Glossary:
1. Inhalational anesthesia : Anesthetics are inhaled through the respiratory tract to inhibit the central nervous system, so that the patient loses consciousness and does not feel pain all over the body. This is called inhalational anesthesia.
2. General spinal anesthesia : 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 is injected into the subarachnoid space, which may cause An unusually wide block is produced, known as a panspinal anesthesia.
3. MAC : the minimum effective alveolar concentration, which is the concentration at which 50% of patients in the alveoli will not cause shaking of the head or movement of limbs when inhaled simultaneously with anesthesia and pure oxygen.
4. Target-controlled infusion (TCI) : According to the pharmacokinetics and pharmacodynamics of different intravenous anesthetics, as well as the individual conditions of patients of different genders, ages and weights, anesthesia is controlled by adjusting the corresponding target blood drug concentration In-depth computerized drug delivery system.
5. Total intravenous anesthesia (TIVA) : Intravenous general anesthesia is called intravenous general anesthesia.
6. Oculocardiac reflex: It is caused by strong pulling of eye muscles, or twisting and compressing the eyeball. It is easily seen in eye muscle surgery, enucleation surgery and retinal detachment surgery. It is a trigeminal nerve-vagus nerve reflex, manifested as bradycardia , premature beat, bigeminy, junctional rhythm and atrioventricular block, and even cause cardiac arrest.
7. Hypertensive crisis : Hypertensive state with systolic blood pressure higher than 250mmHg and lasting for more than 1min.
8. Rapid intravenous induction: This is the most commonly used induction method at present. After the patient has fully inhaled oxygen, first use sedative hypnosis or intravenous anesthetic to make the patient lose consciousness, then pressurize the oxygen through the mask, and then use narcotic analgesia. A method of induction of anesthesia followed by intravenous intubation of succinylcholine or a nondepolarizing muscle relaxant followed by endotracheal intubation.
9. Endotracheal intubation : Insert a special endotracheal tube into the trachea through the mouth or nostrils and through the throat. Bronchial intubation: Insert a special endotracheal tube into one side of the bronchus through the mouth or nostrils and through the larynx Difficult airway: Difficulty with face mask ventilation and direct laryngoscopy
10. General anesthesia : Anesthetics are inhaled through the respiratory tract, intravenously or intramuscularly injected into the body, resulting in inhibition of the central nervous system.
11. Induction of general anesthesia : 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 induction of general anesthesia.
12. Total intravenous anesthesia (TIVA) refers to the method of anesthesizing the patient by completely using intravenous anesthetics and auxiliary drugs.
13. Epidural anesthesia: local anesthetic is injected into the epidural space to block the roots of the spinal nerves and temporarily paralyze the areas it innervates.
14. Compound anesthesia : refers to the simultaneous or successive application of two or more anesthetic drugs in the same anesthesia process.
15. Combined anesthesia : refers to the simultaneous or successive use of two or more anesthesia techniques in the same anesthesia process. Intravenous inhalation compound anesthesia: refers to the simultaneous or successive application of intravenous anesthesia and inhalation anesthesia to the same anesthesia process.
16. Combined spinal anesthesia-epidural anesthesia (CSEA) : An anesthesia method that combines spinal anesthesia (SA) and epidural anesthesia (EA), which has played a role in rapid onset of spinal anesthesia, exact effect, and small amount of local anesthetics. And the continuity of epidural anesthesia, the convenience of controlling the plane and the advantages of postoperative pain relief have been successfully applied to almost all surgical anesthesia and labor analgesia below the lower abdomen.
17. Controlled blood pressure reduction refers to artificially lowering 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, without ischemia and hypoxia damage to important organs. After the blood pressure is stopped, the blood pressure can quickly return to normal levels without permanent organ damage.
18. Knowing during the operation : It means that the patient can recall what happened during the operation after the operation, and can tell whether there is pain or not.
19. Positive end-expiratory pressure (PEEP) : refers to the airway internal pressure that is still higher than the ambient pressure at the end of the expiratory phase. This is a pressure indicator. PEEP can be combined with various ventilation modes.
20. Delayed awakening: Refers to 30 minutes after stopping anesthesia, the patient still cannot open eyes and shake hands, and has no obvious response to pain stimulation, which is regarded as delayed awakening.
21. Cardiopulmonary resuscitation (CPR): refers to a technique that combines artificial respiration and extracardiac massage for first aid when breathing stops and heartbeat stops.
22. One-lung ventilation : One-lung ventilation refers to a method in which patients undergoing thoracic surgery use only one lung (non-operated side) for ventilation through a bronchial catheter.
23. Arterial blood oxygen saturation (SPQ2) : It is the capacity of oxyhemoglobin (HbO2) bound by oxygen in arterial blood to the total hemoglobin that can be combined
The percentage of white (Hb) volume, that is, the concentration of blood oxygen in the blood, is an important physiological parameter of the respiratory cycle.
24. End-tidal carbon dioxide (ETCO2) : refers to the partial pressure or concentration of carbon dioxide contained in the mixed alveolar gas exhaled at the end of expiration.
25. Respiratory depression: a common respiratory complication of anesthesia. In the case of oxygen, the patient is hypoventilated and PaCO2 rises, but there is no airway obstruction. It may be due to the overdose of narcotic analgesics and sedatives in the pre-anesthesia medication, the deep anesthesia and the application of muscle relaxants during the induction of intravenous anesthesia with thiopental sodium, etc. The result is carbon dioxide accumulation, and the patient may not be accompanied by hypoxia under oxygen inhalation conditions. Clinical manifestations include skin flushing, rapid heart rate, high blood pressure, and shallow or slow breathing.
26. Malignant hyperthermia: also known as abnormal hyperthermia, it is not a simple rise in body temperature that usually occurs during anesthesia, but refers to a 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.
27. Abnormal breathing: After one side of the thorax is cut open, when inhaling, due to the decrease in the intrathoracic pressure of the healthy side, part of the gas is inhaled from the thoracotomy side into the healthy lung, and when exhaling, part of the gas from the healthy side lung enters the thoracotomy side In the lungs, this phenomenon is called paradoxical breathing.
28. Acute Respiratory Distress Syndrome (ARDS) : It refers to the syndrome characterized by acute respiratory failure caused by acute diffuse alveolar capillary damage and severe external respiratory dysfunction in patients without cardiopulmonary disease. Manifested by progressive dyspnea and hypoxemia.
29. Systemic Inflammatory Response Syndrome (SIRS) : It is an out-of-control self-sustained amplification and self-destructive systemic inflammatory response caused by infection or non-infection etiology acting on the body.
30. First Pass effect : Also known as the first pass effect, it refers to the effect that drugs are absorbed from the digestive tract, metabolized and decomposed with the blood flowing through the liver, and the actual amount of drugs entering the systemic circulation is reduced .
31. Supine Hypotension Syndrome : The enlarged uterus or huge mass in the abdominal cavity 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, collapse and even syncope in the patient clinical syndrome. Elevating the left or right hip in the maternal position can prevent supine hypotensive syndrome.
32. Test dose: when performing continuous epidural anesthesia, inject 2~3ml for the first time as a test volume, and observe the size of the block range to determine whether there are signs of spinal anesthesia or whether the epidural anesthesia is effective or the patient's tolerance to anesthesia , and then reduce the dose and add additional drugs as appropriate.
33. Oxygen poisoning : the body inhales high pressure oxygen, which exceeds a certain pressure and time course, causing a series of physiological function disorders or pathological phenomena. Clinical manifestations include pulmonary oxygen toxicity, cerebral (convulsive) oxygen toxicity, and ocular oxygen toxicity.
34. Biphasic block: refers to the desensitization of the receptor due to the long-term binding of the muscle relaxant to the receptor. The binding ability of the normal transmitter in the body decreases, showing a state of block, so it is called biphasic block.
35. Cerebral blood flow automatic regulation : when MAP fluctuates between 50-150mmHg, cerebral blood flow can be kept constant due to the automatic contraction and relaxation of cerebral blood vessels, which is called the automatic regulation mechanism of cerebral blood vessels.
36. Postoperative cognitive dysfunction (POCD) : Central nervous system complications after surgery in the elderly, manifested as confusion, anxiety, personality changes, and memory impairment. This postoperative change in personality, social skills, and cognitive abilities and skills is called postoperative cognitive dysfunction.
37. PONV Postoperative nausea and vomiting (PONV) is the most common anesthesia complication after surgery. Severe and difficult-to-control PONV may lead to unexpected hospitalization and prolonged recovery time. Persistent vomiting can cause electrolyte abnormalities and dehydration. Persistent postoperative retching or vomiting can put tension on the sutures, cause a surgical subvalvular hematoma, and expose the patient to the risk of vomiting lung aspiration when airway reflexes are weakened by the delayed effects of anesthetics and analgesics.
38. TEE transesophageal echocardiography (TEE) is to place an ultrasound probe into the esophagus to explore the deep structure of the heart from the rear to the front, avoiding the interference of chest wall, lung gas and other factors, so it can show clearly It improves the sensitivity and reliability of the diagnosis of cardiovascular diseases, and facilitates the ultrasound monitoring and evaluation in cardiac surgery. In particular, patients with difficulty in imaging by transthoracic echocardiography (TTE) such as obesity, emphysema, thoracic deformity, recent surgery or trauma, and patients who are using mechanically assisted ventilation are more suitable for TEE examination.
29. Forced Vital Capacity (FVC): Refers to the volume of exhaled air that can be exhaled with the greatest effort and the fastest speed to complete (RV position) after maximum inhalation (TLC position). Under normal circumstances, FVC is consistent with VC, and FVC<VC when airway is obstructed.
40. Forced expiratory volume in 1 second (FEV1) : refers to the fastest expiratory volume within 1 second after the maximum inhalation reaches the TLC position. FEV1 is both a volume measurement value and a flow measurement value, that is, the measurement of the average expiratory flow rate within 1 second, and its measurement stability and repeatability are good, and it is the most important and most commonly used indicator of impaired lung function.
41.1 Second rate (FEV1/FVC or FEV1/VC) : The ratio of FEV1 to FVC or VC. It is used to distinguish whether the decrease in FEV1 is due to the decrease of expiratory flow or expiratory volume. It is the most commonly used indicator for judging airway obstruction.
42. Functional residual capacity (FRC): Functional residual capacity, which refers to the amount of gas remaining in the lungs at the end of quiet expiration. Normal adult male about 2500ml, female about 1600ml.
43. Laryngeal mask airway (LMA) : referred to as laryngeal mask, it is placed in the laryngopharyngeal cavity, the esophagus and the laryngeal cavity are closed with air bags, and the artificial airway is ventilated through the laryngeal cavity.
44. Cardiac output (CO): Refers to the amount of blood pumped by the left or right ventricle per minute. It is the product of heart rate and stroke volume. Also known as cardiac output or cardiac output per minute. Usually the cardiac output of the left and right ventricle is roughly equal, and the cardiac output that is customarily referred to refers to the cardiac output of the left ventricle. It is an important index to evaluate the pumping function of the heart.
45. Cardiac output index : Cardiac output (CO) per unit body surface area, the calculation formula is CI=CO/body surface area.
46. Post-anesthesia recovery unit (PACU) : It is a unit that closely observes and monitors patients after anesthesia until the patient's vital signs return to stability. The main tasks of the anesthesia recovery room are: to treat patients who are not awakened after general anesthesia and non-general anesthesia patients whose postoperative condition is not stable or whose neurological function has not recovered, to ensure the safety of patients in the anesthesia recovery room, monitor and treat patients Physiological dysfunction that occurs during this phase.
47. Volume resuscitation: also known as volume replacement therapy, is an important alternative to reduce unnecessary blood transfusion. Its main goal is to restore circulation and microcirculatory perfusion, and prevent adverse consequences such as organ dysfunction and MODS.
48. Permissive effect : The existence of one hormone can significantly enhance the effect of another hormone.
49. Holden effect : The combination of oxygen and hemoglobin promotes the release of carbon dioxide, while deoxygenated hemoglobin is easy to combine with carbon dioxide. This phenomenon is called Holden effect.
50. False neurotransmitters: When the liver function is severely impaired, the aromatic amino acid products styrenolamine and hydroxyphenylethanolamine formed in the body are very similar in chemical structure to the true neurotransmitters norepinephrine and dopamine, but their physiological effects Far weaker than the real neurotransmitter, so called false neurotransmitter
51. Shock lung : when the shock lasts for a long time, severe interstitial and alveolar pulmonary edema, congestion and hemorrhage, localized atelectasis, microthrombosis in capillaries, and formation of alveolar hyaline membranes may occur in the lungs. The characteristic lung is called shock lung. Because respiratory dysfunction occurs during shock. If the pulmonary dysfunction is mild, acute lung injury will occur, and if it is severe, it will lead to systemic inflammatory response syndrome.
52. PCA Patient-Controlled Analgesia (PCA) : When the patient feels pain, he actively injects the drug dose set by the doctor into the body through the computer-controlled micropump to press the button for analgesia.
short answer questions
1. What is the purpose of premedication before anesthesia ?
Answer: Make the patient emotionally stable and cooperative; increase the pain threshold and enhance the analgesic effect; prevent and reduce the side effects or poisoning of some anesthetics; reduce the basal metabolic rate; eliminate some unfavorable reflexes; thus making the anesthesia process stable.
2. Briefly describe the indications and contraindications of epidural space block
Answer: 1. Indications It is mainly suitable for abdominal surgery. Epidural block can be used for any operation on the lower abdomen and lower limbs that is suitable for subarachnoid space block. Neck, upper extremity, and chest surgery can also be used, but should strengthen the management of breathing and circulation. 2. Contraindications It is basically the same as subarachnoid space block, but patients with chronic diseases of the central nervous system are not contraindicated. Patients with bleeding disorders or anticoagulant therapy should be used with caution to avoid epidural hematoma. For patients with dyspnea, cervical and thoracic epidural block should not be used.
3. What is the purpose of mechanical ventilation therapy?
Answer: 1. Assist or replace the respiratory system to maintain proper ventilation. 2. Control the pattern of breathing and airway pressure in order to send gas exchange. 3. Reduce the work of breathing and the oxygen consumption of the respiratory system to reduce the heart load. 4. Strengthen airway management, keep the airway unobstructed, and prevent suffocation, such as atomization inhalation. 5. Preventive mechanical ventilation, used for preventive treatment of respiratory failure after cardiothoracic surgery, severe trauma and shock.
4. Briefly describe the main measures for emergency potassium reduction in the treatment of hyperkalemia
Answer: Common measures: ①Apply calcium, inject 10-20ml of 5% calcium chloride or 10% calcium gluconate intravenously, and reuse it if necessary. ②Use 50-100ml of 25%-50% glucose solution plus insulin 10U intravenously, and the infusion is completed in about 30 minutes. ③ 5% sodium bicarbonate intravenous infusion 100 ~ 200ml, this method is more effective for patients with metabolic acidosis and hyperkalemia. ④Hypertonic saline can counteract the toxicity of hyperkalemia, and it has a better effect on patients with hyponatric dehydration. ⑤ Potassium-extracting diuretics are used, and hemodialysis can be used for patients with renal insufficiency. ⑥ Appropriate nutritional support to correct negative nitrogen balance.
5. Briefly describe the basic contents of A, B, and C of basic life support in the CPCR stage
Answer: The purpose of this stage is to quickly establish artificial respiration and circulation, which is suitable for on-site rescue of disasters and accidents and emergency treatment of CA patients in hospitals. Among the three steps A, B, and C, mouth-to-mouth (nose) artificial respiration and chest compressions should become the common measures of CPR. Not only must medical staff at all levels and medical assistants be proficient in basic skills, but they should also be popularized in the society. , such as grassroots industrial and mining enterprises, transportation departments, and military and police personnel, so as to carry out treatment before medical personnel arrive at the scene.
6 What are the indications for endotracheal intubation?
Answer: Normal respiratory function must have an unobstructed airway, adequate respiratory drive, normal neuromuscular response, complete chest anatomy, normal lung skills, and protection against coughing, sighing, and aspiration.
7. What is the principle of the three-step drug administration for pain?
Answer: The first step: for mild pain, use non-opioid analgesics + adjuvant drugs. The second step: for moderate pain or not responding to the drug treatment of the first step, use weak opioids + adjuvant drugs. The third step: Severe pain or not responding to the second step drug treatment, choose strong opioid + non-opioid analgesics + adjuvant drugs.
8. Why is pre-anesthesia examination required?
Answer: Before the anesthesia operation, review the medical records and examine the patient to understand the main pathophysiological problems and specific disease characteristics. To make an objective assessment of risks, etc., to provide a basis for formulating a reasonable anesthesia plan.
9. Briefly describe the advantages and principles of compound anesthesia .
Answer: Compound anesthesia can make full use of the advantages of various anesthesia drugs and anesthesia techniques, reduce the dose and side effects of each drug, maintain the stability of physiological functions to the greatest extent, improve the safety and controllability of anesthesia, and better meet the needs of surgery. Provide adequate postoperative analgesia if needed. The principles of its application are: A. Reasonable selection of drugs; B. Optimizing compound medication; C. Accurately judging the depth of anesthesia; D. Strengthening the management during anesthesia; E. Adhering to the principle of individualization.
10. Briefly describe the causes, manifestations and treatment of intraoperative laryngospasm and bronchospasm
Answer: Reason: Under normal circumstances, the glottis closure reflex is to close the glottis to prevent foreign bodies or secretions from being inhaled into the airway. Laryngospasm is due to the increased excitability of the vagus nerve that innervates the pharynx, which increases the irritability of the pharynx, resulting in increased glottic closure activity. Thiopenthal is a common general anesthetic used to induce laryngospasm. Laryngospasm mostly occurs in the depth of general anesthesia stage I~II, which is induced by hypoxemia, hypercapnia, oropharyngeal secretions and regurgitated stomach contents that stimulate the throat, oropharyngeal airway, direct laryngoscopy Laryngeal spasm can be induced by direct stimulation of the larynx, such as endotracheal intubation, and reflex laryngospasm can be induced by surgical operations under light anesthesia, such as dilating the anal sphincter. Manifestations: Mild laryngospasm only presents laryngeal noise during inhalation, moderate laryngospasm produces laryngeal noise both inhalation and exhalation, and severe laryngospasm causes glottis to close completely and airway is completely blocked. Treatment: Mild laryngospasm will be relieved by itself after removing the local irritation. Moderate cases need to be treated with pressurized oxygen inhalation with a face mask, and severe cases can be relieved quickly by cricothyropuncture with a thick intravenous infusion needle or intravenous succinylcholine Convulsions, followed by deprivation of oxygen or immediate intubation for artificial ventilation
11. Prevention and treatment of gallbladder reflex
1) Adequate amount of anticholinergic drugs such as atropine should be given before operation; (2) Immediately stop stretching the biliary system; if the heart rate slows down, an appropriate amount of atropine can be given; if the blood pressure drops, an appropriate amount of vasopressor can be given; (3) ), 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; (5) celiac plexus block
12. What are the clinical signs for judging the depth of general anesthesia? (please give an example)
Answer: General anesthesia should meet the requirements of loss of consciousness of the patient, good analgesia, moderate muscle relaxation, control of stress response at an appropriate level, and relatively stable internal environment, so as to meet the needs of surgery and maintain patient safety. Therefore, the monitoring of the depth of general anesthesia should include three aspects: the monitoring of the level of consciousness, the monitoring of muscle relaxation and the monitoring of stress response. These three aspects can be judged by some clinical signs, such as respiratory rate and amplitude; changes in muscle tone, circulation, eye signs, and autonomic reflex activity. For example, after general anesthesia with ketamine, the patient falls asleep quietly, with stable breathing and blood pressure. At the beginning of the operation, the patient has body movement, increased respiratory rate, increased heart rate, increased blood pressure, increased respiratory secretions, and tears, indicating that the patient's anesthesia is light, and the anesthesia should be appropriately deepened at this time. In the case of the patient's loss of consciousness and the use of muscle relaxants, the circulation and nerve reflexes are the main basis for judging the depth of anesthesia.
13. What are the main causes of laryngospasm in patients under general anesthesia? How to prevent and deal with it?
Answer: The main causes of laryngospasm in patients under general anesthesia are: A Anesthesia drugs: such as thiosulfate intravenous anesthesia, the patient's sympathetic nerves are inhibited, parasympathetic nerves are relatively hyperactive, and throat sensitivity is enhanced. B anesthesia operation: viewing the throat and endotracheal intubation, oropharynx sputum suction, etc.; C operation operation: performing operations under light anesthesia, such as anal dilation, periosteum stripping, pulling the mesentery, gallbladder, etc. Prevention: Use sufficient anticholinergic drugs before using thiosulfate. The depth of anesthesia should be sufficient when performing anesthesia operations and surgical operations.
Treatment: Mild cases will be relieved by themselves after removing the local irritation, moderate cases need face mask pressurized oxygen therapy, severe cases can be treated with thick intravenous infusion needle for cricothyroid oxygen inhalation, or intravenous injection of succinylcholine to quickly relieve spasm, and then add Compressed oxygen or immediate tracheal intubation for artificial ventilation.
14. What are the conditions for an ideal muscle relaxant?
Answer: The ideal muscle relaxant should be: A fast-acting non-depolarizing muscle relaxant B no histamine release and adverse cardiovascular reactions C muscle relaxation easy to reverse with antagonists D stable pharmacokinetics and Pharmacodynamics, even in liver and kidney diseases are not affected.
15. Briefly describe the clinical manifestations and prevention principles of local anesthetic poisoning
Answer: Clinical manifestations of local anesthetic poisoning reaction: central nervous system: early mental symptoms, dizziness, multilingualism, restlessness, lethargy, uncoordinated movements, nystagmus; mid-term nausea and vomiting, headache, blurred vision, facial muscle twitching ; Advanced patients with muscle spasms and convulsions. Circulatory system: Early flushing, elevated blood pressure, rapid pulse, narrowed pulse pressure, followed by pale complexion, cold sweats, decreased blood pressure, weak pulse, arrhythmia, heart failure or cardiac arrest in severe cases. Respiratory system: chest tightness, shortness of breath, dyspnea or respiratory depression, cyanosis in convulsions, respiratory arrest and suffocation in severe cases.
Prevention and treatment: A: Do not exceed the amount of local anesthetic at one time, and reduce the dose for children, infirm, poor liver and kidney function; B: Lower effective concentration of local anesthetic should be used for blood-rich areas, head, face, neck, mucous membrane , Inflammatory and congested areas, the maximum dose of local anesthetic should be reduced at one time; C, Medication before anesthesia: barbiturates and stable drugs can prevent local anesthetic poisoning; D should be used during anesthesia operation, and must be Pull back to prevent stray into the blood vessel.
Treatment: A. Immediately stop the medication. B. Inhale oxygen and rehydration early to maintain a stable respiratory cycle. With stability 5 ~ 10mg intramuscular or intravenous injection. C Convulsions and convulsions can be slow intravenous injection of diazepam or 2.5% thiopental sodium 3~5ml, if the effect is not good, you can inject succinylcholine, endotracheal intubation to control breathing; D have respiratory depression or stop, severe low For patients with blood pressure, arrhythmia, or non-sudden cardiac arrest, appointments should be made, including breathing control, vasopressor drugs, blood transfusion, cardiopulmonary cerebral resuscitation, etc.
16. Briefly describe the causes and prevention of hypertension during anesthesia
Answer: Hypertension during anesthesia refers to the increase in blood pressure exceeding 20% of that before anesthesia or the increase in blood pressure above 160/95mmHg. The common reasons for blood pressure to rise above 30 mmHg before anesthesia are: A. Anesthesia factors, endotracheal intubation operation, certain anesthetic effects such as ketamine and sodium oxybate, hypoxia and early carbon dioxide accumulation; B. Surgical factors, intracranial surgery. Lobe or stimulate the first V, IX, X cranial nerve, can cause blood pressure to rise. Squeezing the spleen during splenectomy can significantly increase blood pressure due to a sharp increase in circulation capacity. When the tumor is detected during pheochromocytoma surgery, the blood pressure can immediately and rapidly rise to a dangerous level; C patients with disease factors such as hyperthyroidism and pheochromocytoma often have uncontrollable blood pressure rise after anesthesia. Death from acute heart failure or pulmonary edema is inevitable. In addition, the blood pressure of patients who are extremely stressed before operation can be extremely high, and a few of them may die of cerebral hemorrhage or heart failure before entering the operating room.
Treatment: In order to prevent high blood pressure caused by various reasons, for patients who are under general anesthesia, the preoperative visit should be patient and do ideological work, eliminate the patient's tension, and give sufficient preoperative medication according to the patient's condition. For patients with pheochromocytoma and hyperthyroidism, surgeons must perform routine preoperative preparations. In order to prevent hypertension during induction of intubation, the depth of anesthesia should be appropriate. If it can be combined with surface anesthesia of the throat and trachea or a certain amount of α and β receptor blockers, the effect is particularly good. During the whole process of anesthesia, hypoxia and carbon dioxide accumulation should be avoided, and the amount of blood transfusion should be strictly controlled. In order to eliminate the hypertension caused by brain surgery, a relatively large amount of droperidol can be given; in order to eliminate the stress hypertension caused by surgery below the neck, it can be combined with epidural block, especially suitable for pheochromocytoma surgery of patients. Once the blood pressure increases significantly during anesthesia, if the anesthesia is too shallow, the anesthesia should be deepened; if it is an obvious stress response, α and β receptor blockers or vascular smooth muscle relaxation can be given according to the situation to reduce blood pressure. In the case of hypoxia and carbon dioxide accumulation hypertension, the oxygen concentration of the inhaled gas should be increased while increasing the ventilation.
17. What are the factors that cause a difficult airway? Factors that cause a difficult airway are
(1) Physiological and anatomical variation of the airway: the main manifestation is short neck. Lower collar retraction, abalone teeth, narrow oropharyngeal cavity, high zygomatic arch, maxillary protrusion, malocclusion, mandibular hyperplasia, hypertrophy of the epiglottis, etc.
(2) Local or systemic diseases: ① musculoskeletal diseases, such as cervical spine ankylosis, temporomandibular joint ankylosis; ② endocrine diseases, such as obesity, acromegaly, goiter, diabetes, etc.; ③ infectious inflammation, such as gangrenous stoma inflammation, perioral scar contracture and temporomandibular joint ankylosis, peritonsillar abscess, epiglottitis, laryngeal edema; ④ non-specific inflammation, such as rheumatic diseases and ankylosing spondylitis; ⑤ tumors, such as upper respiratory tract or throat, epiglottis, Oral and maxillofacial tumors, etc. (3) Maxillofacial trauma: can cause upper respiratory tract bleeding, foreign body obstruction, jaw fracture or even displacement. (4) Changes in airway anatomy, such as satiety, pregnancy, unstable circulatory function, and respiratory insufficiency, or restrictions on the use of anesthesia-inducing drugs may potentially increase the difficulty of tracheal intubation.
18. Briefly describe the advantages and disadvantages of intravenous general anesthesia
Answer: Intravenous anesthesia has many advantages, including rapid induction. No irritation to the respiratory tract. Patient comfort. Wake up faster. Do not burn. No explosion. No pollution and easy operation without special equipment. Among them, there is no need for administration through the airway and no pollution are the two most prominent advantages compared with inhalation anesthesia. However, intravenous anesthesia has always had some limitations, such as irritation to blood vessels and subcutaneous tissue causing pain during injection; controllability is not as good as inhalation anesthesia; inability to continuously monitor changes in the blood concentration of intravenous anesthesia drugs in the body and lack of control over the depth of anesthesia Estimate; In addition, there are large individual differences in intravenous anesthetics.
19. Common complications of brachial plexus block
1①Pneumothorax: mostly occurs in the supraclavicular block method; ②Hemorrhage and hematoma: each puncture route may puncture the blood vessel and cause bleeding; ③Toxic reaction of local anesthetic: mostly caused by the large amount of local anesthetic or mistaken blood vessel; ④September Nerve palsy: Occurs in the intermuscular groove method and supraclavicular method; ⑤Hoarseness: Due to block of the recurrent laryngeal nerve, it can occur in the intermuscular groove method and supraclavicular method; ⑥High epidural block or general spinal anesthesia : Interscalene block caused by too deep needle insertion; ⑦Horner syndrome: It is more common in interscalene block, which is caused by stellate ganglion block.
20. What are the contraindications for subarachnoid block?
A: Absolute contraindications include infection at the puncture site. Bacteremia and intracranial hypertension patients. Relative contraindications include circulatory volume depletion, aortic stenosis, progressive degenerative neurological disorders, low back pain, and coagulopathy.
21. What is the physiological effect of epidural anesthesia?
Decreased blood pressure; altered heart rate; respiratory depression; urinary retention; intestinal spasms; altered thermoregulation; neuroendocrine alterations
22. Contraindications for subarachnoid blockade
Answer: ① Central nervous system disease; ② Severe systemic infection; ③ Low spinal anesthesia for hypertension combined with coronary artery disease; ④ Shock; ⑤ Patients with chronic anemia; Low spinal anesthesia is selected for cardiovascular disease; ⑧ significantly increased intra-abdominal pressure; ⑨ uncooperative patients such as mental illness.
twenty three. What are the requirements for an ideal anesthesia state?
Answer: Ideal anesthesia requirements: to ensure the safety of the patient and the smooth progress of the operation, effectively regulate the stress state of the body, maintain the functions of important vital organs and systems, prevent the development of primary diseases, and eliminate the physiological and psychological effects of the malignant stimulation of anesthesia operations on the patient. Influence.
23. Serious complications during general anesthesia
Answer: airway obstruction; respiratory depression; hypotension and hypertension; cardiac
Muscle ischemia; increased or decreased body temperature; delayed awareness and awakening during surgery; cough. Ugh. Postoperative vomiting. Postoperative pulmonary infection; malignant hyperthermia.
24. A patient with an intracranial tumor suddenly experienced increased intracranial pressure during the operation. Please briefly describe the treatment method.
Answer: A: Limit fluid intake; B: Use diuretics (osmotic and loop diuretics should be used according to the situation); C: Apply corticosteroids; D: Hyperventilate and use muscle relaxants for mechanical ventilation to reduce mechanical ventilation resistance. E use of cerebral vasoconstrictors such as thiosulfate, lidocaine; F other methods.
25. Complications of epidural anesthesia
1. ①Dural puncture; ②Puncture needle or catheter strayed into blood vessel; ③Air embolism; ④Pleural puncture; ⑤Catheter broken; ⑥General spinal anesthesia; Hematoma; ⑩ infection.
26. Complications of subarachnoid block
Answer: 1) headache; (2) urinary retention; (3) neurological complications: ① cranial nerve involvement; ② pseudomeningitis; ③ adhesive arachnoiditis; ④ cauda equina syndrome; ⑤ myelitis.
27. Common complications of controlled blood pressure reduction are
Answer: ① cerebral embolism and cerebral hypoxia; ② coronary insufficiency. Myocardial infarction. Heart failure. Cardiac arrest; ③ renal insufficiency, oliguria. Anuria; ④ vascular embolism; ⑤ reactive bleeding after blood pressure reduction, surgical site bleeding; ⑥ persistent hypotension, shock; ⑦ lethargy. Delayed awakening, etc.
28. What are the common causes of airway obstruction during anesthesia?
Answer: Tongue back, respiratory secretions, regurgitation and aspiration, malfunction of anesthesia equipment, tracheal compression, oropharyngeal lesions, laryngospasm and bronchospasm.
29. ASA standard classification
Patients I have normal vital organs and system functions, are well tolerated by anesthesia and surgery, and have no risks under normal circumstances; patients II have mild systemic diseases, with mild lesions in vital organs, but have sound compensatory functions. General anesthesia and surgery can be tolerated, and the risk is small; III has severe systemic diseases, and the function of important organs is impaired, but it is still within the scope of compensation. Restricted mobility, but not incapacitated. The implementation of anesthesia and surgery has certain concerns and risks; IV has serious systemic diseases, serious lesions of vital organs, functional insufficiency, has lost the ability to work, and often faces threats to his life safety. Both anesthesia and surgery are dangerous, and the risk is very high; V is in a critical condition and is on the verge of death, and surgery is desperate. Anesthesia and surgery are extremely dangerous.