復(fù)合麻醉與聯(lián)合麻醉

Introduction

1.Background2.Balancedorcombinedanesthesia3.Forte：4.Commonlyusedmethod：（1）intravenousanesthesia+inhalationanesthesia（2）totalintravenousanesthesia（3）generalanaesthesia+othersApplicationprinciple

ofCombinedAanesthesia1.Selectdrugsreasonably：（1）synergism（2）additive（3）antagonism2.Judgedepthofanesthesiaaccurately3.Enhanceperianestheticmanagement4.Optimizedrugsscheme5.Mmaintenanceindividualization6.CombinationofdifferentanesthetictechniquesApplicationprinciple

ofCombinedAanesthesiaCombinedIntravenous-

Inhalationalanesthesia

Introduction（1）concept：（2）method：ComparisonofIntravenousanesthesia

andInhalationalanesthesia

Intravenousanesthesia

Inhalationalanesthesia起效快、誘導(dǎo)迅速、無興奮期起效慢、誘導(dǎo)過程有興奮期基本無鎮(zhèn)痛作用有鎮(zhèn)痛效應(yīng)無肌松作用有肌松作用術(shù)中可能知曉無知曉術(shù)后惡心嘔吐發(fā)生率低術(shù)后惡心嘔吐多見所需麻醉設(shè)備簡單需要一定復(fù)雜的麻醉設(shè)備操作可控性差操作簡單、可控性好無環(huán)境污染有環(huán)境污染代謝物可能有藥理活性基本不代謝個體差異大個體差異小無明確的麻醉深度指標(biāo)可用MAC表示麻醉深度CombinedIntravenous-

Inhalationalanesthesia

一、Anestheticmethod：1.Inductionofanesthesia：（1）intravenousinduction：thiopental、

etomidate、propofol、midazolam

fentanyl+scoline、vecurium（2）inhaledinduction：2.Maintenanceofanesthesia：（1）inhalationanesthesia（2）intravenousbalancedanesthesia

（3）Intravenousanesthesia+InhalationanesthesiaCombinedIntravenous-

Inhalationalanesthesia

二、Announcements：1.Individualization2.Endotrachealtube3.Accuratelymonitoring4.Minimumeffectivedose5.ResiduaryeffectofanestheticsCombinedIntravenous-

Inhalationalanesthesia

Totalintravenousanesthesia

一、TotalintravenousanesthesiaTIVA：二、IntravenouscombinedanesthesiabyProcaine：（一）Anestheticmethod1.Inductionofanesthesia：Totalintravenousanesthesia

2.Maintenanceofanesthesia：1%procaine（二）Indications：（三）contraindications：（四）Announcements：

靜脈普魯卡因復(fù)合麻醉的分期

呼吸血壓脈搏末梢眼瞼眼壓眼球瞳孔肌張力肢體循環(huán)張力位置大小活動 淺淺快升高快速疼痛時增加正常不正常手指屈曲明顯麻醉期皮膚蒼固定痛時有張力白濕涼散大中平穩(wěn)穩(wěn)定正常良好皮稍稍固定不大手指稍屈手指麻醉期有力膚紅潤減弱降低曲但無力微動深抑制下降細(xì)弱遲滯松弛明顯固定散大肌松弛手對刺麻醉期脈壓先快紫紺中毒時降低平伸、中激無縮小后慢抽搐毒時亢進反應(yīng)

三、IntravenouscombinedanesthesiabyPropofol：（一）Anestheticmethod：1.Inductionofanesthesia：1.5~2.5mg/kg2.Maintenanceofanesthesia：75~200μg/（kg·min）

TCI-3~7μg/ml（二）Announcements：Totalintravenousanesthesia

Propofol

+Fentanyl

/Sulfentanyl

/Remifentanil

Premedication：

induction：Midazolam

+Fentanyl/Rulfentanyl/Remifentanil+Etomidate

/Propofol

+Vecuronium

maintenance：

Propofol

：10mg/kg/h→8mg/kg/h→6mg/kg/h

Fentanyl

：3μg/kg/h/Alfentanil：50μg/kg/h/Sulfentanyl：0.2~1.5μg/kg/h

/Remifentanil：0.125~0.25μg/kg/min

Musclerelaxant：Vecuronium、Tracrium四、Intravenouscombinedanesthesiaby

Ketamine：（一）Anestheticmethod：1.Inductionofanesthesia：

ketamine2mg/kgiv

ketamine4~6mg/kgim2.Maintenanceofanesthesia：Totalintravenousanesthesia

（1）ketamine+

-OH（2）ketamine+diazepam（3）ketamine+diazepam+scoline（二）Indications：（三）contraindications：（四）Announcements：Totalintravenousanesthesia

IntravenouscombinedanesthesiabyFentanyl50~100

g/kg

→

cardiacsurgeryCombinedGeneral

-otheranaesthesia

一、Forte1.↑anesthesiaeffect，↑perioperationsafety2.Avoidfearandpsychentonia3.ReducethedosageofnarcoticanalgesicsorlocalanestheticsCombinedGeneral

-otheranaesthesia

4.Reducethedosageofintravenousanestheticsorinhalationalanesthetics5.Reducethedosageofmusclerelaxant6.Postoperationanalgesia二、Method（一）Combined（Intravenous+Inhalation）-Epiduralanesthesia1.Premedication2.Inductionofanesthesia3.Maintenanceofanesthesia4.Announcements（二）Combined

Intravenous