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Chapter 14 prevention and treatment of serious complications during general anesthesia

Chapter 14 prevention and treatment of serious complications during general anesthesia. Introduction Complications of anesthesia involve three aspects ： 1. Patient's condition 2. Diathesis of anesthetist 3. Influence and fault of anesthetics 、 anesthetic apparatus and correlated

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Chapter 14 prevention and treatment of serious complications during general anesthesia

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  1. Chapter 14 prevention and treatment of serious complications during general anesthesia

  2. Introduction Complications of anesthesia involve three aspects： 1. Patient's condition 2. Diathesis of anesthetist 3. Influence and fault of anesthetics、 anesthetic apparatus and correlated instrument

  3. Serious Complications during General Anesthesia Respiratory tract obstruction Respiratory depression Hypotension and Hypertension Myocardial ischemia Hyperthermia and Hypothermia Awarenss and Delay of Awake Cough、Singultus、Postoperative vomiting、 Postoperative pulmonary infection Malignant hyperthermia

  4. Respiratory Obstruction 一、Glossocoma： 1．Aetiology： 2．Liability factor： （1）Justo major of corpus linguae （2）Short and stout （3）Short neck （4）Lymphadenosis of throat posterior wall （5）Hypertrophy of tonsils

  5. Respiratory Obstruction 3．Clinical features： 4．Management： （1）Side lying、 （2）Head hypsokinesis、 （3）Lift submaxilla、 （4）Oropharyngeal parichnos Nasopharyngeal parichnos

  6. Respiratory Obstruction 二、Airway obstruction by secretion、 purulent sputum、blood and foreign object 1．Aetiology： （1）Inhalation of stimulant anesthetic， （2）Bronchiectasis、pulmonary abscess、 pulmonary tuberculous cavity

  7. Respiratory Obstruction （3）Operation of cavum nasopharyngeum、 oral cavity、Harelip （4）Desquamation of tooth or artifcal teeth 2．Management： （1）Sufficient belladonna premedication （2）Intubation （3）Suck respiratory tract （4）Pull out dentium vacillatia or artifcal teet

  8. Respiratory Obstruction 三、Regurgitation and Aspiration 1．Aetiology：Anticholinergic agent Morphine General anaesthetics Muscle relaxant 2．Clinical features： （1）Bronchospasm （2）Tachypnea and dyspnea （3）Moist rales （4）Sever hypoxia

  9. Respiratory Obstruction 3．Management： （1）Fasting： Adult：8h before anesthesia Children： milk and solid diet liquid < 6 m 4h 2h 6~36 m 6h 3h > 36 m 8h 3h

  10. Respiratory Obstruction （2）Preoperative administration of an H2-receptor antagonist（cimetidine or ranitidine）to decrease further secretion of additional acid. （3）Application of gastric decompression by a wide- bore nasogastric tube; Preparing for suction （4）Full stomach/high level ileus：awake intubation （5）Rapid - sequence induction and intubation without positive - pressure ventilation before intubation.

  11. Respiratory Obstruction （6）Application of cricoid compression to control regurgitation of gastric contents （7）Extubation when the patient is fully awake （8）Aspiration： Head down position，suck vomitus Bronchial antispasmodic and antibiotics Respiration support Lavage of trachea using 0.9%NaCl

  12. Respiratory Obstruction 四、Malposition of catheter、Obstruction of lumina、Anaeshetic machine failure 1. Aetiology：Catheter twist Block by sputum Corrugated tube twist Malfunction of respiration valve 2. Management：Examine position of catheter Respiratory sound Breathing circuit Respiration valve

  13. Respiratory Obstruction 五、Trachea Compression 1. Aetiology：tumor of neck or mediastinum hematoma 、edema calidum 2. Management： 六、Inflam affection of pharyngo-oral cavity、 Larynx tumer、Allergia laryngeal oedema 1. Aetiology：peritonsillar abscess、 Larynx tumor pharynx posterior wall abscess 2. Management：

  14. Respiratory Obstruction 七、Laryngospasm and Bronchospasm （一）Laryngospasm： 1. Aetiology：pharyngeal vagus nerve excitability↑ 2. Evoked reasons： （1）hyoxemia、hypercapnia、secretion、intubation oropharynx parichnos、laryngoscope （2）light anesthesia 3. Clinical features 4. Management

  15. Respiratory Obstruction 5. Prevention：avoid light anesthesia、hypoxia carbon dioxide accumulation （二）Bronchospasm： 1. Aetiology： （1）Tracheal intubation、aspiration、suck sputum （2）Operation stimulate （3）Thiopental Sodium、Morphine 2. Clinical features： 3. Management：

  16. Respiratory depression 一、Central Respiratory depression 1．Aetiology：anesthetics、hyperventilation narcotic analgesics 、 inflate lung unduly 2．Management： （1）Anesthetics → reduce depth of anesthesia （2）Narcotic analgesics → Naloxone （3）Hyperventilation、inflate lung unduly→↓VT

  17. Respiratory depression 二、Peripheral Respiratory depression 1. Aetiology：muscle relaxant hypopotassemia general anaesthesia + epidural block 2. Management： （1）Muscle relaxant → Neostigmine Bromide （2）Hypopotassemia → supply potassium in time （3）Spinal nerve block → wait

  18. Respiratory depression 三、Respiration Management 1. Effective ventilation 2. Select of ventilation mode： （1）Assistor respiration （2）Controlled respiration

  19. Hypotention and Hypertension 一、Hypotension 1．Hypotension：> 20% or ↓80mmHg 2．Aetiology： （1）anesthesia aspects （2）operation aspects （3）patient aspects

  20. Hypotention and Hypertension 3．Prevention： （1）Insufficient body fluid → sufficiently supply （2）Severe anaemia （3）Severe mitral valve stenosis （4）Myocardial ischemia → maintain blood pressure

  21. Hypotention and Hypertension （5） Myocardial infarction （6） Congestive heart failure （7） Ⅲ°BBB、sick sinus syndrome → pacemaker （8） Hypopotassemia （9） Atrial fibrilation → 80~120 bpm （10）Using long-term corticosteroid

  22. Hypotention and Hypertension 4．Management： （1）Reduce depth of anesthesia （2）Transfusion，Ephedrine （3）Severe coronary heart disease → support cardiac pump function （4）Drag internal organs →stop operative procedure （5）Adrenal insufficiency →large dose of dexamethasone （6）Cardiac arrest→cardiac resuscitation

  23. Hypotention and Hypertension 二、Hypertension 1．Hypertension： 2．Aetiology： （1）Anesthesia aspects （2）Operation aspects （3）Patient aspects

  24. Hypotention and Hypertension 3. Prevention： （1）Sufficient premedication （2）Phaeochromocytoma、hyperthyroidism （3）Intubation → enhance anesthesia surface anaesthesia α or β-receptor blocker （4）Avoid hypoxia and carbon dioxide accumulation

  25. Hypotention and Hypertension （5）Craniocerebral operations→droperidol （6）Operation stress → compound with epidural block 4．Management： （1）Increase depth of anesthesia （2）α or β-Receptor blocker vascular smooth muscle relaxant （3）↑Ventilatory capacity、↑FiO2

  26. Myocardiac Ischemia 一、Correlative physiological knowledge 1. Oxygen consumption of myocardium： （1）HR （2）myocardial contractility （3）intraventricular pressure 2. Coronary Perfusion Pressure = AOP – IMP AOP- aortic pressure IMP- intramyocardial pressure

  27. Myocardiac Ischemia 二、Diagnostic method：ECG 1. Cardiac conduction abnormality 2. Arhythmia 3. Q wave，R wave progressive step down 4. S-T↓> l mm or ↑> 2 mm 5. T wave is low、bidirection or inversion

  28. Myocardiac Ischemia 三、Aetiology 1. Tension、fear、pain 2. Hypotension or hypertension 3. Myocardial contractility suppression and vessel distension by anesthetic 4. Hypoxia 5. Tachyrhythmia or Arhythmia

  29. Myocardiac Ischemia 四、Management 1. Maintain the balance of Oxygen supply- demand 2. Delay selective operation 3. Monitor：ECG、MAP、CVP、CO、 SVR、Urine volume 4. β-receptor blocker or calcium channel blocker 5. Analgesia using morphine 6. General anaesthesia + epidural block

  30. HYPERTHERMIA AND HYPOTHERMIA 一、Heat Production and Elimination 1．Heat Production： 2．Heat Elimination： （1）Radiation：> 60% （2）Conduction：3% （3）Cconvection：12% （4）Evaporation：25%

  31. HYPERTHERMIA AND HYPOTHERMIA 二、Normal Thermoregulation ： 1. Thermoregulatory control system： （1）Cold-response thresholds：36.5℃,vasoconstriction （2）Warm-response thresholds：37℃,sweat 2. Thermoregulation during General Anesthesia： （1）warm-response thresholds：↑1℃ to 38℃ （2）cold-response thresholds：↓2℃ to 34.5℃ 3. Responses in infants and the elderly

  32. HYPOTHERMIA 三、Hypothermia：core temperature < 36℃ 1．Evoked reasons： （1）Cold operating rooms （2）Indoor vent （3）Administration of cold intravenous fluids （4）Evaporation from surgical incisions （5）General anesthetic

  33. HYPOTHERMIA 2．Influence of hypothermia： （1）Drug metabolism is markedly ↓ ↓ duration of action of anesthetics ↑ （2）Coagulation is impaired （3）Blood vicidity↑ （4）Oxygen dissociation curve shift to left （5）Shivering → oxygen capacity↑↑ 3．Prevention

  34. HYPERTHERMIA 四、Hyperthermia： 1．Evoked reasons： （1）Room temperature > 28℃ （2）无菌单覆盖过于严密 （3）开颅手术在下视丘附近操作 （4）large dosage of atropine （5）Response to transfusions （6）Ventilation：循环紧闭法

  35. HYPERTHERMIA 2．Influence of Hyperthermia （1）Basal metabolic rate↑ （2）Metabolic acidosis、hyperkaliemia hyperglycosemia （3）> 40℃→convulsion 3．Prevention

  36. Awarenss and Delay of Awake 一、Awarenss 1. Neurophysiology of Awarenss 2. Anaesthetic technique （1）N2O-O2- Muscle relaxant （2）Fentanyl - Diazepam （3）Thiopental or Thiopental - Ketamine

  37. Awarenss （4）N2O- Fentanyl （5）Etomidate - Fentanyl （6）Procaine combined anesthesia 3. Management： （1）Avoid light anaesthesia （2）Monitor brain stem auditory evoked potential（BSAEP）

  38. PRST记分系统 指标体征分值 收缩压（mmHg） < 对照值 + 15 0 < 对照值 + 30 1 > 对照值 + 30 2 心率（次/min） < 对照值 + 15 0 < 对照值 + 30 1 > 对照值 + 30 2 汗液 无 0 皮肤潮湿 1 可见汗珠 2 泪液 分开眼睑泪液不多 0 分开眼睑泪液过多 1 闭眼有泪液流出 2

  39. Delay of Awake 二、Delay of Awake：> 30min 1. Aetiology： （1）Influence of Anaesthetic： Premedication Inhalation Anaesthetic Narcotic Analgesic Muscle Relaxant

  40. Delay of Awake （2）Respiratory depression： Narcotic Analgesic and Muscle Relaxant Hypocapnia Hypercarbia Kaliopenia Overdose of Transfusion Complications of operation Severe metabolic acidosis

  41. Delay of Awake （3）Severe Complications ： massive bleeding serious cardiac arrhythmias acute myocardial infarction rupture of intracranial aneurysm cerebral hemorrhage cerebral embolism （4）Long time of hypotension and hypothermia （5）Cerebral vessels affection before operation

  42. Delay of Awake 2. Management： （1）Aspect of Anaesthetic technique （2）corresponding management （3） dehydration：encephaledema intracranial hypertension （4）hypothermia - warm （5）long-term hypotension （6）primary cerebral disease

  43. Cough、Singultus、Postoperative vomiting and postoperative pulmonary infection 一、Cough 1. Degree of cough （1）轻度：阵发性腹肌紧张和屏气 （2）中度：阵发性腹肌紧张、屏气，颈后仰、 下颌僵硬、紫绀 （3）重度：腹肌、颈肌、支气管平滑肌阵发性 强力持续性痉挛，上半身翘起、 长时间屏气、严重紫绀

  44. Cough 2. Harmful effects of cough （1）腹内压剧增→内脏外膨、胃内容物反流、 伤口及组织撕裂 （2）颅内压剧增，对原有颅内病变者可致 脑出血或脑疝 （3）血压剧增→伤口渗血↑、心脏作功↑、 甚至诱发心衰

  45. Cough 3．Evoked reasons of cough： （1）Barbiturates （2）Cold volatility anaesthetics and secretion of trachea （3）Intubate and suck sputum under light anaesthesia （4）Aspiration

  46. Cough 4．Management： （1）Sufficient muscle relaxant （2）Diazepam and Droperidol （3）Aspiration → balloon tracheal catheter、 gastrointestinal decompression

  47. Singultus 二、Singultus： 1. Evoked reasons： （1）强烈牵拉内脏、直接刺激膈肌及膈神经 （2）全麻诱导时将大量气体压入胃内 2. Harmful effects of cough： 3. Management： （1）Sufficient muscle relaxant （2）Postoperation →Diazepam and Droperidol acupuncture of endoclosure cave

  48. Postoperative vomiting 三、Postoperative vomiting 1. Aetiology： （1）role of anaesthetics inhalation anesthetic：ether > methoxyflurane > enflurane > isoflurane > N2O > sevoflurane intravenous anesthetic （2）category of operation （3）conditions of patients

  49. Postoperative vomiting 2. Harmful effects of cough： （1）pain、wound dehiscence： （2）vomit aspiration or asphyxiation （3）Water-Electrolyte unbalance and Acid-Base unbalance 3. Management

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