinainplaceunderalong-actingbubbleofstablesize.N2OismorediffusiblethanSF6andmoresolubleinwater,andrapidlyentersthegasbubble.AdministratingN2Oaftertheinjecti