（眼科手术麻醉）课件

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1、AnesthesiaforOphthalmicSurgery(眼科手术麻醉)XuliProfileandDemandsfineproceduredemandsintraocularpressure(IOP)airwayoculocardiacreflex(OCR)PreoperativeEvaluationandPreparationpsychologicalpreparationtreatmentoftheoriginaldiseasestreatmentoftheco-existingdiseasesPremedicationantich

2、olinegics(抗胆碱药):givenintramuscularly,havenosignificanteffectsonIOP.However,appliedtopicallytotheeyemaycausemydriasis(瞳孔散大)andmayincreaseIOP.sedatives(镇静药)analgesics(镇痛药)antiemetics(止吐药)AnestheticTechniques.localanesthesia.generalanesthesiacomplicationsofretrobulbarblock(将局麻药注

3、入睫状长、短神经及眼球筋膜囊内)ImportantPointsinLocalAnesthesiaapplicationofAdrenalinapplicationofsedativesOCRToxicittyoflocalanestheticsImportantPointsinGeneralAnesthesiacarefulmonitoringsmoothanesthesiaapplicationofmusclerelaxantspreventionofOCRN2OonIOPanestheticsandIOPQuestionsWhat’sthem

4、aincauseofexorbitantIOPduringophthalmicoperations?What’sOCRandhowtotreatit?青光眼(glaucoma)病人的术前用药、局麻用药及全麻肌松药应用注意事项？视网膜脱离修补术中,手术需要往玻璃体内注气，应用吸入全麻药应注意些什么？为什么？THANKyouDemandspatient’scooperationandimmobility—>perfectsedationandanalgesiashouldbeavailablle.fixationoftheeyeball—>relax

5、ationoftheorbicularisoculimuscle(眼轮匝肌)andextraocularmuscles(眼外肌)isnecessary.IOP(眼内压)1、IOP：thepressureontheeyeballwallexertedbytheintraocularcontents.3、ThemaindeterminantofIOPisthedynamicbalancebetweentheproductionofaqueoushumoranditseventualelimination.2、aqueoushumorcirculati

6、on4、themaincauseofexorbitantIOPistheobstructionoftheaqueoushumor(房水)circulation.SeveralimpactfactsonIOPMydriaticdrugs(扩瞳药)Maneuvers(动作行为)Hypercarbia(高碳酸血症)andhypoxia(低氧血症)PressureontheeyeballAnesthetics:MostanestheticsreduceIOP.OnlysuccinylcholineandketaminemayincreaseIOP.Ocu

7、locardiacReflex(OCR)眼心反射TheOCRisatrigeminovagalreflex(三叉-迷走神经反射)thatmaybeinducedbypressureontheeyeball,traction(牵拉)ontheextraocularmuscle(眼外肌),orbital(眼眶内的)hematoma(血肿),oculartrauma(损伤),andeyepain,manifestedbycardiacarrhythmias(心律失常)suchasbradycardia(心动过缓),nodalrhythm(结性节律),e

8、ctopicbeats(异位搏动),ventricularfibrillation(心室纤维颤动),orasystole(心脏停搏).L