6 概述麻醉前准备-英文版

中国医科⼤学附属第⼀医院麻醉科
曹学照
INTRODUCTION
Anesthesia（麻醉）
—— Methods using drugs or others to make local
or systemic temporarily lose feelings, make human body
to eliminate the pain of surgery
Analgesia（镇痛）
—— Using drugs or other methods to make the
patient reduce or eliminate the pain
Anesthesiology（麻醉学）
—— Science of clinical anesthesia, regulating the
function of life, intensive care and diagnosis and
treatment of pain
History of Ancient China
Ancient: People use opium, alcohol,
bloodletting therapy make patient
drop in coma.
Traditional Chinese Medicine:Hua
Tuo use anesthesia powder with
wine for surgery.
Contemporary History
Joseph Priestley
(1733–1804)
England
In 1847 Simpson use chloroform(氯仿) for
labor analgesia
In 1850s halothane(氟烷) was found
In 1934 Sodium thiopental(硫贲妥钠)was used for
clinic
In 1935 King found d-tubocurarine(右旋筒箭毒碱)
from curare(箭毒)
In 1942 tubocurarine(筒箭毒碱) was used for
surgery
Clinical
Anesthesiology
Anesthesiology
Diagnosis and
Intensive Care Treatment of Pain
Clinical Anesthesiology
—— to provide calm disappear
(consciousness), painless, muscle relaxant and
other necessary conditions for surgery, trauma
or non-invasive examination
—— for life function monitoring, regulation
and control, to ensure the safety and recovery of
patients
Intensive Care
—— provide continuous, quantitative monitoring,
rapid and scientific management, advanced diagnosis
and treatment for perioperative critically patients.
Diagnosis and Treatment of Pain

—— research and practice about basic
research, clinical diagnosis and
treatment of pain
The subject status of anesthesiology
➢ To promote the development of "comfortable medical"

➢ To enhances the working efficiency of the hospital
➢ To protect the safety of medical treatment
➢ To coordinate the relationship between various
branches
➢ The key subject known and accepted by the society
Development of anesthesiology has greatly
promote and guarantee the progress of the
surgery
• In The United States the “captain” of the
operating room which used to be the surgeon
had changed to be the anesthesiologist by
law
Anaesthesia Machine
Multi-function ECG Monitor
Bispectral Index（BIS）
Nerve Stimulator、
TOF-Watch
Fiber Bronchoscope、Glidescope、Shikani optical
stylet and others for difficult airway
Anesthesia to guarantee the new technology of the
surgery in congenital heart disease orthopaedic
surgery- a 12 days old child with complex congenital
heart disease
Nerve block technique guided by ultrasound
Treatment of Pain
Ganglion radiofrequency
thermal condensation to treat
神经节射频热凝术 trigeminal neuralgia under CT
Selective spinal nerve roots

release to cure lumbocrural
pain cased by lumbar
intervertebral disc protrusion
under DSA
Preparation Of Anesthesia
Purpose：
Reach the best possible condition in both
physique and spirit
Enhance the patient's tolerance
Improve the safety of patients
Reduce the complications of anesthesia
Risk factors during perioperation
Disease Anesthesia
Operation
Aftertreatment
PATIENT
Preanesthetic Evaluation
1．read the case history

(1)According to the clinical diagnosis and case
history to understand and evaluate the patient.
(2)According to the condition to set up the key
inquiry and check plan.
(3)Consult to the laboratory inspection and
physical examination relating to the anesthesia
and others for necessary preparations.
3．Physical Exam
4．ASA Classification
ASA I No organic, physiologic, biochemical or
psychiatric disturbance
ASA II A patient with mild systemic disease that results
in no functional limitation.
ASA III A patient with severe systemic disease that
results in functional impairment.
ASA IV Severe systemic disease that is a constant threat
to life.
ASA V Moribund condition in a patient who is not
expected to survive with or without the operation.
ASA VI Declared brain death patient whose organs are being har
vested for transplantation.
E Emergency operation is required.
Preparation Of Anesthesia
(A)Improve pathological physiological state
1、Improve the state of malnutrition
influence：Poor nutrition can lead to anemia,

low protein, low blood volume, lack of vitamin,
prone to coagulant function abnormality and
circulation dysfunction
standard：Hb>80g/L
Alb>30g/L
2 、 Correct dehydration, electrolyte imbalance
and acid-base balance disorders
influence：Tolerance of anesthesia significantly

reduced, during anesthesia induction and
maintenance are prone to severe low blood
pressure and cardiac arrhythmias.
standard：Serum potassium, sodium, and acid

and alkali condition, should be corrected to
normal range
3 、 The preparation for common coexisting
diseases
Internal medical disease should be fully aware of

the pathophysiological changes of coexisting
disease, and its severity, making correct
evaluation
Ask the physician to assist the diagnosis and

treatment if necessary.
(1)Patient with heart disease, should pay attention
to improve
A:A history of heart failure, atrial fibrillation, or the heart significantly

increased, digitalis treatment, stop drugs on the day of surgery.
B:Angina pectoris, arrhythmia,high blood pressure, use of -receptor blockers
for a long time, can take the medicine until the day of surgery
C:The postoperative infarction rate of the patient with old myocardial infarction
related to the time interval
Myocardial infarction rate is higher in those who take a surgery
within 6 months after myocardial infarction
D:Myocardial infarction with cardiac function disorder
e.g.LVEF<0.30，LVEDP>18mmHg，elective surgery should be avoided
(2)Patient with hypertension should drop to
normal range before the surgery
The treatment of medical system control blood
pressure ： SBP<180mmHg ， DBP<100mmHg；Avoid using
central blood pressure medication or enzyme inhibitors；take
the medicine until the day of surgery
(3)Diabetic control FBG ( fasting blood-glucose )<8.3 mmol/L

A:Emergency operation with ketoacidosis ， If allowed should
take operation after using insulin to eliminate the ketone body,
and correct acidosis
B:If not allowed ， using insulin, infusion and correct acidosis
during the operation, but significantly increased the risk of
anesthesia
(4) Patient with respiratory system disease
A:Quit smoking for 4－8 weeks，at least 2weeks
B:Respiratory function training
C:Atomization inhalation and chest physical therapy to promote

expectoration drainage
D:Use of antibiotics for 3 ~ 5 days to control the lung infection
E: Acute upper respiratory tract infection, increases the chances

of postoperative pulmonary infection
(B)Psychological preparation
•Eliminate the patient's anxiety

•Make appropriate explanation to patients with anesthesia method,
possible discomfort, etc.
• Listen to and answer the questions patiently.
• Treat hypertension by drugs
• Ask psychology experts for mental disabilities
（C）Preparation for
gastrointestinal
Purpose：Prevent aspiration pneumonia or suffocation
preoperative fasting time for patients with elective surgery

Adult Oil Fried or meat>8h; Digestible solid food or Non-human milk>6h
；water>2h
Child Formula milk powder or digestible solid food>6h ， human breast
milk>4h，water>2h
Emergency patients do not need to be fast, but should pay

attention to vomiting and aspiration
（D）anesthesia instruments
anesthesia machine(麻醉机)
(1) Power（电源）
(2)Gas(⽓源)
(3)Airtight performance(密闭性能)
(4) Soda-lime(钠⽯灰)
(5)safety alarm system(安全报警系统)：Ppeak(⽓道压)、FiO2(吸⼊
氧浓度)、MV(每分通⽓量)。
Detection of the patient vital signs ：
BP(⾎压)
ECG(⼼电图)
SpO2 (脉搏氧饱和度)
PETCO2（呼吸末⼆氧化碳分压）
CVP(中⼼静脉压)
Temperature(体温)
Anesthesia equipment
mask（麻醉⾯罩）
oral/nasal airway(⼝咽或⿐咽通⽓道)
laryngoscope(⽓管插管喉镜)
endotracheal tube(⽓管内插管导管)
Intubation tube core(插管管芯)
vacuum extractor(负压吸引器)
（E）Drugs
narcotique、therapeutic drugs、first aid medicine
first aid medicine：
1．vasoactive agent：Ephedrine, epinephrine, norepinephrine,
sodium nitroprusside,nicardipine
2．antiarrhythmic drugs： atropine、lidocaine、metoprolol
oresmolol
3others：midazolam、dexamethasone。
病⼈⼊室后的复核
（F） Anesthesia
• Method informed consent
of anesthesia
• Monitoring method
• Postoperative analgesia method
• Complications
• Cooperate
Pre-anesthetic Drugs
Purpose
①Sedation
eliminate the mood of patients with tension, anxiety and fea
②Analgesia
enhance the effect of the anesthetic,reduce the amount of anesthetic to
reduce the side effects;relieve the pain cased by primary disease or the
discomfort caused by invasive operation before anesthesia
③Inhibition the gland secretion of respiratory tract , reduce the
production of saliva, keep mouth dry
④ Remove reflection caused by surgery or anaesthesia
especially the vagus nerve reflex，inhibition of sympathetic nerve
excitement caused by excited or pain，to maintain the stability of
hemodynamics
Rules
General anesthesia:Supplemented by sedatives
and choline drug resistance ;Narcotic analgesics for
sharp pain
Spinal epidural anesthesia:Supplemented by

sedatives;Epidural anesthesia is appropriate, to the pain
relievers
2 under the strict monitoring in the operating room
Serious illness
Emergency condition in critically ill patients do not need
medication before anesthesia or by intravenous way
<1year-old
Situation reduce the drug use
poor condition (⼀般状况差 )

frail elderly (年⽼体弱者)
cachexy (恶液质)
shock (休克)
thyroid hypofunction (甲状腺功能低下)
Reduce the amount of pain relievers
Cardiac function obstacle

Respiratory insufficiency, respiratory tract obstruction or
trauma
High intracranial pressure and central respiratory inhibition
Excessive fat or sensitive to sedation and analgesia
medicine
Maternal ：morphine is forbidden
Pethidine can be used 1 hour before delivery of
baby or more than 4 hours
Appropriate increase of cholinesterase drugs
dosage
Ketamine anesthesia
Halothane anesthesia
High spinal canal anesthesia
Patients with bradycardia
None or reduce the use of cholinesterase

drugs
hyperthyroidism
tachycardia
High fever
Questions
医⼤⼀院麻醉科简介
麻醉科共有76名麻醉医⽣，
打造了⾼素质的博⼠：41⼈，54%
硕⼠：32⼈，42%
麻醉医师队伍
本科： 3⼈， 4%
博⼠⽣导师4名，硕⼠⽣导师11名
36%的医⽣在国外获得博⼠学位或有留学美
国、⽇本、新加坡等国的经历
主治医师:25⼈副教授:16⼈
教授:8⼈
住院医师:27⼈
主管护师/技师:11⼈
护师:2⼈
亚专业分组：⼼胸外科组
➢ 临床上实⾏各亚专业轮转乳腺、整形、眼科组
及培训，共分11组⻣科组
➢ 副主任医师及以上担任各普外组
亚专业组组⻓肿瘤外科、烧伤组
➢ 中⻘年医师在亚专业轮转
泌尿、妇科组
中得到核⼼技术的培养和锻
产科组
炼
头颈外科组
（⽿⿐咽喉、神经外科）
疼痛诊疗及麻醉⻔诊组
移植组
急诊组
学术任职
中华医学会麻醉学分会常委
中国医师协会麻醉学医师分会常委
中华医学会麻醉学分会妇产学组副组⻓
中华医学会麻醉学分会质量管理学组委员
全国医师定期考核麻醉专业编辑委员会委员
中华医学会麻醉医疗事故鉴定委员会专家
辽宁省麻醉学会主任委员
辽宁省疼痛学会副主任委员
辽宁省细胞⽣物学会麻醉与疼痛分会副主任委员
沈阳医学会麻醉医师分会主任委员
《中华麻醉学杂志》副主编
Thank
You !

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中国医科⼤学附属第⼀医院麻醉科

Diagnosis and Treatment of Pain

➢ To promote the development of "comfortable medical"

Selective spinal nerve roots

1．read the case history

1、Improve the state of malnutrition

influence：Poor nutrition can lead to anemia,

influence：Tolerance of anesthesia significantly

standard：Serum potassium, sodium, and acid

Internal medical disease should be fully aware of

Ask the physician to assist the diagnosis and

A:A history of heart failure, atrial fibrillation, or the heart significantly

(3)Diabetic control FBG ( fasting blood-glucose )<8.3 mmol/L

A:Quit smoking for 4－8 weeks，at least 2weeks

B:Respiratory function training

C:Atomization inhalation and chest physical therapy to promote

D:Use of antibiotics for 3 ~ 5 days to control the lung infection

E: Acute upper respiratory tract infection, increases the chances

•Eliminate the patient's anxiety

preoperative fasting time for patients with elective surgery

Emergency patients do not need to be fast, but should pay

Spinal epidural anesthesia:Supplemented by

poor condition (⼀般状况差 )

Cardiac function obstacle

None or reduce the use of cholinesterase

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