复合麻醉与联合麻醉.ppt

复合麻醉与联合麻醉
复合麻醉(balanced anesthesia)bined anesthesia)的定义
复合麻醉的应用原则
静吸复合麻醉与全凭静脉麻醉的比较
联合麻醉的优缺点
复合麻醉(balanced anesthesia)bined anesthesia) 的定义
The concept of balanced anaesthesia today is that bination of anaesthetics will act synergistically with respect to desired effects such as hypnosis or analgesia, but not with respect to side-effects.
联合麻醉是指同一麻醉过程同时或先后采用两种或两种以上的技术
理想的麻醉状态
不仅仅局限于无痛、肌肉松弛和意识消失
有效地调控机体的应激状态
维护重要生命器官和系统的功能
消除恶性刺激对病人生理及心理的影响
复合麻醉的应用原则
合理的选择***物和剂量
准确地判断麻醉深度
加强麻醉管理
优化用药方案
坚持个体化原则
不同麻醉技术的联合使用
临床常用的复合麻醉方案

Propofol+Fentanyl+Esmeron 诱导插管
Sevoflurane+Remifentnil 维持
(TIVA or TCI)
Propofol+Fentanyl+Esmeron 诱导插管
Propofol+Remifentanil 维持
两种方法的比较






吸入麻药的药代动力
Figure 1. The 80% decrement times of volatile anaesthetics. By analogy with the context-sensitive half-time, the decrement time describes the decay of the alveolar concentration with the time of administration. The 80% decrement times of both sevoflurane and desflurane are less than 8 minutes and do not increase with the duration of anaesthesia. However, the 80% decrement times of isoflurane and enflurane increase significantly after approximately 60 minutes of anaesthesia, reaching plateaus of approximately 30–35 minutes. The 80% decrement time correlates closely with the clinically observed recovery of consciousness.
阿片类药物的时效敏感半衰期
The CSHT of remifentanil is less than 5 minutes, independently of the time of administration.
Propofol时效敏感半衰期
The CSHT of propofol is 15min after a 2-hour infusion