1、眼科手術(shù)麻醉英語教學(xué)課件眼科手術(shù)麻醉英語教學(xué)課件眼科手術(shù)麻醉英語教學(xué)課件2021/4/272眼科手術(shù)麻醉英語教學(xué)課件眼科手術(shù)麻醉英語教學(xué)課件眼科手術(shù)麻醉2021/4/2722021/4/2722021/4/2732021/4/273 Pro Demandsfine procedure demands intraocular pressure ( IOP)airwayoculocardiac reflex (OCR)2021/4/274 Pro Demandsfine procedure dePreoperative Evaluation and Preparationpsychological

2、 preparationtreatment of the original diseasestreatment of the co-existing diseases2021/4/275Preoperative Evaluation and PPremedicationanticholinegics(抗膽堿藥):given intramuscularly, have no significant effects on IOP. However, applied topically to the eye may cause mydriasis (瞳孔散大) and may increase IO

3、P.sedatives(鎮(zhèn)靜藥)analgesics(鎮(zhèn)痛藥)antiemetics(止吐藥)2021/4/276Premedicationanticholinegics(抗Anesthetic Techniques.local anesthesia.general anesthesia2021/4/277Anesthetic Techniques.local ancomplications of retrobulbar block (將局麻藥注入睫狀長、短神經(jīng)及眼球筋膜囊內(nèi) )Important Points in Local Anesthesiaapplication of Adrenal

4、inapplication of sedativesOCRToxicitty of local anesthetics2021/4/278complications of retrobulbar bImportant Points in General Anesthesiacareful monitoringsmooth anesthesiaapplication of muscle relaxantsprevention of OCRN2O on IOPanesthetics and IOP2021/4/279Important Points in General AnQuestionsWh

5、ats the main cause of exorbitant IOP during ophthalmic operations?Whats OCR and how to treat it?青光眼(glaucoma)病人的術(shù)前用藥、局麻用藥及全麻肌松藥應(yīng)用注意事項(xiàng)？視網(wǎng)膜脫離修補(bǔ)術(shù)中,手術(shù)需要往玻璃體內(nèi)注氣，應(yīng)用吸入全麻藥應(yīng)注意些什么？為什么？ 2021/4/2710QuestionsWhats the main causeTHANK you2021/4/2711THANK you2021/4/2711Demandspatients cooperation and immobility pe

6、rfect sedation and analgesia should be availablle.fixation of the eyeball relaxation of the orbicularis oculi muscle(眼輪匝肌 ) and extraocular muscles(眼外肌 ) is necessary.2021/4/2712Demandspatients cooperation aIOP (眼內(nèi)壓)1、IOP：the pressure on the eyeball wall exerted by the intraocular contents. 3、The ma

7、in determinant of IOP is the dynamic balance between the production of aqueous humor and its eventual elimination.2、aqueous humor circulation4、the main cause of exorbitant IOP is the obstruction of the aqueous humor(房水) circulation. 2021/4/2713IOP (眼內(nèi)壓)1、IOP：the pressure on2021/4/27142021/4/27142021

8、/4/27152021/4/2715Several impact facts on IOP Mydriatic drugs(擴(kuò)瞳藥) Maneuvers (動(dòng)作行為) Hypercarbia (高碳酸血癥) and hypoxia (低氧血癥) Pressure on the eyeball Anesthetics:Most anesthetics reduce IOP. Only succinylcholine and ketamine may increase IOP. 2021/4/2716Several impact facts on IOP MyOculocardiac Reflex

9、(OCR)眼心反射The OCR is a trigeminovagal reflex(三叉-迷走神經(jīng)反射) that may be induced by pressure on the eyeball, traction(牽拉) on the extraocular muscle(眼外肌), orbital(眼眶內(nèi)的) hematoma(血腫), ocular trauma(損傷), and eye pain, manifested by cardiac arrhythmias(心律失常) such as bradycardia(心動(dòng)過緩), nodal rhythm(結(jié)性節(jié)律), ecto

10、pic beats(異位搏動(dòng)), ventricular fibrillation(心室纖維顫動(dòng)), or asystole(心臟停搏).2021/4/2717Oculocardiac Reflex(OCR)眼心反射TLocal Anesthesiatopical anesthesia(表面麻醉)infiltration anesthesia(浸潤麻醉)nerve block(神經(jīng)阻滯)2021/4/2718Local Anesthesiatopical anesthGeneral Anesthesiawith endotracheal intubationwithout endotrache

11、al intubation2021/4/2719General Anesthesiawith endotra2021/4/27202021/4/2720Anesthetics and IOP Most general anesthetics are CNS depressants, they lower IOP. But succinylcholine causes a transient (46min) but significant increase in IOP of 10 to 20 mmHg.The effect of ketamine on IOP varies. Early st

12、udies reported an increase in IOP after intramuscular or intravenous administration of ketamine. Ketamine given after premedication with diazepam and meperidine (哌替啶) does not affect IOP, and intramuscularly administered ketamine may even lower IOP in children.2021/4/2721Anesthetics and IOP Most gen

13、erN2O on IOPOphthalmologists sometimes inject a small bubble of gas (e.g., SF6) into the vitreal (玻璃體的) cavity during reattachment (修補(bǔ)) of the retina (視網(wǎng)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