胃癌根治術(shù)麻醉英文版

AnesthesiaforradicalgastrectomyofgastriccancerinEnglish匯報人：文小庫2024-01-11目錄CONTENTSIntroductionAnatomyandPhysiologyoftheGastrointestinalTractTypesofRadicalGastronomyAnesthesiaTechnologiesforRadicalGastronomyPreoperativeEvaluationandPreparationIntraoperativeManagementPostoperativeCareandRecovery01Introduction123BackgroundofGastricCancerGastriccancerisacommonmalignancyinthedigestivesystem,rankingthirdintheworldintermsofcancerincidenceandmoralityGastriccancerisoftenasymmetricalintheearlystage,andthesymptomsarenon-specific,leadingtoahighrateofmisseddiagnosesRadicalgastronomyisthemaintreatmentforgastriccancer,andasesthesiaisanessentialpartoftheoperation01020304ProvidestableAnesthesiaandmanagementtoensurethesmoothoperationofthesurgeryPreventandtreatperiodiccompilations,suchashypertension,arrhythmia,andrespiratoryandcirculatorydepressionReducesurgicalstressresponseandmaintainthebody'shomeostasisImprovepatientcomfortandsatisfactionbyprovidingappropriatecareImportanceofAnesthesiainRadiology02AnatomyandPhysiologyoftheGastrointestinalTractIthasfourmainregions:thefund,body,antrum,andpyrrusTheStomachWallismadeupofthreelayers:themucosa,submicosa,andmucularisexternaTheStomachisaholloworganizationthatliesintheupperabdominalcavity,betweentheesophagusandtheduodnumAnatomyoftheStomachPhysiologyoftheGastrointestinalTractThegastrointestinaltractisresponsiblefordigestionandabsorptionoffoodDigestioninvolvesthebreakdownoffoodintosmallparticlesthatcanbeabsorbedintothebloodstreamAbsorptionoccursthroughthemucosaofthesmallintention,wherenutrientsaretakenupintothebloodstreamEffectsofAnesthesiaontheGastrointestinalTractGeneralanesthesiacanaffectthenormalfunctionofthegastrointestinaltract02Itcanslowdowngastricemptyinganddelayinitialmobility,leadingtonaseaandinvoicingaftersurgery03Someaestheticagentscanalsocausedirectdamagetothegastrointestinalmucosa,leadingtopositiveileusorinfection0103TypesofRadicalGastronomyOpenGastronomyisthetraditionalsurgicalapproachthatinvolvesalargeinvestmentinthearbitrarywalltoaccesstheStomachandsurroundingstructuresOpengastronomyistypicallyassociatedwithlongeroperatingtimesandgreaterbloodlosscomparedtolaparoscopicandroboticapproachesThisapproachprovidesgoodexposureandvisualizationofthesurgicalfield,butitcanleadtosignificantpositivepay,longerrecoverytimes,andhigherriskofsurgicalsiteinfectionsOpenGastronomyLaparoscopicGastronomy010203LaparoscopicGastronomyinvolvestheuseofsmallimpactsandlaparoscopicinstrumentstoperformthesurgicalprocedureThisapproachoffersseveraladvantagesoveropensurgeries,includinglessconservativepay,fasterrecoverytimes,andlowerriskofsurgicalsiteinfectionsLaparoscopicgastronomytypicallyrequiresadvancedLaparoscopicskillsandcanbetechnicallychallengingincomplexcasesRoboticgastronomymayofferadvantagesincomplexcaseswhereprecisedivisionandsuingarerequired,butittypicallyrequiresahighleveloftechnicalexpertiseandcanbeassociatedwithhighercostscomparedtolaparoscopicsurgeryRoboticGastronomyutilizesrobotictechnologytoperformthesurgicalprocedureTheroboticsystemprovidestumorfree,threedimensionalvisualizationandprecisioninstrumentcontrol,whichcanleadtomoreaccuratedissectionandreportingcomparedtolaparoscopicsurgeryRoboticGastronomy04AnesthesiaTechnologiesforRadicalGastronomyGeneralanesthesiaisthemostcommonlyusedanesthesiatechniqueforradialgastronomyofgascancerItinvolvestheuseofdrugstoinduceunconsciousness,relaxationofmuscles,andlossofsensitivityGeneralanesthesiaprovidesgoodcontroloverthepatient'svitalsignsandallowsforasmoothsurgicalprocedureItalsoensuresthatthepatientdoesnotfeelanypainordiscomfortduringtheoperationHowever,generalanesthesiahassomerisksandsideeffects,suchasrespiratoryandcardiovascularcomplexes,andpostoperationalnaseaandinvoicingTherefore,itisessentialtocarefullyselectpatientsandmonitortheirconditionsduringtheoperationGeneralAnesthesia123RegionalAnesthesiaRegionalanesthesiaisatechniquethatinvolvestheblockageofnerveimpulsesinaspecificareaofthebodyItcanbeusedformedicalgastronomyofgastriccancertoprovidemanagementandmusclerelaxationThemostcommonlyusedregionalasesthesiatechnologyforradialgastronomyistropicalempiricalasesthesiaItinvolvestheinjectionofanaerobicdrugsintotheempiricalspacearoundthespinalcordThisblocksthenerveimpulsestothedominantregion,advancingmanagementandmusclerelaxationRegionalasesthesiahassomeadvantagesovergeneralasesthesia,suchasFewersideeffectsandamorerapidrecoverytimeHowever,itmaynotbesuitableforallpatientsandrequiresexpertiseandcaremonitoringduringtheoperationCombinedGeneralandRegionalAnesthesiaCombinedgeneralandregionalasesthesiaisatechniquethatinvolvestheuseofbothgeneralasesthesiaandregionalasesthesiaduringthesamesurgicalprocedureItiscommonlyusedformedicalgastronomyofgastriccancertoprovideoptimalmanagement,musclerelaxation,andcontroloverthepatient'svitalsignsIncombinedasesthesia,generalasesthesiaisusedtoinduceunconsciousness,relaxationofmuscles,andlossofsensitivity,whileregionalasesthesiaisusedtoblocknerveimpulsesinthedominantregionThiscombinationprovidesbettercontroloversurgicalbleeding,reducespostoperationalpain,andimprovesrecoverytimecomparedtogeneralanesthesiaoneCombinedgeneralandregionalanesthesiarequiresexpertiseandcarefulmonitoringduringtheoperationTheanesthesiologistmusthaveagoodunderstandingofbothgeneralandregionalanesthesiatechnologiestoensuresafetyandeffectivepatientcare05PreoperativeEvaluationandPreparation1234PhysicalStatusLifeFunctionCardiopulmonaryFunctionRenalFunctionPreoperationalEvaluationAssessthepatient'soverallphysicalcondition,includinganyexistingcomorbiditiesthatmayaffectaestheticmanagementAssessthepatient'soverallphysicalcondition,includinganyexistingcomorbiditiesthatmayaffectaestheticmanagementAssessthepatient'soverallphysicalcondition,includinganyexistingcomorbiditiesthatmayaffectaestheticmanagementAssessthepatient'soverallphysicalcondition,includinganyexistingcomorbiditiesthatmayaffectaestheticmanagementPreoperativePreparationProvideinotropicsupportforpatientswithsevereheartdiseaseorlowcardiacoutputtoensureastablecardiovascularsystemduringsurgeryInotropicSupportProvidenutritionalsupporttopatientswhoaremalnourishedoratriskofmalnutritiontoimprovetheirtoleranceofsurgeryandeverythingNutritionalSupportControlanycomorbiditiesthatmayaffectaestheticmanagement,suchastension,diabetes,andarthritisControlofComorbiditiesInformedConsentExplaintheprocedure,risks,andpossibleapplicationstothepatientandobservedinformedconsentPreoperationalInstructionsInstructthepatientonpreoperationalfast,preoperationalmedicine,andotherrelevantpreoperationalproceduresPatientEducation06IntraoperativeManagement要點三VitalSignsMonitoringContinuousmonitoringofheartrate,bloodpressure,respiratoryrate,andoxygensaturationthroughtheexcesssafeguardsofthepatient'sstablehemodynamicstatus要點一要點二EndtidalCO2MonitoringThishelpstoassesstheopportunityofexploitationanddetectaspirationeventsTemperatureMonitoringMaintainingnormothermiaisessentialtoavoidperiodichyperthermia,whichcanleadtovaryingadverseoutcomes要點三MonitoringduringAnesthesiaChoiceofAnesthesiaCircuitTheuseofaclosedcircuitwithlowdeadspaceandlowresistancetoflowispreferredLunarMaskAirway(LMA)vs.TrachealTubeInselectedpatients,LMAcanbeusedasitprovidesasecureairwaywithouttheneedfortractionRespiratoryRateandVolumeTitratedtomaintainnormocapniaManagementofAirwaysandVentilation01FormultimodalmonitoringandfluidmanagementCentralVenousAccess02ForbloodpressuremonitoringandbloodgassamplingArtAccess03VigilanceisrequiredtoavoidinadvertentinjectionintotheartisticlineSafeAdministrationofMedicationsManagementofVascularAccess07PostoperativeCareandRecoveryRecoverytimeRecoveryroomRecoveryprocessRecoveryoutcomesRecoveryfromAnesthesiaAdesignedareawherepatientsarerecoveredunderpostanesthesiaItisstackedwithtrainedpersonnelwhomonitorthepatient'svitalsignsandensureasmoothrecoveryThetimerequiredforthepatienttofullyrecoverfromAnesthesiaaftersurgeryThisperiodisessentialforthepatienttoregisterconsciousness,normalbreaking,andmotorfunctionTheexpectedoutcomesoftherecoveryprocess,whichmayvarydependingonthetypeofAnesthesiausedandthesubstantialprocedureperformedThestepsinvolvedintherecoveryfr