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静脉全麻

静脉全麻

作者：佚名文献来源：本站原创点击数：更新时间：2005-6-15

中南大学麻醉学专业教案

科目临床麻醉学 任课教师姓名

授课对象麻醉学专业5 年制 2000 年级 60 人数 1 次数

授课章节、内容第8章吸入麻醉

授课时数 1学时授课时间 2003－9－8

【目的与要求】

1 掌握静全身脉麻醉的方法。

2 熟悉ketamine fentanyl propofol etomate r－OH 等静脉麻醉。

3 了解常用静脉麻醉方法的不良反应。

4 了解部分麻醉专业词汇。

【重点】

常用静脉麻醉药的用量、使用方法、适应症、禁忌症和并发症

【难点】

静脉麻醉的管理

【授课方式】

1，课堂讲授辅以启发式提问；

2，双语

3，多媒体

【板书设计的要求】讲授的主要内容与时间安排见后

【作业】

1 How to observe the patients with intravenous ?

【思考题】

what are the characteristics of ketamine Anesthesia ?

【小结】

第八章静脉全身麻醉
Intravenous anesthesia

Wang yunjiao

1. Introduction 8'

Definition

General anesthesia maybe produced by many drugs which are administered via intravenous injection and depress the central nervous system.

● Rapid induction of anesthesia

● Non-irritant to the respiratory tract

● No environmental pollution

● Making patient comfortable

● Rapid recovery

● Simply to use

● No muscle relaxation

● Poor control

● Poor analgesia

● Intravenous basal anesthesia

● Intravenous induction of anesthesia

● Intravenous maintenance of anesthesia

● Bolus

induction of anesthesia, minor operation

● Intermittent injection

● Continuous infusion

● Target-controlled infusion(TCI)

2. Intravenous Anesthesia of Thiopentone Sodium 10'

Methods

① Bolus（2-2.5%）

◆ short procedures or induction of anesthesia

● adults: 2.5—4.5 mg/kg

● young children: 5-6 mg/kg

● elder: 2.5-3 mg/kg

◆ Basal anesthesia for children :

● 2.5%, 15-20 mg/kg, i.m

---- induce sleep in 5 min

● 5-10%, 44 mg/kg, rectal administration

---- induce sleep in 10-15 min

② intermittent injection

●首次3-5ml，递增5-10ml，意识消失，睫毛反射消失，疼痛刺激无反应，开始手术

● 每2-3分钟，注药1-2ml

● 成人总量≤0.5g，最大剂量0.75-1.0g

③ Continuous infusion

● 辅助麻醉，解痉、控制惊厥

● 0.1%-0.5%，20-100滴/分钟滴注

● 蓄积、中毒

Indications

● Induction

● Maintenance

● Basal narcosis

● Treatment of status epilepticus and convulsion

● Assistant of other anesthesia

● Reduction of intracranial pressure

Absolute Contraindications

● Airway obstruction

● Porphyria

● Previous hypersensitiving reaction

Precautions

● Cardiovascular disease (hypovolaemia, myocardial disease, cardiac valvular stenosis )

● Severe hepatic disease

● Renal disease

● Muscle disease

● Reduced metabolic rate

Precautions

● Obstetrics

● Outpatient anesthesia

● Adrenocortical insufficiency

● Extremes of age(neonate, infant)

● Asthma

Complications

● Phlebitis

● Tissue necrosis

● Intra-artery injection: endarteritis

● Severe cardiovascular and respiratory depression

● Allergic reaction

● Laryngeal spasm

● Bronchospasm

● Coughing and hiccups

3. Intravenous Anesthesia of Ketamine 10'

Methods

①肌肉注射法(intramuscular injection )

●Children 4-6 mg/kg，<1year increased to 10mg/kg

● 1-5min起效，维持15-25分钟

● 追加首量1/2—1/3

② 静脉注射法（intravenous injection）

●首量 1-2mg/kg，1-2min起效，维持5-10min

● 追加：首量的1/2或全量

●总量< 6mg/kg

③连续静脉输注法
（continuous intravenous injection）
1-2mg/kg induction,0.1% ketamine，iv by drip,maintenance of anesthesia

④ 氯胺酮亚分离麻醉

(analgesia without loss of consciousness )

● 0.5(0.25-0.5)mg/kg,iv

● 50 ng/kg/min

Indications

● Superficial operation with minor and short procedure

● Basal narcosis in children for regional anesthesia (pediatric anesthesia)

● Induction of anesthesia for children, shock or hypovolemia patient

● Assistant of epidural anesthesia or nerve block(analgesia and sedation)

● Elderly or high-risk patient: may stable circulatory and respiratory system function

● Anesthesia for asthmatic patients

Absolute Contraindications

● Airway obstruction

● Raised intracranial pressure

Precautions

n Hypertension

n Cardiovascular disease,cardiac failure and angina

n Prolonged operations

n Hyperthyroid and chromaffinoma

n epilepticus and mental confusion

n Blood pressure increased (Bp↑)

n Intracranial pressure increased (ICP↑)

n Intraocular pressure increased

n Agitation, night mares or hallucination

n Transient apnoea , respiration depress

n salivation

n Nausea and vomitting

n Transient blindness

n Laryngeal spasm and airway obstruction

4.羟丁酸钠静脉麻醉 5'
药物特点：低毒、催眠作用强，作用时间长，
循环、呼吸、肝肾功能影响小

麻醉方法

术前用药：阿托品足量

麻醉诱导：

成人 50-80mg/kg

儿童可达100mg/kg

麻醉维持：

复合应用，作用时间60-90min,1-2小时追加半量

适应症与禁忌症

适应症：

n 麻醉诱导

n 辅助麻醉或基础麻醉

禁忌症

n 严重高血压

n 心脏传导阻滞或左束支传导阻滞

n 心动过缓

n 癫痫和惊厥病人

并发症

n 锥体外系兴奋表现

n 低钾血症

n 幻觉、激动、兴奋、躁狂

n 恶心、呕吐、甚至大小便失禁

5. Intravenous Anesthesia of Propofol 5'

● Rapid induction
● Favorable recovery
● Short lasting duration
● Antiemetic effect

Dosage and Administration

Induction：

2 mg/kg iv

Maintenance：

2 mg/kg iv

50-150 ìg/kg/min

4-12 mg/kg/hr

Sedation：

25-75 ì g/kg/min

Indications

● Induction of anesthesia

● Total venous anesthesia

● Outpatient anesthesia

● Sedation in ICU

● Sedation during surgery

(Regional analgesic and endoscopy)

n Cardiovascular depression

n Respiratory depression

n Excitatory phenomena

n Pain on injection

n Allergic reaction

Absolute Contraindications

● Airway obstruction

● Hypersensitivity

● < 3 years old

5. Intravenous Anesthesia of Etomidate 3'

● Rapid acting and recovery
● Less depression of cardiovascular
and respiratory
● Short duration of action

Dosage and Administration

Induction：

0.3 mg/kg (0.1-0.4 mg/kg )

Maintenance：

Administration sole only for short procedures

Indications

● Induction of anesthesia

●Anesthesia for compromised cardiovascular system, cardiac failure, shock patient

● Outpatient anesthesia

Contraindications

● Airway obstruction

● Porphyria

● Adrenal insufficiency

● Long-term infusion

n Pain on injection

n Nausea and vomitting

n Venous thrombosis

n Restlessness and delirium during recovery

n Myopalmus, myoclonia or convulsion

6. Intravenous Anesthesia of Fentanyl 6'

● Analgesia potency is powerful
● Onset of action is rapid
● Cardiovascular depression is slight

Dosage and Administration

Induction of anesthesia

6-8 ìg/kg

10-20 ìg/kg for cardiovascular surgery

Maintenance of anesthesia

Total dosage may up to 50-100 ìg/kg for cardiovascular surgery

Disadvantages

Indications

● Induction of anesthesia

● Sedation and analgesia

●Cardiovascular anesthesia

● Trauma

● General Surgery

● Neurosurgery

7. Intravenous Anesthesia of Midazolam 3'

● Water-soluble benzodiazepine
● Slightly more rapid onset and action
● Short duration of action
Elimination half-life is 1.5-2.5h, in some
critically ill patients is prolonged up to 21h
and greatly delayed recovery consciousness.

Indications

● Induction of anesthesia

● Maintenance of anesthesia

● Sedation

● Premedication

n Cardiovascular depression in the

hypovolemic patients

n Respiratory depression in elderly

n Recovery is prolonged in critically ill patients

文献录入：mzk 责任编辑：mzk

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第八章 静脉全身麻醉Intravenous anesthesia

Wang yunjiao

1. Introduction 8'

Definition

General anesthesia maybe produced by many drugs which are administered via intravenous injection and depress the central nervous system.

● Rapid induction of anesthesia

● Non-irritant to the respiratory tract

● No environmental pollution

● Making patient comfortable

● Rapid recovery

● Simply to use

● No muscle relaxation

● Poor control

● Poor analgesia

● Intravenous basal anesthesia

● Intravenous induction of anesthesia

● Intravenous maintenance of anesthesia

● Bolus

induction of anesthesia, minor operation

● Intermittent injection

● Continuous infusion

● Target-controlled infusion(TCI)

2. Intravenous Anesthesia of Thiopentone Sodium 10'

Methods

① Bolus（2-2.5%）

◆ short procedures or induction of anesthesia

● adults: 2.5—4.5 mg/kg

● young children: 5-6 mg/kg

● elder: 2.5-3 mg/kg

◆ Basal anesthesia for children :

● 2.5%, 15-20 mg/kg, i.m

---- induce sleep in 5 min

● 5-10%, 44 mg/kg, rectal administration

---- induce sleep in 10-15 min

② intermittent injection

●首次3-5ml，递增5-10ml，意识消失，睫毛反射消失，疼痛刺激无反应，开始手术

● 每2-3分钟，注药1-2ml

● 成人总量≤0.5g，最大剂量0.75-1.0g

③ Continuous infusion

● 辅助麻醉，解痉、控制惊厥

● 0.1%-0.5%，20-100滴/分钟滴注

● 蓄积、中毒

Indications

● Induction

● Maintenance

● Basal narcosis

● Treatment of status epilepticus and convulsion

● Assistant of other anesthesia

● Reduction of intracranial pressure

Absolute Contraindications

● Airway obstruction

● Porphyria

● Previous hypersensitiving reaction

Precautions

● Cardiovascular disease (hypovolaemia, myocardial disease, cardiac valvular stenosis )

● Severe hepatic disease

● Renal disease

● Muscle disease

● Reduced metabolic rate

Precautions

● Obstetrics

● Outpatient anesthesia

● Adrenocortical insufficiency

● Extremes of age(neonate, infant)

● Asthma

Complications

● Phlebitis

● Tissue necrosis

● Intra-artery injection: endarteritis

● Severe cardiovascular and respiratory depression

● Allergic reaction

● Laryngeal spasm

● Bronchospasm

● Coughing and hiccups

3. Intravenous Anesthesia of Ketamine 10'

Methods

①肌肉注射法(intramuscular injection )

●Children 4-6 mg/kg，<1year increased to 10mg/kg

● 1-5min起效，维持15-25分钟

● 追加首量1/2—1/3

第八章静脉全身麻醉
Intravenous anesthesia

③连续静脉输注法
（continuous intravenous injection）
1-2mg/kg induction,0.1% ketamine，iv by drip,maintenance of anesthesia

4.羟丁酸钠静脉麻醉 5'
药物特点：低毒、催眠作用强，作用时间长，
循环、呼吸、肝肾功能影响小

● Rapid induction
● Favorable recovery
● Short lasting duration
● Antiemetic effect