口腔颌面麻醉

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1、Oralandmaxillofacialsurgeryanesthesia一、Characteristicsofthepatientsandtheoperation.Anesthesiamanagement.(一)Anatomyandphysiolosy(1)CongenitallipandpalatecleftInfants—anestheticendurance—compensationfunction—respirationsystemisspecialCoexistentdiseases—VSDA

2、SDetcOral-noseconnected—difficultyingettingfoodrespirationsysteminfection.(2)BilateraltemporomandibularjointsrigidityDifficultyinopeningthemouth—Chronichypoxaemia—Poororalsanitation—Malnutrition—fluidandelectrolytesunbalance(3)OraltumorDifficultyinopening

3、themouth,pharyngealobstruction—TrachealintubationisdifficultOldagepatients—coexistentdiseases(hypertension,chronicbronchialinflammation.coronaryheartdisease,diabetic(4)TraumaIfthesoftpalate、peripharynx、baseofthetongueareinvolved,tissueswelling,pharyngealc

4、avityisnarrowed.Fracturedislocationstifle(suffocate)Bleeding,secretionsaspiration.(5)Mandible-thorax,mandible-neckadherence,scarformationandcontractionsaroundthemouth.—Head-neckisfixed,headisextremelybent—Tracheaisshiftedtooneside—Trachealintubationandtra

5、cheostomyaredifficult(6)CongenitalmaxillofacialdeformityPierre-Robinsyndrome,Treacher-Collinssyndrome—TrachealIntubationisdifficultAnesthesiaenduranceisdecreased.（二）Characteristicsofthesurgery(1)Premedication（Atropine.Sod-luminalMorphine.Midazolumetc.）The

6、objectivesofpremedicationareto：—Allayanxietyandfear—Reducesecretions—Enhancethehypnoticeffectofgeneralanestheticagents—Reducepostoperativenauseaandvomiting—ReducethevolumeandincreasethePHofgastriccontents—Attenuatevagalreflexes—Attenuatesympathoadrenalres

7、ponsesIfthepreoperationairwayobstrutionisexisted,don’tuseanypremedicationsthatwillsuppresstherespiration(e.gmorphine)(2)Anestheticinductionandtrachealintubationmaybedifficult.—temporomandibularjointsrigidity—Hugetumor—Severetrauma(3)Sharedairway—Observati

8、onandmanagementarelimited.—Blood、secretionsanddebrismaycontaminatethelartynx.—Gagandoperationapparatusmaycompressthetrachealtube,causepartialairwayobstruction(4)Heamorrhage—Thesurgeoncann’toperateclearly—Largequanti