prevention and treatment of serious complications

Chapter14preventionandtreatmentofseriouscomplicationsduringgeneralanesthesiaIntroductionComplicationsofanesthesiainvolvethreeaspects：1.Patient'scondition2.Diathesisofanesthetist3.Influenceandfaultofanesthetics、anestheticapparatusandcorrelatedinstrumentSeriousComplicationsduringGeneralAnesthesiaRespiratorytractobstructionRespiratorydepressionHypotensionandHypertensionMyocardialischemiaHyperthermiaandHypothermiaAwarenssandDelayofAwakeCough、Singultus、Postoperativevomiting、PostoperativepulmonaryinfectionMalignanthyperthermiaRespiratoryObstruction一、Glossocoma：1．Aetiology：2．Liabilityfactor：（1）Justomajorofcorpuslinguae（2）Shortandstout（3）Shortneck（4）Lymphadenosisofthroatposteriorwall（5）HypertrophyoftonsilsRespiratoryObstruction3．Clinicalfeatures：4．Management：（1）Sidelying、（2）Headhypsokinesis、（3）Liftsubmaxilla、（4）OropharyngealparichnosNasopharyngealparichnosRespiratoryObstruction二、Airwayobstructionbysecretion、purulentsputum、bloodandforeignobject1．Aetiology：（1）Inhalationofstimulantanesthetic，（2）Bronchiectasis、pulmonaryabscess、pulmonarytuberculouscavityRespiratoryObstruction（3）Operationofcavumnasopharyngeum、oralcavity、Harelip（4）Desquamationoftoothorartifcalteeth2．Management：（1）Sufficientbelladonnapremedication（2）Intubation（3）Suckrespiratorytract（4）PulloutdentiumvacillatiaorartifcalteetRespiratoryObstruction三、RegurgitationandAspiration1．Aetiology：AnticholinergicagentMorphineGeneralanaestheticsMusclerelaxant2．Clinicalfeatures：（1）Bronchospasm（2）Tachypneaanddyspnea（3）Moistrales（4）SeverhypoxiaRespiratoryObstruction3．Management：（1）Fasting：Adult：8hbeforeanesthesiaChildren：milkandsoliddietliquid6m4h2h6~36m6h3h36m8h3hRespiratoryObstruction（2）PreoperativeadministrationofanH2-receptorantagonist（cimetidineorranitidine）todecreasefurthersecretionofadditionalacid.（3）Applicationofgastricdecompressionbyawide-borenasogastrictube;Preparingforsuction（4）Fullstomach/highlevelileus：awakeintubation（5）Rapid-sequenceinductionandintubationwithoutpositive-pressureventilationbeforeintubation.RespiratoryObstruction（6）Applicationofcricoidcompressiontocontrolregurgitationofgastriccontents（7）Extubationwhenthepatientisfullyawake（8）Aspiration：Headdownposition，suckvomitusBronchialantispasmodicandantibioticsRespirationsupportLavageoftracheausing0.9%NaClRespiratoryObstruction四、Malpositionofcatheter、Obstructionoflumina、Anaesheticmachinefailure1.Aetiology：CathetertwistBlockbysputumCorrugatedtubetwistMalfunctionofrespirationvalve2.Management：ExaminepositionofcatheterRespiratorysoundBreathingcircuitRespirationvalveRespiratoryObstruction五、TracheaCompression1.Aetiology：tumorofneckormediastinumhematoma、edemacalidum2.Management：六、Inflamaffectionofpharyngo-oralcavity、Larynxtumer、Allergialaryngealoedema1.Aetiology：peritonsillarabscess、Larynxtumorpharynxposteriorwallabscess2.Management：RespiratoryObstruction七、LaryngospasmandBronchospasm（一）Laryngospasm：1.Aetiology：pharyngealvagusnerveexcitability↑2.Evokedreasons：（1）hyoxemia、hypercapnia、secretion、intubationoropharynxparichnos、laryngoscope（2）lightanesthesia3.Clinicalfeatures4.ManagementRespiratoryObstruction5.Prevention：avoidlightanesthesia、hypoxiacarbondioxideaccumulation（二）Bronchospasm：1.Aetiology：（1）Trachealintubation、aspiration、sucksputum（2）Operationstimulate（3）ThiopentalSodium、Morphine2.Clinicalfeatures：3.Management：Respiratorydepression一、CentralRespiratorydepression1．Aetiology：anesthetics、hyperventilationnarcoticanalgesics、inflatelungunduly2．Management：（1）Anesthetics→reducedepthofanesthesia（2）Narcoticanalgesics→Naloxone（3）Hyperventilation、inflatelungunduly→↓VTRespiratorydepression二、PeripheralRespiratorydepression1.Aetiology：musclerelaxanthypopotassemiageneralanaesthesia+epiduralblock2.Management：（1）Musclerelaxant→NeostigmineBromide（2）Hypopotassemia→supplypotassiumintime（3）Spinalnerveblock→waitRespiratorydepression三、RespirationManagement1.Effectiveventilation2.Selectofventilationmode：（1）Assistorrespiration（2）ControlledrespirationHypotentionandHypertension一、Hypotension1．Hypotension：20%or↓80mmHg2．Aetiology：（1）anesthesiaaspects（2）operationaspects（3）patientaspectsHypotentionandHypertension3．Prevention：（1）Insufficientbodyfluid→sufficientlysupply（2）Severeanaemia（3）Severemitralvalvestenosis（4）Myocardialischemia→maintainbloodpressureHypotentionandHypertension（5）Myocardialinfarction（6）Congestiveheartfailure（7）Ⅲ°BBB、sicksinussyndrome→pacemaker（8）Hypopotassemia（9）Atrialfibrilation→80~120bpm（10）Usinglong-termcorticosteroidHypotentionandHypertension4．Management：（1）Reducedepthofanesthesia（2）Transfusion，Ephedrine（3）Severecoronaryheartdisease→supportcardiacpumpfunction（4）Draginternalorgans→stopoperativeprocedure（5）Adrenalinsufficiency→largedoseofdexamethasone（6）Cardiacarrest→cardiacresuscitationHypotentionandHypertension二、Hypertension1．Hypertension：2．Aetiology：（1）Anesthesiaaspects（2）Operationaspects（3）PatientaspectsHypotentionandHypertension3.Prevention：（1）Sufficientpremedication（2）Phaeochromocytoma、hyperthyroidism（3）Intubation→enhanceanesthesiasurfaceanaesthesiaαorβ-receptorblocker（4）AvoidhypoxiaandcarbondioxideaccumulationHyp