1. General Anesthesia (GA)

2. What’s general anesthesia？
How to anesthetize the patient？

3. Four clinical end points of GA

4. Classification of General Anesthesia
Inhalational GA　
Intravenous GA
Combined GA

5. Procedure of GA
Induction from awake to sleep (hypnotic) and ready for surgery
preoxygenation
induction with intravenous or inhalational anesthetics
Tracheal intubation , mechanical ventilation
Maintenance
four endpoints
Emergence
Awake, spontaneous respiration
no residual muscle relaxation

6. Tracheal intubation Open and seal the air way ventilation
Deliver inhalational anesthetics
stiletto

7. Tracheal intubation

8. Special Apparatus
McCoy
Mccoy
Polio
Polio
Soper
Soper
Hinged blade tip

9. Supraglottic Devices
Laryngeal Mask Airway
Combitube

10. Difficult airway Apparatus
Tracheotomy

11. Verify Position chest expansion bilaterally
listening over the epigastrium and the lung fields
Continuous waveform capnography
exhaled CO2 ,esophageal detector device (EDD)
If in doubt, laryngoscope to visualize the tube passing through the vocal cords
If still in doubt, bag-mask ventilation
chest x-ray (when feasible) above the carina

12. Anesthetic Machine Composition of AM Gas supplies Vaporizer ventilator
Breath circle

13. Maintenance and Monitoring

14. Depth of Hypnotic effect

15. Neuromuscular Function
TOF

16. Autonomic stability evaluation
ECG
SPO2 BP
CVP T

17. Autonomic stability evaluation
PETCO2
Sevoflurane
BIS
BIS

18. What about analgesia ?
MAC
Spinal reflex
Intravenous GA
analgesic

19. Emergence Conscious No residual relaxation Spontaneous respiration
Head rise 5 s , tongue protrude
VT > 500ml
SpO2 >95% (inspiration air)
No residual relaxation
TOF ratio > 90%
Analgesia
PCA

20. for management of anesthetized patient
Special techniques
for management of anesthetized patient

21. Deliberade Hypotension
Methods
Inhalational anesthetics
isoflurane
Vasodilator
Nitroprusside sodium
Nitroglycerine
Autonomic ganglia blocker
Objectives
facilitate surgery
decrease blood loss
Safety stand
≥70 % of Basic lever
SAP ≥ 80mmHg
MAP ≥ 60~70mmHg
Time limit
30~90 min

22. Hypothermia Objectives Grades Methods Decrease MR
Maintain Basic metabolic requirement of Cell
Grades
Low hypothermia ℃ ~ 32 ℃
Middle hypothermia 31 ℃ ~ 26 ℃
Deep hypothermia ＜25 ℃
Methods
Extracorporeal
Cardiopulmonary Bypass

23. Cardiopulmonary Bypass
Basic parts of the Set
Preload and hemodilution
HCT 20%~25% Hb 70 ~ 80 g/L
Heparin 300~400 U / kg
ACT>480~ 600s
Pup flow 2.2~2.8L/(m2.min)
100~150 ml/kg (child)
Myocardial protection K+ 20mmol/L

24. Autologous transfusion
Preoperational hemodilution
ANH
10~15ml/kg
Blood Salvages
anticoagulation
Prof. Wang Xue-ren

25. The best safety
lies in
f e a r