麻醉學

全書共分13章，涵蓋了臨床麻醉、重症及疼痛診療相關內容，包括術前評估、麻醉監測、氣道管理、局麻藥與區域阻滯、全身麻醉、酸鹼平衡、呼吸衰竭、休克、心肺復甦、營養支持和疼痛診療等。可供醫學留學生、七年制或八年制醫學生、醫學本科生英語或雙語教學使用。

In recent years, anesthesiology as the grade-2 subject and grade-1 clinical department has

been independently learned by many students including foreign students. Now, it is urgent that

an English textbook of anesthesiology is needed for undergraduate program for international

students. This textbook is written according to the depth of Chinese undergraduate textbook

of anesthesiology and the requirement of textbook of 1-and 2-year international anesthesia

residents, which is suitable for undergraduate program for international students.

This book covers the related contents of clinical anesthesia, intensive care and pain, which

is divided into 13 chapters including preoperative assessment, anesthesia monitoring, airway

management, local anesthetics and regional anesthesia, general anesthesia, acid-base balance,

respiratory failure, shock, cardiopulmonary resuscitation, nutrition support, and diagnosis and

treatment of pain, etc. This book is written by 15 anesthesia experts and scholars from teaching

hospital of different areas in China, which is the final version after the first draft, twice cross

review and finalization. This book highlights the combination of fundamental information,

related progress and latest knowledge, which can help students to facilitate the understanding

of discipline development.

We hope that every teacher can give advices in the process of using this book, which can

make it republication more perfect.

Editors

Oct 30, 2014

Chapter 1 Introduction …………………………………………………………………………… 1

1 History of anesthesiology ………………………………………………………………… 2

2 The scope of anesthesiology ……………………………………………………………… 6

3 Classification of anesthesia 9

4 How to learn anesthesiology well ……………………………………………………… 11

Suggested Reading …………………………………………………………………………… 12

Chapter 2 Evaluation before Anesthesia ………………………………………………………… 13

1 History ……………………………………………………………………………………… 13

2 The physical examination ………………………………………………………………… 16

3 Laboratory studies ………………………………………………………………………… 17

4 Anesthesiologist-patient relationship …………………………………………………… 18

5 Premedication……………………………………………………………………………… 20

6 Delaying surgical procedures …………………………………………………………… 21

Suggested Reading …………………………………………………………………………… 22

Chapter 3 Anesthesia Monitoring………………………………………………………………… 23

1 Standard monitoring ……………………………………………………………………… 23

2 Respiratory system monitoring ………………………………………………………… 23

3 Cardiovascular system monitoring ……………………………………………………… 29

4 Depth of anesthesia ……………………………………………………………………… 41

5 Neuromuscular blockade monitoring ………………………………………………… 43

6 Temperature monitoring ………………………………………………………………… 45

Suggested Reading …………………………………………………………………………… 45

Chapter 4 Local Anesthetics and Regional Anesthesia ………………………………………… 46

1 Local anesthetics…………………………………………………………………………… 46

2 Anatomy and physiology ………………………………………………………………… 49

3 Nerve block ………………………………………………………………………………… 54

4 Spinal anesthesia ………………………………………………………………………… 59

5 Epidural anesthesia ……………………………………………………………………… 61

6 Combined spinal and epidural anesthesia ……………………………………………… 64

7 Caudal anesthesia ………………………………………………………………………… 64

8 Complications of neuraxial blocks ……………………………………………………… 65

Suggested Reading …………………………………………………………………………… 66

Chapter 5 Airway Evaluation and Management ……………………………………………… 69

1 Anatomy …………………………………………………………………………………… 69

2 Evaluation of airway ……………………………………………………………………… 69

3 Equipment ………………………………………………………………………………… 71

4 Airway management ……………………………………………………………………… 76

Suggested Reading …………………………………………………………………………… 79

Chapter 6 General Anesthesia …………………………………………………………………… 80

1 Anesthetics for general anesthesia ……………………………………………………… 80

2 Administration of general anesthesia …………………………………………………… 95

3 Complications of general anesthesia 103

Suggested Reading 107

Chapter 7 Acid-Base Balance and Fluid Therapy 108

1 Regulation of fluid and electrolytes 109

2 Fluid therapy 121

Suggested Reading 123

Chapter 8 The Postanesthesia Care Unit……………………………………………………… 124

1 Admission to the PACU 124

2 Monitoring 124

3 Complications…………………………………………………………………………… 124

4 Recovery from regional anesthesia …………………………………………………… 142

5 Criteria for discharge…………………………………………………………………… 142

Suggested Reading 143

Chapter 9 Perioperative Acute Respiratory Failure and Acute

Lung Injury (ALI) / Acute Respiratory Distress Syndrome (ARDS) …………… 144

1 Perioperative respiratory failure ……………………………………………………… 145

2 Acute respiratory distress syndrome 155

Suggested Reading 164

Chapter 10 Shock 165

1 Introduction …………………………………………………………………165

2 Classification of shock …………………………………………………………………166

3 Pathophysiology of shock……………………………………………………………… 168

4 Diagnosis and management of shock ………………………………………………… 173

5 Patient monitoring ……………………………………………………………………… 177

6 Treatment………………………………………………………………………………… 184

7 Specific shock syndromes ……………………………………………………………… 191

Suggested Reading 192

Chapter 11 Cardiopulmonary Resuscitation 195

1 Definition and causes of cardiac arrest 195

2 Cardiopulmonary resuscitation (CPR) 197

3 Post resuscitation care 208

4 Prognostication following cardiopulmonary cerebral resuscitation 211

Suggested Reading 211

Chapter 12 Nutritional Aspects 212

1 Fasting and malnutrition 212

2 Metabolic response to surgical and traumatic injury 212

3 The metabolic response to sepsis……………………………………………………… 214

4 Modulation of the stress response (during anesthesia) 215

5 Nutritional support …………………………………………………………………… 218

6 Special consideration…………………………………………………………………… 220

Suggested Reading 223

Chapter 13 Pain Management ………………………………………………………………… 224

1 Definition of pain 224

2 Neural basis of pain 224

3 Classification of pain …………………………………………………………………… 229

4 Pain assessment ………………………………………………………………………… 231

5 Pain therapy 235

Suggested Reading 239

Appendix 241

Appendix Ⅰ : Inhaled anaesthetic agents—physical properties ……………………… 241

Appendix Ⅱ a: Cardiovascular system—normal values …………………………………………241

Appendix Ⅱ b: Vasoactive infusions…………………………… 243

Appendix Ⅲ : Chemical pathology—biochemical values 244

Appendix Ⅳ a: Haematology normal values …………………………………………… 245

Appendix Ⅳ b: Coagulation tests………………………………………………………… 246

Appendix Ⅳ c: Coagulation screen ……………………………………………………… 247

Appendix Ⅴ a: Fluid balance…………………………… 248

Appendix Ⅴ b: Intraoperative fluid requirements—adult ……………………………248

Appendix Ⅴ c: Fluid, electrolyte and nutritional requirements ……………………… 249

Appendix Ⅴ d: Composition of common intravenous fluids ………………………… 249

Appendix Ⅵ : Renal function tests……………………………………………… 250

Appendix Ⅶ a: Pulmonary function tests ……………………………………251

Appendix Ⅶ b: Lung function : adult and neonatal values …………………………… 252

Appendix Ⅷ : Paediatrics …………………………252

Appendix Ⅸ : Gas flows in ananesthetic breathing systems 253