1、第一节 、 腹、盆腔手术麻醉的特点The features of anesthesia for operations in abdominal and pelvic cavities1、腹、盆腔脏器的主要生理功能和围术期病理生理变化 The organs in abdominal and pelvic cavities include digestive system and genitourinary system. The main physiological functions are digestion, absorption,metabolism, elimination, immu
2、ne function and secretion. The adequate preoperative preparation should be done to avoid anesthetic complications.2、腹、盆腔手术围术期液体管理 Severe bleeding(massive hemorrhage), massive loss of body fluid,internal redistribution of fluidsoften called “third space” can cause severe intravascular depletion. The
3、fluids infusion rate is 10ml/kg/h and the crystalloid and colloid solutions should be administered properly. When the danger of anemia outweighs the risks of transfusion, further blood loss should be replaced with transfusion of red blood cells to maintain hemoglobin concentration or hematocrit.3、手术
4、体位 (Patients position in operation）对生理功能的影响 截石位（ Lithotomy position） 头低位（ Trendelenburg position）Lithotomy position and Trendelenburg tilt would result in changes in pulmonary blood volume, a decrease in pulmonary compliance, a cephalad shift of the diaphragm, and a decrease in lung volume parameter
5、s.Cardiac preload may increase.Nerve injuries to the common peroneal, sciatic, and femoral nerves are likely.4、腹压对生理功能的影响 Increased abdominal pressure and elevation of diaphragm lead to dyspnea. Anesthetic agents,anesthetic techniques and rapid decompression exacerbate vasodilatation, decreased veno
6、us return to heart and cardiac output. The measures should be taken: Administration of IV fluids. Modulate the position. Administration of ephedrine. Avoid rapid decompression.5、腹、盆腔手术对肌松弛的要求Complete neuromuscular blocking is required in operations.6、腹、盆腔手术中的内脏牵拉反应Distension of viscera or traction o
7、n peritoneum may induce bradycardia, reducing of arterial pressure and cardiac arrest. Vagus reflexion and pelvic nerves reflexion Mesentery traction syndrome7、腹、盆腔急症手术的特点 Preoperative assessmentHistory and physical examination Full stomachHypovolemiaFluid and electrolytes disturbanceAcid-base unbalance Preparation for emergency operations第二节、 腹、盆腔手术的常用麻醉方法The commonly used anesthesia techniques for surgery in abdominal and pelvic cavities 一 . 局部麻醉（ local anesthesia) Local infiltration anesthesia Field blocking anesthesia Intercostal blockAdvantages.Disadvantages.
