Explanation of professional terms in anesthesiology:
1. Respiratory acidosis
That is hypercapnia, PaCO2> 45mmHg. Mainly due to insufficient alveolar ventilation and CO2 accumulation in the body. Common causes of CO2 accumulation during anesthesia include: respiratory depression of anesthetic drugs, poor respiratory management, failure of anesthesia equipment or failure of CO2 absorption devices, etc.
2. Meyer-Overton rule
At the beginning of this century, Meyer and Overton successively measured the solubility of commonly used inhaled anesthetics such as ether, nitrous oxide and chloroform in olive oil, and compared the relationship between their fat solubility and general anesthesia potency, and found that inhaled general anesthetics It has high lipophilicity and is directly proportional to its potency. Therefore, it is believed that the general anesthetic is loosely combined with the lipid components in the nerve, resulting in changes in the normal relationship of various components in the nerve cells, resulting in anesthesia, which is called the Meyer-Overton law.
3、 PCA
That is, patient-controlled analgesia, which allows the patient to administer a certain amount of analgesic drugs by himself through a specific PCA control system. The control system will not respond to the patient's second drug administration request within a preset time, so it can be effective control drug overdose. When PCA is used, whenever the blood concentration of opioids is lower than the minimum effective analgesic concentration (MEAC), the patient can self-administer analgesia, which effectively avoids the inflexibility, dependence, and inconvenience of traditional analgesic methods. Timely shortcomings.
4. Three-level medication ladder for cancer analgesia
The administration principles of the cancer pain three-step analgesic regimen are: step-wise administration, oral administration, on-time administration, individualized medication, and adjuvant medication. (1) The first step: mild cancer pain, the first-line analgesics are non-opioid analgesics such as aspirin and other NSAIDs, and adjuvant drugs are added if necessary; (2) The second step: moderate cancer pain and the first-line analgesic When the effect of the first step of treatment is not satisfactory, weak opioids such as codeine can be used, and analgesics or adjuvant drugs of the first step can also be used together; (3) The third step: severe opioids that do not respond well to the second step of treatment For cancer pain, strong opioids such as morphine can be used, which can also assist the first and second step drugs.
5、 TOF
That is, four series of stimulations are a series of stimulation waves composed of four rectangular waves with a frequency of 2Hz and a wave width of 0.2-0.3ms. The four series of stimulations cause four muscle twitches (T1, T2, T3, T4), the distance between the series of continuous stimulation is 10-12s. When the neuromuscular transmission function is normal, the twitch amplitudes of the four muscles are equal, but attenuation occurs when the partial non-depolarization block occurs, and the twitch amplitudes of the four muscles decrease sequentially.
Studies have shown that the ratio (T4/T1) of the fourth muscle twitch (T4) to the first muscle twitch (T1) of each train of stimulation is the same as that of the first muscle twitch of the train during non-depolarization block. There is a good correlation between the ratio (T1/C) and the control value (C) before medication, so the degree of blockage can be directly evaluated from the ratio of T4/T1, and the nature of blockage can also be determined according to whether there is attenuation.
In partial depolarization block, T4/T1>0.9 or close to 1.0, although the twitch amplitudes of all four muscles were reduced. When the degree of non-depolarization block increases, the ratio of T4/T1 decreases gradually. When T4 disappears, it is equivalent to 75% inhibition of single-stimulus muscle twitch. They are equivalent to 80%, 90%, and 100% inhibition of single-stimulus muscle twitch, respectively. T4/T1>0.75 indicates that muscle tone has been fully restored clinically.
6、 FRC
The functional residual volume is the amount of gas remaining in the lungs at the end of quiet expiration. Normal adult male is about 2500ml, and female is about 1600ml. Functional residual capacity plays a buffer role in the change of alveolar gas PO2 and PCO2 partial pressure in gas exchange. Functional residual volume decreases in the supine position and decreases further after induction of anesthesia in supine patients. When the functional residual volume increases, the induction and recovery of inhalational anesthesia can be delayed, and the improvement of hypoxia can be slowed down.
7、 ETCO2
The exhaled carbon dioxide curve. is a method of monitoring lung function, especially pulmonary ventilation, using non-invasive techniques,
It can be monitored continuously and quantitatively at the bedside, providing clear indicators for anesthetized patients and respiratory medicine for respiratory support and respiratory management.
8. CO2 Exclusion Syndrome
Hypercapnic patients rapid discharge of CO2 can lead to hypocapnia, clinical manifestations of blood pressure drop sharply, pulse weakening, respiratory depression and so on. In severe cases, arrhythmia or cardiac arrest may occur.
9. Closed anesthesia
Inhalation anesthesia is divided into four methods: semi-open, open, semi-closed and closed according to the degree of repeated inhalation and whether a CO2 absorption device is needed. When the fresh oxygen flow is equal to the oxygen consumption per minute, all the exhaled air is reinhaled, and a CO2 absorption device is necessary, which is called closed anesthesia. Its advantages are: (1) the humidity of the inhaled gas is close to normal, and it is easy to keep the respiratory tract moist; (2) it can reduce the loss of body heat; (3) it can save anesthetics and oxygen; (4) it can reduce air pollution in the operating room. The disadvantages are: (1) CO2 emission requires CO2
Absorption device; (2) The depth of anesthesia is not easy to adjust.
10. First-degree atrioventricular block
Refers to the conduction delay or interruption in the atrioventricular node or below the atrioventricular node, which is more common in the pathological changes of the conduction pathway (such as calcification, necrosis, ligation, etc.), prolonged refractory period (such as digitalis) or supraventricular cycle Shortened, but prolonged AV node refractory period. The electrocardiogram showed: (1) regular heart rhythm; (2) each P wave was accompanied by a QRS wave with normal waveform; (3) PR interval > 0.20 seconds.
11、 postoperative cognitive dysfunction(POCD)
That is, postoperative cognitive dysfunction. It mostly occurs in the elderly over 65 years old, after major operations such as heart surgery, hip joint replacement, and mandibular fracture. Changes in personality, social skills, and cognitive abilities and skills. Mild symptoms only show cognitive abnormalities; moderate symptoms show severe memory impairment or amnesia syndrome; severe symptoms show dementia with severe memory impairment, loss of judgment and language generalization ability, and personality changes. According to different degrees of cognitive impairment, it can be divided into three grades: mild cognitive abnormality, amnesia and dementia.
12、 ischemia preconditioning
Clinical observations show that short-term and multiple blockade of the canine anterior descending coronary artery results in milder changes in the electrocardiogram than after one-time blockage, which is called myocardial ischemic preconditioning. It can make the myocardium resist the subsequent persistent ischemic attack, and it is still effective when repeated. Its protective effect is manifested in the reduction of myocardial infarction, the improvement of cardiac diastolic and systolic function, and the enhancement of antiarrhythmic effect. It may be related to the support of the following factors: (1) adenosine plays an important role in ischemic preconditioning, which can activate intracellular G protein and further activate protein kinase C (PKC), thereby playing a protective role; (2) stress In this state, the myocardium can rapidly activate and synthesize a large number of heat shock proteins (HSP) to resist the effects of various stressors and produce protective effects such as anti-oxidation. (3) Myocardial ischemic preconditioning can produce delayed myocardial protection, which can last for several hours to several days, and is also related to the increased synthesis of HSP and SOD.
13、 intraoperative awareness
That is known intraoperatively. Patients under general anesthesia can recall part or all of the anesthesia operation process (with or without pain), which can bring great mental pain to the patient. Knowing during the operation has different forms and degrees of influence on the patient's behavior, emotion, and recovery process after the operation, and can induce anxiety, near-death feeling, repeated nightmares, reluctance to talk to others about the adverse experience during the operation, etc. symptom. Mild cases lead to neurosis, and severe cases lead to the occurrence of post-traumatic stress syndrome.
14、 preemptive analgesia
That is, preemptive analgesia refers to the use of opioids or nerve blocks before pain transmission occurs in the spinal cord and brain, thereby inhibiting the enhancement of pain stimulation in the spinal cord and brain and the improvement of pain perception, that is, the inhibition of the so-called " Up-regulation" and "central sensitization" phenomena, so that the body can obtain better analgesia before the pain stimulus and last for a period of time after the pain stimulus is eliminated.
15、 CESA
That is, continuous subarachnoid space-epidural combined analgesia. Mainly used in labor analgesia. That is, by indwelling a microcatheter and a thin catheter in the subarachnoid space and the epidural space respectively, opioids and local anesthetics are injected in small doses or continuously through the catheter. This method blocks the sensory nerves of the uterus and vagina to the greatest extent, while the motor nerve block is relatively slight, which can make up for the defects of simple epidural analgesia for incomplete sacral nerve block or too deep subarachnoid space block , the analgesic effect is fast and the effect is good, and it does not affect the expansion of the cervix, the speed of fetal head descent and the time of the first and third stages of labor
, although prolonging the time of the second stage of labor, it does not increase the cesarean section rate and postpartum hemorrhage, and has no significant impact on neonatal breathing.
16. Low-flow inhalation anesthesia refers to the closed or semi-closed inhalation anesthesia, the fresh gas flow rate is 1L/min (50% O2 and 50% N2O).
17. Phase II block
Intravenous infusion of succinylcholine for 30-60 minutes or 7-10 mg/kg can cause biphasic block, and when biphasic block occurs, 50% muscle tension recovery is delayed. The occurrence of phase II block is related to factors such as the dosage of succinylcholine, maintenance time, method of administration, and compatible drugs. When the total amount of intravenous infusion of succinylcholine exceeds 1.0g, biphasic block is prone to occur. If the dosage is controlled below 0.5g, the chance of occurrence is less. The characteristics of phase II block include: (1) muscle twitch attenuation with tetanic stimulation and four-stimulus train; (2) facilitation of muscle twitch with a single stimulus after tetanic stimulation; (3) delayed recovery of muscle tone in most patients ; (4) When the plasma concentration of succinylcholine drops, anticholinesterase drugs can be tried to antagonize it.
18、 KNOW
That is, total intravenous anesthesia refers to the method of anesthesizing the patient by completely using intravenous anesthetics and auxiliary drugs. This method has rapid induction, stable anesthesia process, no pollution, and quick recovery. For some special operations (such as lung lavage surgery for alveolar proteinosis) and some patients with severe respiratory diseases, TIVA reflects its advantages. great advantage.
19. Mendelson syndrome This syndrome was first described by Mendelson, that is, an "asthma-like syndrome" appeared shortly after or 2 to 4 hours after aspiration occurred,
The patient presented with cyanosis, tachycardia, bronchospasm, and dyspnea. Wheezing or rales may be heard in the affected lung fields. The degree of lung tissue damage is directly related to the pH value of gastric contents, and the damage caused by gastric juice with pH>2.5 is much lighter than that with pH<2.5. In addition to the chemical properties of gastric juice, the damage of lung tissue is also related to the activity of digestive enzymes. Chest x-rays are characterized by irregular, indistinctly bordered, patchy shadows of the involved lung fields. Usually more than 24 hours after the aspiration occurs.
20、 SIRS
After the body is traumatized, the complement system, immune cells and other stromal cells such as vascular endothelial cells are activated due to factors such as damaged tissue, foreign body and infection, triggering non-specific and specific defense responses to facilitate the repair of the body's trauma. When the defense response is out of control or excessive, it can cause systemic inflammatory response syndrome (SIRS), which will lead to an imbalance in the internal environment of the body and cause secondary damage to organ function, which is not conducive to the recovery of the body.
21、 PEEP
positive end-expiratory pressure ventilation. PEEP can expand collapsed alveoli, correct the imbalance of ventilation/blood flow ratio, increase functional residual capacity and lung compliance, and facilitate the diffusion of oxygen through the respiratory membrane. Therefore, PEEP can effectively increase PaO2, improve arterial oxygenation, and reduce FiO2 to improve ventilation. It can be used as a support method for ARDS treatment to prolong the survival time of patients and win opportunities for comprehensive treatment.
22. VAS score
the visual analogue scale. It is a simple and effective method to measure the degree of pain. Usually, a 10cm-long straight line is used, and the two ends are respectively marked with "no pain (0)" and "worst pain (10)" (or similar descriptors) to indicate the intensity of pain and psychological impact. The distance to the mark is the amount of pain. VAS can also be used to assess pain relief. One end of the line is labeled "No Pain Relief" and the other end is marked "Complete Pain Relief." Pain relief is the initial pain score minus the post-treatment pain score, also known as the Visual Analogue Scale of Pain Relief (VAP ).
23. Massive blood transfusion
Refers to a blood transfusion exceeding 1 to 1.5 times the patient's own blood volume, or a blood transfusion greater than 1/2 of the patient's own blood volume within 1 hour, or a blood transfusion rate greater than 1.5ml/(kg.min). It can lead to complications such as decreased oxygen supply capacity, bleeding tendency, citric acid poisoning, hyperkalemia, hypothermia, acid-base balance disturbance, and infusion of tiny thrombus.
24. Electromechanical separation
It is a manifestation of cardiac arrest, that is, the ECG still has low-amplitude ventricular complexes, but the heart has no effective pumping function. Some people think that electromechanical dissociation (EMD) has no exact definition, except for ventricular fibrillation (VF) and ventricular tachycardia (VT) with no palpable aortic pulse, any sinus and nodal arrhythmia with no palpable aortic pulse And ventricular bradycardia or tachycardia belong to the category of EMD.
25、 MAC
It is the minimum effective concentration of alveolar gas, which is defined as 50% of patients have no body movement response to skin incision stimulation under one atmospheric pressure, and the concentration of anesthetic drugs in the alveoli at this time is 1 MAC. It includes four basic elements: (1) When a strong noxious stimulus is received, an "all" or "none" body movement response must occur; (2) The end-tidal anesthetic concentration in the alveoli is used as a balance sample point to Reflect the concentration of anesthetics in the brain; (3) Use appropriate mathematical methods to express the quantitative relationship between the concentration of anesthetics in the alveoli and the corresponding response to evaluate MAC; (4) MAC can also be quantified to reflect changes in physiological or pharmacological states, Such as can be used as a sensitive means to determine the interaction of other anesthetics, central drugs and inhalational anesthetics.
26, ASA Grade 3
The evaluation criteria are: severe systemic disease with certain functional limitations. Level 3 patients have certain risks when receiving anesthesia, and they should be fully prepared as much as possible before anesthesia, and effective measures should be taken to prevent complications that may occur during and after anesthesia.
27. CVP is central venous pressure. The normal value is 5-12cmH2O. It reflects the ability of the heart to pump out the returning blood volume, and indicates whether the venous returning blood volume is sufficient. CVP<2.5
cmH2O indicates cardiac filling or hypovolemia, even if the arterial pressure is normal, fluid infusion is still required; CVP>15~20
cmH2O, suggesting right ventricular dysfunction, the infusion volume should be controlled. But CVP can not reflect the left heart function.
28. Metabolic acidosis
It is due to the increased production of H+ in the body and (or) the obstruction and accumulation of excretion, such as reduced tissue blood flow (shock), hypoxia and metabolic disorders, renal insufficiency or failure, etc.; or due to excessive loss of HCO3- ions in the body (such as intestinal Fistula, excessive loss of intestinal fluid, and acute diarrhea, etc.), resulting in an acid-base imbalance. The diagnostic criteria are: BE<-3mEq/L, or RA>15
mEq/L
29、SaO2
the arterial oxygen saturation. Refers to the degree to which hemoglobin is saturated with oxygen, expressed as a percentage, that is, the ratio of the oxygen content of hemoglobin to the oxygen capacity multiplied by 100. Under normal circumstances, there is a correlation between SaO2 and PaO2, so SaO2 is usually used as an indicator of tissue oxygen supply. Such as SaO2<90%, PaO2 is often lower than 60mmHg, and SaO2<90% often indicates hypoxemia. However, SaO2 is not as sensitive as PaO2 as an indicator of tissue hypoxia. The level of blood oxygen saturation is related to the affinity of hemoglobin and oxygen.
30、 VD/VT
That is, the ratio of dead space volume to tidal volume can be used as an index reflecting ventilation efficiency. In healthy adults the ratio is usually less than 0.30, ie 70% of the ventilation is effective. In severe obstructive pulmonary disease, VD/VT can increase to 60% to 70%, and the ventilation efficiency is significantly reduced at this time. If VD/VT increases, the minute ventilation will decrease correspondingly and cause PaCO2 to rise rapidly. If the PaCO2 is to be kept constant when VD/VT increases, the minute ventilation must be increased.
31. Respiratory depression
It refers to the weakening of respiratory action due to various factors during anesthesia, and the decrease of respiratory frequency, tidal volume, and pulmonary ventilation. Inhalational anesthetics cause patients to actively hold their breath, and surgical operations under light anesthesia cause reflex respiratory depression and CO2 excretion syndrome.
32. PH is the negative logarithm of hydrogen ion concentration in blood, which is the basic index to judge whether the acid-base balance is out of balance. A pH < 7.35 indicates acidemia, and a pH > 7.45 indicates alkalemia.
33. Plasma colloid osmotic pressure refers to the osmotic pressure formed by plasma protein colloids in blood vessels, and is one of the important mechanisms involved in the fluid balance between tissues.
34. Glasgow score
It is a scoring standard used to judge the degree of disturbance of consciousness, evaluate the effect of treatment and estimate the prognosis. It includes three items: (1) Eye-opening response: normal eye-opening, call-opening, stimulus-opening and no-response. Score 4, 3, 2, 1 points; (2) Verbal response: correct answer, wrong answer, ambiguity, only groaning and no response, score 5, 4, 3, 2, 1 in turn; (3) Motor response: obey Action, positioning action, escape response, limb flexion, limb extension and no response, scored 6, 5, 4, 3, 2, 1 points in turn. The total score of the three items is 15 points. A score below 3 is considered brain dead, and a score below 7 is considered deep coma.
35. Intermittent Mandatory Ventilation (IMV)
Also known as intermittent mandatory breathing, in recent years, Synchronized Intermittent Mandatory Ventilation (SIMV) has been used more often. On the basis of spontaneous breathing, the command tidal volume is triggered regularly and intermittently for the patient, and the gas is forced into the lungs to provide the patient The part of the ventilation required to keep the blood gas analysis value in the normal range (pH7.35~7.45, PaCO235~45mmHg), similar to CMV, the tidal volume is automatically generated by the ventilator, and the patient is easy to transition from the ventilator to spontaneous breathing. And finally evacuate the ventilator.
36. Cholinergic crisis
Anticholinesterase drugs inhibit cholinesterase, thereby enhancing the effect of endogenous acetylcholine, manifested as the enhancement of the M-like effect and N-like effect of acetylcholine. The main targets of action are the neuromuscular junction of striated muscle and the gastrointestinal tract. The effect on cardiovascular and eyes is relatively weak. Most of them also have a direct excitatory effect on muscles. Therefore, muscle strength can be improved after application. When the dose is too large, not only the adverse reactions of its M-like effect are significant, but also the muscle is more weak due to the excess of acetylcholine at the neuromuscular junction, which is called .
37. Hyperthyroid crisis
It refers to the sudden exacerbation of hyperthyroidism due to stress, resulting in a life-threatening state. It usually occurs in the case of uncontrolled hyperthyroidism or after surgical stimulation, usually 6 to 18 hours after surgery. Manifestations: elevated body temperature, tachycardia (heart rate >160 beats/min), profuse sweating, irritability, vomiting, diarrhea, delirium, or coma.
38. Front load
It refers to the load encountered before the myocardial contraction. For the left ventricle, it is the left ventricular end-diastolic pressure (LVEDV).
39. Apgar's score"
Proposed by Apgar, five indicators (heart rate, breathing conditions, muscle tension, nerve reflexes and skin color) are used to evaluate the situation of newborns at birth. Each indicator is divided into three categories: 0 points, 1 points, and 2 points, and 10 points Full marks, indicating that the newborn is in good condition, call it. Scores at 1 and 5 minutes after birth can also be used to assess the effect of resuscitation.
40、MSOF
That is, multiple system organ dysfunction syndrome is the dysfunction or even failure of more than one organ. If it is not corrected in time, or life support measures are taken, it will inevitably endanger the safety of life. Stresses such as trauma, shock, infection, and inflammation often lead to uncontrolled systemic inflammatory responses, resulting in acute multi-system or organ dysfunction, thereby affecting the stability of the systemic internal environment. Organ dysfunction can be absolute or relative.
41. Autologous blood transfusion
The technique of reinfusing one's own blood. There are three types of autologous blood transfusion methods commonly used in clinical practice: preoperative autologous blood collection storage technology, acute hemodilution technology, intraoperative and postoperative blood salvage technology. Its advantages include: (1) Avoid the complications of allogeneic blood transfusion; (2) Save blood resources; (3) Solve the problem of blood use for some rare blood types.
42. PAO2-PaO2 is the difference in partial pressure of oxygen in alveolar-arterial blood. Refers to the difference in partial pressure of oxygen between alveolar gas and arterial blood, the normal value is 10-30
mmHg, which can increase with age. It is an important indicator for judging the oxygen diffusing capacity of the lungs. Because it reflects the damage of lung oxygen exchange efficiency earlier than any other common single parameter, it is one of the sensitive indicators for early reflection of pulmonary insufficiency. if
PAO2－PaO2 >30mmHg, indicating severe hypoxia; after inhaling pure oxygen for 15 minutes, PAO2－PaO2 should not exceed 100
mmHg; but in the case of extensive pulmonary consolidation, atelectasis, pulmonary edema, and a large amount of phlegm in the respiratory tract, PAO2-PaO2 can increase to 100-200
mmHg; in ARDS, it is difficult for PaO2 to exceed 50 mmHg after inhaling pure oxygen.
43、 PetCO2
That is, the end-tidal CO2 partial pressure refers to the PCO2 of the end-expiratory part of the gas, which reflects the average PCO2 value of all ventilated alveoli, which also includes the part diluted by alveolar dead space gas. Therefore, PetCO2≈PACO2≈PaCO2, and it is confirmed that PaCO2 and PetCO2 diffusion barriers, V/Q ratio imbalance, right-left shunt and special ventilation methods such as PEEP can make PetCO2 lower than PaCO2.
44. Hoffman Elimination
In alkaline medium, the quaternary ammonium compound removes the β-hydrogen atom and the α-CN bond to automatically break and degrade. Atracurium can undergo Hoffman elimination at physiological pH and body temperature, so its storage should be at a temperature of 4 °C and pH 3.0.
45. Deep hypothermia refers to lowering the body temperature to about 12°C during hypothermic anesthesia.
46. Neuroleptic analgesia is composed of droperidol and fentanyl in a ratio of 50:1.
47. Local anesthetics can be divided into two categories according to their molecular structure:
(1) Esters such as procaine, tetracaine
(2) Amides such as lidocaine, bupivacaine
48. When pulmonary arterial pressure is higher than 30/12 mmHg, it is called pulmonary hypertension.
49. The minimum effective alveolar concentration is that 50% of the patients have no body movement response to skin incision stimulation under one atmospheric pressure. At this time, the concentration of anesthetic drugs in the alveoli is 1 MAC.
1. controlled blood pressure reduction
Answer: For some special operations, in order to reduce the blood loss in the surgical field, create good conditions for the operation, reduce the amount of blood transfusion, use various drugs and methods to consciously lower the patient's blood pressure during the operation, and control the degree and degree of blood pressure reduction according to the specific situation. duration, this technique is called controlled decompression.
2. target controlled infusion
Answer: TCI is a computer drug delivery system that controls the depth of anesthesia by adjusting the corresponding target blood drug concentration according to the pharmacokinetics and pharmacodynamics of different intravenous anesthetics, as well as the individual conditions of patients of different genders, ages and weights.
3. supine hypotensive syndrome
Answer: The large retroperitoneal blood vessels compressed by the enlarged uterus or intra-abdominal mass of the parturient will cause a sharp decrease in blood return to the heart and a decrease in cardiac output, leading to clinical syndromes of hypotension, tachycardia, collapse and even syncope. Elevating the left or right hip in the maternal position can prevent supine hypotensive syndrome.
Questions and Answers
1. What is total spinal anesthesia?
Answer: It refers to the blockage of all spinal cord nerves from the neck and brainstem. Usually due to local anesthetic overdose. Symptoms and signs: dysphonia, dyspnea, upper limb weakness, and rapid loss of consciousness, hypotension, bradycardia, cardiopulmonary arrest. The emphasis is on prevention and early identification. Treatment: respiratory and circulatory support.
2. What is combined spinal-epidural anesthesia? advantage?
Answer: It refers to a method of anesthesia that combines subarachnoid anesthesia and epidural anesthesia. Main advantages: they can learn from each other, not only have the advantages of spinal anesthesia such as fast onset of anesthesia, muscle relaxation, and exact analgesic effect, but also have the advantages of epidural anesthesia that can meet the needs of long-term operations. Methods include one-point method and two-point puncture method. One-point puncture, that is, both spinal anesthesia and epidural anesthesia are punctured in the same spinal space. The two-point puncture method refers to puncture in different spinal spaces for spinal anesthesia and epidural anesthesia respectively.
3. Briefly describe the main tasks and steps of initial resuscitation (cardiopulmonary resuscitation)?
A: The main task is to quickly and effectively restore blood perfusion and oxygen supply to vital organs, especially the heart and brain. The tasks and steps of initial resuscitation can be summarized into ABC: A (air way) refers to keeping the airway smooth, B (breathing) refers to effective artificial respiration, and C (circulation) refers to establishing effective artificial circulation. Artificial respiration and cardiac compressions are the main measures of initial resuscitation.
4. Briefly describe the common causes of postoperative hypotension?
Answer: ① Hypovolemia: manifested as dry mucous membranes, rapid heart rate and oliguria. ②Venous reflux disorder; can occur in mechanical ventilation, tension pneumothorax, cardiac tamponade, etc. ③ Decreased vascular tone; can occur in spinal anesthesia, allergic reactions, adrenal insufficiency, etc., and can also be seen in the application of antihypertensive drugs, antiarrhythmic drugs and rewarming.
5. Epidural anesthesia, the adjustment of the anesthesia plane is mainly determined by what factors?
Answer: ①Local anesthetic volume: Since there is no cerebrospinal fluid in the epidural space, the diffusion of the local anesthetic depends entirely on its own volume. The more the amount injected, the wider the diffusion and the wider the range of anesthesia. ② Puncture gap: The height of the upper and lower planes of anesthesia is determined by the height of the puncture gap. ③Catheter direction: if the catheter is intubated toward the head end, the drug solution will easily spread to the chest and neck; if it is inserted toward the tail end, it will easily spread to the lumbar and sacral segments. ④Injection method: the dose is the same, if one concentrated injection, the anesthesia range will be wider, and if divided injection, the range will be narrowed. ⑤Other factors such as drug concentration, injection speed and patient body can have certain influences.
6. Briefly describe the common causes and preventive measures of local anesthetic toxicity?
Answer: The common causes of local anesthetic toxicity are: ① one-time dosage exceeds the tolerance of the patient; ② mistakenly injected into the blood vessel; ③ the site of action is rich in blood supply, and the dose is not reduced as appropriate, or no adrenaline is added to the local anesthetic liquid; ④ The patient's tolerance is reduced due to physical weakness and other reasons. To prevent local anesthetic toxicity, measures should be taken according to the cause of the occurrence, such as the dosage of the drug at one time should not exceed the limit; before injection, the blood should be withdrawn before injection, or the drug should be injected while the needle is being inserted; the dose should be reduced according to the specific situation of the patient or the site of application. ; If there are no contraindications, a small amount of epinephrine is added to the liquid; and diazepam or barbiturates are used as pre-anesthesia drugs.
7. Endotracheal intubation, catheter into the trachea, how to confirm?
Chest rises and falls symmetrically, and clear alveolar breath sounds can be heard on auscultation of both lungs. ③ If a transparent catheter is used, the tube wall is clear when inhaling, and a clear "white mist"-like change can be seen when exhaling. ④ If the patient breathes spontaneously, the breathing bag can be seen to expand and contract with the breathing after being connected to the anesthesia machine. ⑤ If the partial pressure of end-tidal CO2 (ETCO2) can be monitored, it will be easier to judge, and if ETCO2 is displayed, it can be confirmed that it is correct.
8. What complications can arise after general anesthesia?
Answer: (1) Reflux and aspiration; (2) Airway obstruction; (3) Insufficient ventilation; (4) Hypoxemia; (5) Hypotension; (6) Hypertension; (7) Arrhythmia; (8) High fever, convulsions and convulsions.
9. What are the principles of the (WHO)-recommended three-step therapy for cancer pain?
A: The principles are: ①According to the strength of the drug effect, use it in a stepwise manner; ②Use oral medicine; ③Take the medicine on time; ④The dosage is individualized. Most patients are satisfied with pain relief after receiving this therapy.
10. Briefly describe the precautions for cardiac surgery preoperative preparation?
Answer: ①Patients who have used low-salt diet and diuretic drugs for a long time and have water and electrolyte imbalance should be corrected before operation; ②Patients with anemia have poor oxygen-carrying capacity, which will affect the oxygen supply to the myocardium. One blood transfusion to correct anemia; ③ People with arrhythmia, such as occasional ventricular extrasystoles, generally do not need special treatment. If there is atrial fibrillation accompanied by increased ventricular rate, or confirmed coronary heart disease with bradycardia, effective medical treatment should be used to control the heart rate within the normal range as much as possible.
Endotracheal Tube Endotracheal Tube Endotracheal Tube Endotracheal Tube: Insert a special endotracheal tube into the trachea through the mouth or nostrils and through the larynx. Endotracheal intubation Endotracheal intubation Endotracheal intubation Endotracheal intubation: Insert a special endotracheal tube through the mouth or nostrils and through the larynx into the unilateral endobronchial difficult airway: : : : mask ventilation and direct laryngeal Endoscopic endotracheal intubation is difficult General anesthesia General anesthesia General anesthesia; the anesthetic is injected into the body through inhalation, intravenous intramuscular injection or rectal perfusion, so that the central nervous system is suppressed by general anesthesia. Induction of general anesthesia Induction of general anesthesia Induction of general anesthesia: No matter intravenous anesthesia or inhalation anesthesia, there is a process of changing the patient from an awake state to an anesthesia state where surgery can be performed. This process is called general anesthesia. Induction of hemp. Inhalation anesthesia Inhalation anesthesia Inhalation anesthesia Inhalation anesthesia Inhalation anesthesia:::: The anesthetic is inhaled through the respiratory tract, which produces central nervous system inhibition, so that the patient loses consciousness and does not feel pain all over the body. Low-flow inhalational anesthesia: fresh gas flow is less than 2L/min Continuous infusion Continuous infusion Continuous infusion Immediate half-life Note Immediate half-life Note Immediate half-life Note Immediate half-life: refers to the plasma drug concentration after a period of time when the infusion is stopped at a constant rate The continuation infusion half-life is not a time constant for the time required to decrease by 50%, and the immediate continuation infusion half-life increases significantly as the duration varies from minutes to hours. Cp50Cp50Cp50Cp50 with and with and with Ce50Ce50Ce50Ce50 : Cp50 refers to the plasma drug concentration that prevents 50% of patients from responding to noxious stimuli. Ce50 is the effector drug concentration that prevents 50% of patients from responding to noxious stimuli. Target-controlled infusion Target-controlled infusion Target-controlled infusion ((((TCITCITCITCI)))): refers to the principle of pharmacokinetics and pharmacodynamics during the infusion of intravenous anesthetics. An intravenous administration method for clinical anesthesia by adjusting the drug concentration of the target or target (plasma or effect compartment) to control or maintain an appropriate depth of anesthesia. Total intravenous anesthesia Total intravenous anesthesia Total intravenous anesthesia ((((TIVATIVATIVATIVA)))) refers to the method of anesthesia for patients using intravenous anesthetics and auxiliary drugs. Closed-loop anesthesia Closed-loop anesthesia Closed-loop anesthesia Closed-loop anesthesia:::: means that during the process of target-controlled infusion, if the effect information can be fed back to the target control system and the target concentration can be adjusted automatically The adjustment of the regulation target concentration can accomplish the so-called closed-loop control of anesthesia. There are two sources of effect information: one is drug effect, such as using BIS or EP as feedback information to form a closed-loop anesthesia; the other is drug concentration. The current concentration monitoring cannot immediately measure the blood concentration of intravenous anesthetics. MACMAMAMAMAC: diagnosed by an anesthesiologist. Special medical care for patients undergoing therapeutic procedures. Its work mainly includes the following aspects: monitoring vital signs. Maintain airway patency. Diagnosis and management of clinical problems in MAC. Give sedation at the right time. Analgesics, etc. Provide other necessary medical services. TOF TOF TOF TOF Four series of stimulation Four series of stimulation Four series of stimulation Four series of stimulation is to produce four muscle twitches after four single stimulations, which are T1, T2, T3, T4 respectively. The recovery index is the recovery index when the range of muscle twitch recovers from 25% to 75% during the disappearance of muscle relaxants. Intravenous local anesthesia Intravenous local anesthesia Intravenous local anesthesia Intravenous local anesthesia refers to the method of anesthesizing the distal limbs of the tourniquet after ligating the tourniquet on the limbs and injecting local anesthetics intravenously. Due to the limitation of tourniquet ligation time, it can only be used for 1-1. A short operation within 5 hours. Epidural anesthesia Epidural anesthesia Epidural anesthesia Epidural anesthesia is the injection of local anesthetics into the epidural space to block the root of the spinal nerve and temporarily paralyze the area it innervates. Spinal anesthesia Spinal anesthesia is a method of anesthesia in which local anesthetics are injected into the subarachnoid space to block the roots of the spinal nerves. Compound anesthesia Compound anesthesia Compound anesthesia Compound anesthesia:::: refers to the simultaneous or successive application of two or more anesthesia drugs in the same anesthesia process. Combined anesthesia Combined anesthesia Combined anesthesia Combined anesthesia: refers to the simultaneous or successive use of two or more anesthesia techniques in the same anesthesia process. Total Intravenous Anesthesia Total Intravenous Anesthesia Total Intravenous Anesthesia (TIVA): refers to the anesthesia method that completely uses intravenous anesthetics and intravenous anesthesia auxiliary drugs. Intravenous inhalation compound anesthesia Intravenous inhalation compound anesthesia Intravenous inhalation compound anesthesia Intravenous inhalation compound anesthesia: refers to the application of intravenous anesthesia and inhalation anesthesia at the same time or successively in the same anesthesia process. Controlled blood pressure reduction refers to controlled blood pressure reduction. Controlled blood pressure reduction refers to ;;;; During the operation under general anesthesia, under the condition of ensuring the oxygen supply of important organs, artificially reduce the mean arterial pressure to 50-65mmHg ( 6.67-8.67kPa), so that the blood loss in the surgical field will be reduced correspondingly with the reduction of blood pressure, and there will be no ischemia and hypoxia damage to important organs. Awareness during the operation Awareness during the operation:::: means that the patient can recall what happened during the operation after the operation, and can tell whether there is pain or not. Delayed awakening Delayed awakening Delayed awakening Delayed awakening: It is generally believed that those who call for more than 30 minutes after surgery cannot open their eyes and shake hands, and do not respond to painful stimuli. 67kPa), so that the amount of blood loss in the surgical field will be reduced correspondingly with the reduction of blood pressure, and there will be no ischemia and hypoxia damage to important organs. After the blood pressure is stopped, the blood pressure can quickly return to normal levels, and there will be no permanent organ damage. Awareness during the operation Awareness during the operation:::: means that the patient can recall what happened during the operation after the operation, and can tell whether there is pain or not. Delayed awakening Delayed awakening Delayed awakening Delayed awakening: It is generally believed that those who call for more than 30 minutes after surgery cannot open their eyes and shake hands, and do not respond to painful stimuli. 67kPa), so that the amount of blood loss in the surgical field will be reduced correspondingly with the reduction of blood pressure, and there will be no ischemia and hypoxia damage to important organs. After the blood pressure is stopped, the blood pressure can quickly return to normal levels, and there will be no permanent organ damage. Awareness during the operation Awareness during the operation:::: means that the patient can recall what happened during the operation after the operation, and can tell whether there is pain or not. Delayed awakening Delayed awakening Delayed awakening Delayed awakening: It is generally believed that those who call for more than 30 minutes after surgery cannot open their eyes and shake hands, and do not respond to painful stimuli. 67kPa), so that the amount of blood loss in the surgical field will be reduced correspondingly with the reduction of blood pressure, and there will be no ischemia and hypoxia damage to important organs. After the blood pressure is stopped, the blood pressure can quickly return to normal levels, and there will be no permanent organ damage. Awareness during the operation Awareness during the operation:::: means that the patient can recall what happened during the operation after the operation, and can tell whether there is pain or not. Delayed awakening Delayed awakening Delayed awakening Delayed awakening: It is generally believed that those who call for more than 30 minutes after surgery cannot open their eyes and shake hands, and do not respond to painful stimuli. 67kPa), so that the amount of blood loss in the surgical field will be reduced correspondingly with the reduction of blood pressure, and there will be no ischemia and hypoxia damage to important organs. After the blood pressure is stopped, the blood pressure can quickly return to normal levels, and there will be no permanent organ damage. Awareness during the operation Awareness during the operation:::: means that the patient can recall what happened during the operation after the operation, and can tell whether there is pain or not. Delayed awakening Delayed awakening Delayed awakening Delayed awakening: It is generally believed that those who call for more than 30 minutes after surgery cannot open their eyes and shake hands, and do not respond to painful stimuli.
Malignant hyperthermia is also called abnormally high fever. Malignant hyperthermia is also called abnormally high fever. Malignant hyperthermia is also called abnormally high fever. It is not a simple increase in body temperature that occurs in general anesthesia, but refers to the strong muscle contraction of the whole body stimulated by certain anesthetic drugs. ．Concurrent with a sharp rise in body temperature and hypermetabolism of progressive circulatory failure Blood protection Blood protection Blood protection:::: It is to protect and preserve blood and prevent loss through various methods. Destruction and infection, and managed in a planned way. Make good use of this natural resource. Component blood transfusion component blood transfusion component blood transfusion blood transfusion:::: is to separate various active components in the whole blood, and make high-concentration blood component products and plasma protein products, protein products, protein products, protein products, and then according to According to the needs of different patients, we will provide corresponding products. Abnormal breathing Abnormal breathing Abnormal breathing Abnormal breathing:::: Under normal circumstances, the negative pressure in the left and right sides of the pleural cavity is equal. After one side of the thorax is cut open, the intrathoracic pressure of that side is atmospheric pressure, so part of the air in the lung on the side of the thoracotomy is sucked into the opposite lung along with the outside air through the trachea, and the lung on the side is further shrunk. It is the opposite when exhaling, so that the expansion and retraction of the side lung after thoracotomy is completely opposite to that of normal breathing. One-lung ventilation. One-lung ventilation. One-lung ventilation. A method that uses one lung (the non-operated side) for ventilation. Extracorporeal circulation Extracorporeal circulation Extracorporeal circulation ((((ECC)))), also known as cardiopulmonary bypass (CPB), its basic principle is to transfer the human venous blood through the blood. The inferior vena cava is taken out of the body, oxygenated through the artificial lung and carbon dioxide removed, and then the oxygenated blood is pumped into the arterial system of the body through the artificial heart. Third interstitial fluid Third interstitial fluid Third interstitial fluid "Third interstitial fluid third interstitial fluid" In superficial II° burns, due to the increased permeability of the papillary blood vessel wall, a large amount of plasma leaks out of the body, and at the same time there is a large amount of protein-rich The fluid is transferred to the interstitium, which increases the volume of the interstitium. This part of the fluid transferred to the interstitium is temporarily "isolated", forming burn blood poisoning. Burn blood poisoning. Burn blood poisoning. A series of symptom groups that appear during a long course of disease, including high fever, increased heart rate, abnormal mental state, loss of appetite, nausea and vomiting, rapid breathing, etc. Anemia Anemia Anemia is caused by various causes of decreased red blood cell production or A syndrome caused by excessive loss.Disseminated intravascular coagulation is a secondary form of extensive microthrombosis followed by hemostasis and coagulation A clinical syndrome in which dysfunction is a pathological feature. DIC is a type of extensive platelet and/or fibrin thrombus in the microcirculation, leading to massive consumption of platelets and other coagulation factors, and hyperlytic activity of fibrin, leading to multiple organ dysfunction and extensive severe hemorrhage clinically syndrome. ART, short for acute renal failure, short for acute renal failure, short for acute renal failure, short for acute renal failure, is a sharp loss of renal function caused by various reasons, causing acute uremia such as water retention, azotemia, electrolyte and acid-base balance disorders characteristic clinical syndrome. Crush Syndrome Crush Syndrome Crush Syndrome:::: Severe trauma to the limbs or torso is often combined with Crush Syndrome, which is caused by a large number of muscle ischemic necrosis caused by prolonged muscle compression, and the mortality rate is very high High; the clinical manifestations are skin swelling, hardening, increased tension, blister formation, subcutaneous blood stasis, small blood vessel obstruction and limb ischemia, and severe systemic poisoning symptoms and renal insufficiency may occur after absorption of toxin released by necrotic tissue.
Explanation of terms for short-answer questions 2. What are the tasks of pre-anesthesia preparation? The tasks of pre-anesthesia preparation include: 1. Prepare the patient physically and mentally, which is the primary task; 2. Give the patient appropriate pre-anesthesia medication; Prepare to wait. 3. What are the basic requirements for thoracic hand anesthesia? 1. Eliminate and reduce mediastinal vibration and abnormal breathing 2. Avoid the diffusion of substances in the lungs 3. Keep PaCO2 and PaO2 at basically normal levels 4. Relieve circulatory disturbance 1. Axillary arm What are the advantages of a plexus block? 1. The N branches of the brachial plexus are all wrapped in the nerve sheath of the axillary vessel. Because of its superficial position and obvious arterial pulse, it is easy to block; 2. It will not cause pneumothorax; 3. It will not block the phrenic nerve, vagus nerve or recurrent laryngeal nerve 4. There is no danger of entering the epidural space or subarachnoid space by mistake; 2. Why is epinephrine often added to local anesthetics? [Answer] Adding epinephrine to local anesthetics can: 1. Constrict local blood vessels and delay the absorption of local anesthetics; 2. Accelerate the onset time and enhance the blocking effect; 3. Prolong the action time and reduce the toxicity of local anesthetics; 4. Eliminate the vasodilation effect caused by local anesthetics and reduce wound bleeding; 3. What is the purpose of preoperative medication? [Answer] 1. To make the patient emotionally stable, cooperate, reduce fear, and relieve anxiety; 2. To reduce the side effects of some anesthetics, such as increased respiratory secretions, toxic effects of local anesthetics, etc.; 3. , Adjust autonomic nerve function, eliminate or weaken some unfavorable nerve reflex activities, especially vagus nerve reflex; 4. Relieve preoperative pain; 1. What is gallbladder reflex? How to prevent and deal with it? (Chapter 21) Answer: Patients with biliary system diseases are prone to strong vagal reflex due to surgical stimulation of the biliary tract rich in vagus nerve distribution during surgery, resulting in a sudden drop in blood pressure, bradycardia, and even cardiac arrest. Prevention and treatment: 1. Sufficient anticholinergic drugs such as atropine should be given before operation; 2. Immediately stop stretching the biliary system; if the heart rate slows down, a proper amount of atropine can be given; if the blood pressure drops, a proper amount of booster drugs can be given; 3 1. If the operation is completed under general anesthesia, the anesthesia should be deepened immediately; 4. If the operation is completed under epidural anesthesia, an appropriate amount of general anesthetics such as dufid, flufen mixture, etc. can be supplemented during the operation; Plex block. 2. What are the complications of ketamine anesthesia? (Chapter 8) Answer: The complications of ketamine intravenous anesthesia are: 1. High blood pressure. 2. Brief confusion and abnormal behavior. 3. respiratory depression. 4. Increased intracranial pressure. 5. Emotional agitation and nightmares. 6. feel sick and vomit. 7. Double vision or temporary blindness. 8. Laryngospasm and airway obstruction. 9. When used as an auxiliary for epidural anesthesia or in patients with extensive depression of other sympathetic nerves, the usual dose can sometimes cause a sharp drop in blood pressure or cardiac arrest. 3. What are the common causes of airway obstruction during anesthesia? (Chapter 15) Answers: Retrotongue, airway secretions, regurgitation and aspiration, malfunction of anesthesia equipment, tracheal compression, oropharyngeal lesions, laryngospasm and bronchospasm 1. What are the clinical manifestations of airway obstruction during anesthesia? [Answer] Abnormal breathing movements of the chest and abdomen, different degrees of inspiratory stridor, low or no breath sounds, and in severe cases, suprasternal and supraclavicular depressions, as well as the "three depressions" of intercostal space depression , The patient has difficulty breathing, and the breathing action is strong, but there is no ventilation or the ventilation is very low. 2. What are the characteristics of propofol intravenous anesthesia? [Answer] Propofol is currently the most widely used intravenous anesthetic in clinical practice. After intravenous injection, it has a quick onset and a short duration of action, and its anesthetic effect lasts for 5 to 10 minutes after a single intravenous administration to patients with normal liver and kidney functions. Propofol can reduce intracranial pressure, reduce cerebral blood flow and cerebral metabolic rate, and has significant advantages in anesthesia for neurosurgery. However, propofol has a strong inhibitory effect on circulatory function, and can cause a significant drop in blood pressure through the dual effects of directly inhibiting myocardial contraction and dilating peripheral blood vessels, especially for elderly and frail patients or patients with insufficient effective circulating blood volume. It is also somewhat respiratory depressant, causing slowed respiratory rate, decreased tidal volume, and even apnea, especially in larger doses, rapid infusion rates, or in combination with opioid analgesics. In addition, intravenous administration of propofol to conscious patients can cause venous irritation. 3. What are the pre-anesthesia tasks? [Answer] The tasks of preparation before anesthesia include: ① Prepare the patient physically and mentally, which is the primary task; ② Give the patient appropriate pre-anesthesia medication; emergency medicines) etc. 4. What are the causes of increased myocardial oxygen consumption or myocardial hypoxia during anesthesia? [Answer] The causes of increased myocardial oxygen consumption or myocardial hypoxia during anesthesia are as follows: ①The patient’s mental stress, fear and pain cause the release of catecholamines in the body to increase, which increases the afterload of the heart and increases the heart rate, thereby increasing myocardial oxygen consumption. ; 2. Too low or too high blood pressure can affect myocardial blood supply and oxygen supply; 3. The inhibition of myocardial contractility by anesthetics reduces cardiac output, and the effect on blood vessels reduces the amount of blood returned to the heart; 4. Insufficient oxygen supply or Hypoxia; ⑤ increased heart rate or arrhythmia caused by various reasons. 1. What measures can be taken to reduce intracranial pressure during anesthesia and surgery? [Answer] 1. Drugs to reduce intracranial pressure: 1. Osmotic dehydrating agent; 2. Loop diuretic 3. Adrenal cortex hormone hypertonic liquid 2. Physiological reduction of intracranial pressure: 1. Hyperventilation 2. Hypothermia therapy 3. External ventricular drainage 4. Body position 2. What are the advantages of using the combined method of general anesthesia and non-general anesthesia? [Answer] The combination of general anesthesia and non-general anesthesia has the following advantages: 1. A better anesthesia effect can be achieved, and the safety of the patient during the perioperative period is higher. 2. Eliminate the fear and mental stress of patients about surgery and anesthesia. 3. Reduce the dosage of analgesics in general anesthesia, or the application of local anesthetics, thereby reducing the toxic side effects and adverse reactions caused by general anesthesia or local anesthetics. 4. The application of intravenous anesthetics or inhalational anesthetics is reduced, and the patient wakes up quickly and recovers quickly after surgery. 5. Muscle relaxants can be avoided or used less. 6. The epidural catheter is retained after the operation, which can provide perfect postoperative analgesia. In addition, the combined application of general anesthesia and non-general anesthesia is still helpful to improve the original pathophysiological disorders of some special conditions. 3. Why are the hemodynamic changes of elderly patients often more significant when using neuraxial anesthesia than general anesthesia? [Answer] The hemodynamic changes of elderly patients with epidural anesthesia are more obvious than general anesthesia, especially elderly patients with high blood pressure are more prone to hypotension when performing middle thoracic epidural anesthesia. cause respiratory depression. Mainly due to the narrowing of the epidural space in the elderly, the drug solution is easy to spread to the head side, and the volume of drug solution required to block each segment decreases with age after middle age. In addition, the arachnoid villi of elderly patients are significantly increased, which increases the permeability of the dura mater, and the local anesthetic in the epidural space may diffuse into the subarachnoid space, so that the test dose of 5m1 may cause epidural anesthesia. demand effect. Therefore, it must be emphasized that small doses should be given in small doses under close observation. More caution is required for blocks above the mid-thoracic segment. If the level of anesthesia in the spinal canal is too high, it will have a serious impact on the circulatory and respiratory systems, leading to severe fluctuations in hemodynamics or respiratory depression. The elderly's own circulatory and respiratory functions have been damaged, such as in the case of low reserve function The application is very dangerous. Elderly people choose spinal anesthesia, and generally the level of anesthesia should be controlled below T6. Special care should be taken in the use of adjuvant drugs in the case of incomplete neuraxial anesthesia in the elderly. If necessary, general anesthesia with endotracheal intubation should be used for safety. 4. Why should patients who advocate taking antihypertensive drugs not stop taking antihypertensive drugs before surgery? [Answer] For patients who have already used antihypertensive drugs, it is generally not recommended to stop using antihypertensive drugs before surgery. One is to avoid re-fluctuation of blood pressure that has been stabilized, and even cardiovascular and cerebrovascular accidents; the other is that withdrawal syndrome may occur when some drugs are stopped suddenly, and the dose can be adjusted appropriately according to the situation. Anesthesiologists should take into account the pharmacological properties of the drugs used, their interactions with anesthetic drugs, and the patient’s clinical manifestations, in the overall consideration of the anesthesia program, that is, the antihypertensive drugs should be fully considered during anesthesia. the presence of a factor. __ VI. Explanation of terms 1. Inhalational anesthesia [Answer] Inhalational anesthesia is called inhalational anesthesia, when the anesthetic is inhaled through the respiratory tract, which can inhibit the central nervous system and make the patient lose consciousness without feeling pain all over the body. 2. One-lung ventilation [Answer] One-lung ventilation refers to a method in which only one lung (non-operated side) is used for ventilation in patients undergoing thoracic surgery through a bronchial catheter. Due to the improvement of the bronchial tube, the in-depth understanding of the physiological changes caused by one-lung ventilation, and the use of fiberoptic bronchoscopic assistance when necessary, the safety and success rate of one-lung ventilation have been significantly improved. At present, the scope of application of endobronchial anesthesia It has been greatly expanded. In addition to being used for patients with excessive pulmonary secretions, lung abscess, massive hemoptysis ("wet lung"), and bronchial pleurisy, it is also often used for operations such as esophagus, lung lobe, whole lung, and thoracoscopic surgery. , reduce thoracotomy side lung injury, prevent cross-infection between the two lungs. 1. General spinal anesthesia [Answer] When epidural block is performed, if the puncture needle or epidural catheter enters the subarachnoid space by mistake and fails to be detected in time, local anesthetic several times more than spinal anesthesia should be injected into the subarachnoid space , can produce an abnormally wide block, known as general spinal anesthesia, with an average incidence of 0.24% (0.12% to 0.57%). Clinical manifestations include no pain sensation in all spinal nerve-innervated areas, hypotension, loss of consciousness, and respiratory arrest. The symptoms and signs of spinal anesthesia usually appear within a few minutes after the injection, and cardiac arrest may occur if the treatment is not timely. The principle of general spinal anesthesia is to maintain the patient's circulation and respiratory function. 2. MAC [Answer] MAC (minimal alveolar concentration) is the minimum effective alveolar concentration, which can reach 50% of the patients in the alveoli when inhaled simultaneously with anesthesia and pure oxygen. concentration. 3. Target-controlled infusion [Answer] TCI is based on the pharmacokinetics and pharmacodynamics of different intravenous anesthetics, as well as the individual conditions of patients of different genders, ages and weights, and controls the anesthesia by adjusting the corresponding target blood drug concentration. In-depth computerized drug delivery system. 4. Inhalational anesthesia 【Answer】Anesthetics are inhaled through the respiratory tract, which can inhibit the central nervous system and make the patient lose consciousness without feeling pain all over the body. This is called inhalational anesthesia. 1. Controlled blood pressure reduction (Chapter 14) Answer: For some special operations, in order to reduce the blood loss in the surgical field, create good conditions for the operation, reduce the amount of blood transfusion, use various drugs and methods to consciously lower the patient’s blood pressure during the operation, and visually The degree and duration of blood pressure reduction is controlled by the specific situation, a technique called controlled blood pressure reduction. 3. Supine Hypotension Syndrome (Chapter 26) Answer: The enlarged uterus or huge intra-abdominal mass of the parturient oppresses the retroperitoneal large blood vessels, causing a sharp decrease in blood return to the heart and a decrease in cardiac output, resulting in hypotension, tachycardia, and collapse in the patient Even the clinical syndrome of syncope. Elevating the left or right hip in the maternal position can prevent supine hypotensive syndrome. 1. Intravenous general anesthesia [Answer] The method of injecting drugs through veins and acting on the central nervous system through blood circulation to produce general anesthesia is called ~. 2. Eye-cardiac reflex [Answer] is caused by strong pulling of eye muscles, or twisting and compressing the eyeball. It is easily seen in eye muscle surgery, enucleation and retinal detachment surgery. It is a trigeminal-vagus reflex, manifested as heartbeat Brady, premature beat, bigeminy, junctional rhythm and atrioventricular block, and even cause cardiac arrest. 3. Hypertensive crisis [Answer] A hypertensive state with a systolic blood pressure higher than 250mmHg and lasting for more than 1 minute. 4. TCI [Answer] According to the pharmacokinetics and pharmacodynamics of different intravenous anesthetics, as well as the individual conditions of patients of different genders, ages and weights, the computer can control the depth of anesthesia by adjusting the corresponding target blood drug concentration. medicine system. 5. Induction of general anesthesia [Answer] Regardless of intravenous anesthesia or inhalation anesthesia, there is a process of changing the patient from an awake state to an anesthesia state where surgery can be performed. This process is called ~. Hypertensive crisis [Answer] Hypertensive state with systolic blood pressure higher than 250mmHg and lasting for more than 1min. 4. TCI [Answer] According to the pharmacokinetics and pharmacodynamics of different intravenous anesthetics, as well as the individual conditions of patients of different genders, ages and weights, the computer can control the depth of anesthesia by adjusting the corresponding target blood drug concentration. medicine system. 5. Induction of general anesthesia [Answer] Regardless of intravenous anesthesia or inhalation anesthesia, there is a process of changing the patient from an awake state to an anesthesia state where surgery can be performed. This process is called ~. Hypertensive crisis [Answer] Hypertensive state with systolic blood pressure higher than 250mmHg and lasting for more than 1min. 4. TCI [Answer] According to the pharmacokinetics and pharmacodynamics of different intravenous anesthetics, as well as the individual conditions of patients of different genders, ages and weights, the computer can control the depth of anesthesia by adjusting the corresponding target blood drug concentration. medicine system. 5. Induction of general anesthesia [Answer] Regardless of intravenous anesthesia or inhalation anesthesia, there is a process of changing the patient from an awake state to an anesthesia state where surgery can be performed. This process is called ~.
5. Gallbladder reflex [Answer] Surgery to stimulate the gallbladder causes a strong vagal reflex, leading to a sudden drop in blood pressure, bradycardia and even cardiac arrest.