局部麻醉（英文）PPT.ppt

Zhang Lan Department of Anesthesiology of West China Hospital;Clinical Anesthesia ;一、Nerve Blocks;LOCAL ANESTHETICS(LA);十八世纪中，人们咀嚼古柯叶感受舒适感和增加耐力 1860年，从古柯叶中发现了可卡因 1884年，可卡因先后用于眼部局麻手术、颌神经阻滞、脊髓麻醉、硬膜外麻醉和蛛网膜下腔阻滞麻醉;;Local anesthetics of Peripheral nerve block;◆The toxicity of Local anesthetics ;Reason;CNS Excitation;CNS Conduction Pathways;BP ? Heart rate? Cardiac Arrest;Direct Cardiac Effects;Excessive doses of LA Systemic absorption of LA intravascular injection of LA Test doses of LA Premedication ;Incipient toxic reactions: Stop administering LA,ventilation support CNS excitation : Sedativetreatment,Benzodiazepine Convulsion Thiopental :therapy Convulsion Succinylcholine: Intubation maintaining adequate ventilation Cardiovascular System depression : supported by using IV fluids and vasopressors Cardiac arrest : Cardiopulmonary resuscitation;Anatomy and Technique;Upper extremity blocks– Brachial plexus blockade Lower extremity blocks— Lumbar Plexus Nerve Blocks Sciatic Nerve Blocks Femoral Nerve Blocks Blocks of the head and neck Blocks of the thorax and abdomen ;Upper extremity blocks– Brachial plexus blockade; ;;;;Interscalene Block;Axillary Block;Axillary Block;Supraclavicular Block;Supraclavicular Block;Lower extremity blocks- Lumbar Plexus Nerve Blocks  Sciatic Nerve Blocks Femoral Nerve Blocks;;The major branches of Lumbar Plexus : Femoral nerve Lateral femoral cutaneous nerve Obturator nerve Saphenous nerve;The sciatic nerve;Lumbar Plexus Nerve Blocks;;Complications;Sciatic Nerve Blocks;;Complications;Femoral Nerve Blocks;;Complications;二、Spinal Epidural Anesthesia;Spinal Epidural Anesthesia;ANATOMY;;Subarachnoid space --Spinal Anesthesia Epidural space--Epidural Anesthesia;;TECHNIQUE;;Spinal anesthesia: L3–L4, or L4–L5 spaces;;;;Spinal anesthesia Volume Rate of injection Density of