ANESTHESIOLOGY

Muhammad khan
 （一） Respiratory Complication
1.Vomitting and suffocation
Full stomach, hemorrhage in gastrointestinal tract , bo
wel obstruction
Some anesthetic agents 、 hypoxia
Mendelson Syndrome ：
Typical manifestation ： Bronchial spasm ， acc
ompanied with asthma, cough and cyanosis. Bad pro
gnosis
Prevention ： awake intubation ， induce vomitting
et al.
2.Airway Obstruction ：
Upper airway obstruction
Etiology: secretion accumulation and laryngosp
asm
Treatment: suction, jaw lift, oropharyngal airw
ay, intubation
Lower airway obstruction
Induced by secretion in trachea and
bronchus
IV injection of aminophylline
3. Hypoventilation
Overdose of anesthetic or inappropriate bo
dy posture.
4. Pulmonary Complication
Pneumonia: Preoperational infection, relate
d to old age, smoking
Increased airway secretion by anesthetic
Stimulation by tracheal tube
Acute atelectasis
Airway obstruction is the m
ost common reason
Sputum clogging, wound pain
Hypoventilation caused by occasional ov
erdeep intubation
（二） Circulatory Complication
1.Hypotension
Overdepth of anesthesia→hypotesion, narrow pul
se pressure
Bleeding during operation cause hemorrhagic sho
ck
Reflected BP decrease, such as vagal reflex et al.
2.Arrhythmia
Inappropriate anesthetic depth ， operational sti
mulus ， hemorrhage ， CO2 accumulation all ca
n lead tachycardia
Traction of viscera and late stage of hypoxia cause
bradycardia
3.Cardia Arrest and Ventricular Fibrillation
The most severe complication in anesthesia .
Reasons ： Myocardial hypoxia （ ischemi
a ）， Hypovolemia, Hypercapnia, Hyperkale
mia or hypokalemia, Hypothermia, Inappropr
iate anesthetic depth, Airway obstruction, Ser
ious operational stimulus, Viscera traction ,et
al.
Treatment: Follow the procedure of Resuscitat
ion.
4.Hypertension

not enough depth of anesthesia Hypove

ntilation
Carbon dioxide retention
（三） CNS Complications
1. Twitch, Convulsion
Ordinary in pediatric anesthesia
Occasionlly in malignant hyperthermia
2.Delayed Recovery
Reasons:
Too deep anesthesia,
Circulatory and respiratory function failure,
Cyanosis or hypoxia occur during anesthesia
Hyperglycemia, Hypokalemia, or central nerve disease (
hemorrhage ,thrombus, blood vessel deformity
Anesthetic Machine

The sketch map of anesthetic machine

corrugated tubing flap
Anesthetic Machine
Laryngoscope
Endo-Tracheal Tubes
Face Mask
Vocal gate exposure by curved laryngoscope
 四、
REGIONAL ANESTHESIA
Local anesthesia is the effect produced by loc
al aesthetic agents, which block the conduction of
peripherial nerve impulse and anesthetize the corre
sponding innervated region.
Regional anesthesia:
local anesthesia
epidural anesthesia
spinal anesthesia
Pharmacology of Local Anesthetic Agents

1.Classification

Classification ： Ester procaine, tetracaine

Amide lidocaine,bupivacaine,
ropivacaine
 2. Physiochemical property and anesthetic potency
Procaine Tetracain Lidocane Bupivacai
e ne
CP pKa 9.0 8.5 7.9 8.1
Liposolubility low high moderate high
BindRate of 5.8 75.6 64.3 95.6
plasmaProtein

AP Potency weak strong moderate strong

Diffusive weak weak strong moderate
Onset time superficial － slow moderate －
infiltratio rapid － rapid rapid
Nervebloc slow slow rapid moderate
0.75 ～ 1 2 ～ 3 1 ～ 2 5 ～6
Action time 1000 40 （ S 100 （ S ） 150
Limited ） 400 （ I 、 B
dose(mg) 80 （ B ）
）
3.Absorption,Metabolism and
Excretion

Factors influence Absorption ：

Dosage and Concentration
Path of administration
Vessel constrictor
 （二）
The Adverse Reactions Due To Local Anesth
etics

★ 1. Toxic Reactions ：
what is Toxic Reactions or toxicity of l
ocal anesthetics?
The manifestation which occur when th
e blood concentration of certain local anesth
etic is higher than a threshold value.
 Toxic Reactions
A. Common reasons ：
Overdose surpass patients’ toleranc
e;
Injection into vessel inadvertently ;
Decrease of patient’s tolerance due to ill
ness;
B. Clinical manifestation ：
CNS toxicity: more sensitive
Mild: drowsy, vertigo, talkative, chilling,

disorientation
Severe: unconsciousness, tremor, convulsion
Cardio-vascular system toxicity:
early stage : HR and BP increase
late stage: HR and BP decrease ,
atrioventricular blockage, bradycardia ,
cardiac arrest
 C. Treatment ：
Routine ： stop injection, inhale oxygen,
build venous path
Sedation : diazepam,
Stabilize circulation
Prevent inadvertent injury
D. Prevention ： Principle of administer
1. The lowest concentration and smallest dose
2. Under safe dose
3. Reduce dose in certain situation
4. Aspirate before injection
5. Vasoconstrictor
6 . Sedative as premedication
2. Allergic reactions ：
Even a small dose of local anesthetics may c
ause urticaria,bronchial spasm, hypotension
or angioedema, even endanger to life.

Treatment ： adrenaline ， inhale oxygen,

anti anaphylactic treatment.
Prevention ： intracutaneous sensitive test
THANKS !!