CHAPTER 3
Managing the Airway
Basic techniques, 37 The laryngeal mask airway, 42 Emergency airway
Simple adjuncts, 39 Tracheal intubation, 43 techniques, 50
Maintenance of a patent airway is an essential prerequisite for the safe
and successful conduct of anesthesia. In addition, during resuscitation
patients often have an obstructed airway either as the cause or result of
their loss of consciousness. The skill of airway maintenance should be
acquired by all doctors, and not simply regarded as the responsibility of
the anesthetist. The descriptions of airway management techniques, which
follow, are intended to supplement practice either on a manikin or
preferably on and anesthetized patient under the direction of a skilled
anesthetist.
Basic techniques
Anesthesia frequently results in loss of the airway and it is most easily
restored by a combination of the head tilt along with a jaw thrust (see
Chapter 2). The latter is provided by the anesthetist’s fourth and fifth
fingers (of one or both hands) lifting the angle of the mandible. The overall
effect desired is that the patient’s mandible is ‘lifted’ into the mask
rather than the mask being pushed into the face (Fig. 3.1). FACEMASKS
●The most commonly used type in adults is the BOC anatomical facemask
(Fig. 3.2) which is designed to fit the contours of the face with
the minimum of pressure.
●Leakage of anesthetic gases is minimized by an air-filled cuff around
the edge.
●Masks ate made in a variety of sizes and the smallest one, which
provides a good seal, should be used (to minimize the increase in
dead space, which occurs).
●The Ambu mask (Fig. 3.2) has a transparent body—allowing
identification of vomit – making it poplar for resuscitation.
●All masks must be disinfected between each patient.
Simple adjuncts
The most commonly and used are the oropharyngeal (Guedel ) and
nasopharyngeal airways, inserted after the induction of anesthesia to help
maintain the airway in conjunction with the techniques described above. OROPHARYNGEAL AIRWAY
●These are curved plastic tubes, flattened in cross-section and
flanged at the oral end, which lie over the tongue, preventing it
from falling back into the pharynx.
●They are available in a variety of sizes from neonates to large adults.
The commonest sizes are 2-4, for small to large adults, respectively.
● A guide to the correct size is determined by comparing the airway
length to the vertical distance from the corner of the patient’s
mouth to the angle of the mandible.
●It is initially inserted ‘upside down’ as far as the back of the
hard palate (Fig. 3.3a), rotated 180 (Fig.3.3b) and fully inserted
util the flange lies in front of the teeth or gums in an edentulous
patient (Fig. 3.3 c).
NASOPHARYNGEAL AIRWAY
●These are round, malleable plastic tubes, beveled at the pharyngeal
end and flanged at the nasal end.
●They are sized on their internal diameter in millimeters, with length
increasing with diameter. The common sizes in adults are 6-8 mm, for
small to large adults, respectively.
● A guide to the correct size is made by comparing the diameter to the
external naris.
●Prior to insertion, the patency of the nostril (usually the right )
should be checked and the airway lubricated.
●The airway is inserted along the floor of the nose, with the bevel
facing medially to avoid catching the turbinates (Fig.3.4).
● A safety pin may be inserted through the flange to prevent inhalation
of the airway.
●If obstruction is encountered, force should not be used as severe
bleeding may be provoked. Instead, the other nostril can be tried. PROBLEMS WITH AIRWAYS
The presence of snoring, indrawing of the supraclavicular, suprasternal and intercastal spaces, use of the accessory muscles or paradoxical
respiratory movement (see-saw respiration) suggest that the above methods ate failing to maintain a patent airway. Common problems arising using these techniques along with a facemask during anesthesia are:
1inability to maintain a good seal between the patient’s face and the mask, particularly in those without teeth;
2fatigue, when holding the mask for prolonged periods;
3the risk of aspiration, due to the loss of upper airway reflexes;
4the anesthetist is not free to deal with any other problems, which may arise.
The laryngeal mask airway (LMA) or tracheal intubation may be used to
overcome these problems.
The laryngeal mask airway
This device was designed for use in spontaneously breathing patients.
It consists of a ‘mask’, which sits over the laryngeal opening,
attached to which is a tube, which protrudes from the mouth and connects
directly to the anesthetic breathing system. On the perimeter of the mask
is an inflatable cuff, which creates a seal and helps to stabilize it.
The LMA is produced in a variety of sizes suitable for all patients, from
neonates to adults, with sizes 3 and 4 being the most commonly used in
female and male adults, respectively. Positive pressure ventilation can
be performed via the LMA provided that high inflation pressure is avoided,
otherwise leakage occurs past the cuff, reducing ventilation and causing
gastric inflation. Aversion with a reinforced tube is also available.
The LMA is reusable, provided that it is sterilized between each patient.
The use of the laryngeal mask overcomes some of the problems of the
previous techniques:
●it is not affected by the shape of the patient’s fac e or the absence
of teeth;
●the anesthetist is not required to hold it in position, avoiding
fatigue and allowing any other problems to be dealt with;
●it reduces the risk of aspiration of regurgitated gastric contents,
but does not eliminate it.
Its use is relatively contraindicated where there is an increased risk of
regurgitation, for example in emergency cases, pregnancy and patients with
a hiatus hernia.
Recently, the laryngeal mask has been shown to be useful in two other
areas:
1In difficult tracheal intubation where it will often allow maintenance of the airway. Alternatively, a small diameter tracheal tube or
introduce can be passed into the larynx via the LMA.
2During cardiopulmonary resuscitation, it has been shown that non-anesthetists are able to insert an LMA more rapidly and successfully
than a tracheal tube and achieve more effective ventilation than using
a self-inflating bag and facemask. It is likely that in the future the
LMA will find a role in airway management during resuscitation. TECHNIQUE FOR INSERTION
The patient’s reflexes must be suppressed to a level similar to the required
for the insertion of an oropharyngeal airway to prevent coughing or
laryngospasm.
●The cuff is deflated and the mask lightly lubricated (Fig.3.5a).
● A head tilt i s performed, the patient’s mouth opened fully and the
tip of the mask inserted along the lard palate with the open side
facing but not touching the tongue (Fig.3.5b).
●The mask is then further inserted, using the index finger to provide
support for the tube (Fig.3.5c). Eventually, resistance will be felt
at the point where the tip of the mask lies at the upper oesophageal
sphincter (Fig.3.5d).
●The cuff is now fully inflated using an air-filled syringe attached
to the valve at the end of the pilot tube (Fig.3.5e).
●The laryngeal mask is secured either by a length of bandage or
adhesive strapping attached to the protruding tube.
Tracheal intubation
This is the best method of providing and securing a clear airway in-patients
during anesthesia and resuscitation, but success requires abolition of the
laryngeal reflexes. During anesthesia, this is usually achieved by the
administration of a muscle relaxant (see Chapter 4). Deep inhalational
anesthesia or local anesthesia of the larynx can also be used, but these are usually reserved for use in those patients where difficulty with
intubation is anticipated, for example in the presence of airway tumors or immobility of the cervical spine.
COMMON INDICATIONS FOR TRACHEAL INTUBATION
●Where muscle relaxants ate used to facilitate surgery (e.g. abdominal
and thoracic surgery ) thereby necessitating the use of mechanical
ventilation.
●In-patients with a full stomach, to protect against aspiration of
regurgitated gastric contents.
●Where the position of the patient would otherwise make maintenance
of the airway difficult, for example the lateral or prone position.
●Where there is competition between surgeon and anesthetist for the
airway (e.g. operations on the head and neck).
●In those patients in whom the airway cannot be satisfactorily
maintained by any other technique.
●During cardiopulmonary resuscitation when intubation allows:
(a)ventilation with 100% oxygen without leaks;
(b)suction clearance of inhaled debris;
(c) a route for the administration of drugs.
EQUIPMENT FOR TRACHEAL INTUBATION
A variety of equipment exists and that chosen will be determined by the
circumstances and by the preferences of the individual anesthetist. The
following is a list of the basic needs for adult oral intubation.
●Laryngoscope with a curved (Macintosh) blade and functioning light.
●Tracheal tubes in a variety of sizes and in which the cuffs work..
The internal diameter is expressed in millimeters and the length in
centimeters. They may be lightly lubricated.
(a)For males: 8.0 –9.0 mm internal diameter, 22 –24 cm lengths.
(b)For females: 7.5 –8.5 mm internal diameter, 20 –22 cm lengths.
●syringe to inflate the cuff once the tube is in place.
●Catheter mounts or ‘elbow’ to connect the tube to the anesthetic
system or ventilator tubing.
●Suction, switched on and immediately to hand in case the patient
vomits or regurgitates.
●Extras: a semi-rigid introducer to help mould the tube to a particular
shape; Magill’s forceps, designed to reach into the pharynx to
remove debris or direct the tip of a tube; bandage or tape to secure
the tube.
Tracheal tubes
●These were traditionally manufactured from red rubber and were
reusable. However, disposable plastic (PVC) ones are now widely used
to eliminate cross-infection and are chemically less irritant to the
larynx (Fig.3.6).
●Tubes are sized an according to their internal diameter in
millimeters and are manufactured in half-millimeter intervals. They
are long enough to be used orally or nasally.
● A standard 15-mm connector is provided to allow connection to the
breathing system.
●In adult anesthesia, a tracheal tube with an inflatable cuff is used
to prevent leakage of anesthetic gases back past the tube when
positive pressure ventilation is used. This also helps prevent
aspiration of any foreign material into the lungs.
●The cuff is inflated by injecting air from a syringe via a
small-diameter tube, at the distal end of which is a one-way valve
to prevent deflation and a small pilot balloon which indicates when
the cuff is inflated.
A wide variety of specialized tubes have been developed, examples of which
are shown in Fig.3.6.
●Reinforced tubes ate used to prevent kinking and subsequent
obstruction of the tracheal tube as a result of the positioning of
the patient’s head (Fig.3.6c).
●Preformed tubes are used during surgery on the head and neck and are
designed to take the connections away from the surgical field
(Fig.3.6d).
●Double lumen tubes are effectively two tubes welded together
side-by-side, with one tube extending distally beyond the other. They
are used during thoracic surgery, and placed such that the distal
tube lies within one main bronchus (endobronchial). This allows the
other lung to be deflated to facilitate via the endobronchial portion
(Fig.3.6E).
●In children under approximately 10 years of age, uncuffed tubes are
used as a natural seal is provided by the narrowing in the subglottic
region(Fig.3.6F).
THE TECHNIQUE OF ORAL INTUBATION
This requires abolition of the laryngeal reflexes and appropriate
monitoring of the patient.
Positioning
The patient is positioned with the neck flexed and the head extended at the atlanto-occipital joint. This is the so-called ‘sniffing the morning air’ position. The patient’s mouth is fully opened using the index finger and thumb of the right hand in a scissors action.
Laryngoscopy
The laryngoscope is always held in the left hand and the blade is introduced into the mouth along the right-hand side of the tongue, displacing it to the left. The blade is advanced until the tip lies in the gap between the
base of the tongue and the epiglottis, the vallecula. Force is then applied in the direction in which the handle of the laryngoscope is pointing, the
effort coming from the upper arm not the wrist, to lift the tongue and
epiglottis to expose the larynx. This should be seen as a triangular opening, with the apex anteriorly and the whitish colored true cords laterally
(Fig.3.7).
Intubation
The tracheal tube is introduced into the right side of the mouth, advanced and seen to pass through the cords until the cuff lies just below the cords.
The tube is then held firmly by the fingers of the right hand and the
laryngoscope is carefully removed. The cuff is then inflated sufficiently to prevent any leak during ventilation. Finally the position of the tube is confirmed by listening for breath sounds in both axillae and it is then secured in place.
For nasotracheal intubation; a well-lubricated tube is introduced usually via the right nostril along the floor of the nose with the bevel pointing medially to avoid damage to the turbinates. It is advanced into the oropharynx, where it is usually visualized using a laryngoscope in the manner described above. It can then either be advanced directly into the larynx by pushing on the proximal end, or the tip picked up with Magill’s
forceps (which are designed not to impair the view of the larynx and directed into the larynx. The procedure then continues as for oral intubation. DIFFICULT INTUBATION
Occasionally, intubation of the trachea is made difficult because of an inability to visualize the larynx. This may have been predicted at the
preoperative assessment or may be unexpected. A variety of techniques have
been described to help solve this problem and include the following:
●manipulation of the thyroid cartilage by downwards and upwards
pressure by an assistant to try and bring the larynx or its posterior
aspect into view;
●at laryngosopy, a gum elastic bougie, 60 cm long, is inserted into
the trachea, over which the tracheal tube is ‘ railroaded’ into
place;
● a fibreoptic bronchoscope is introduced into the trachea via the
mouth or nose and is used as a guide over which a tube can be passed
into the trachea. This technique has the advantage that it can be
used in either anesthetized or awake patients.
COMPLICATIONS OF TRACHEAL INTUBATION
The following is one methods of categorizing them, but it is not an attempt to cover all occurrences.
Hypoxia
●Oesophageal intubation. This is best detected by measuring the carbon
dioxide in expired gas; less than 0.2% indicates oesophageal
intubation. An alternative is to attach a 50 ml ‘bladder’ syringe
临床麻醉学试题及答案 一、单项选择题(每题1分,共30分) 1．双腔支气管插管的主要目的是（）（16章） A有利于更好地控制呼吸 B使健康肺和病侧肺的气道隔离通气 C通气效率高 D手术视野清楚 E避免开胸侧肺萎缩，出现低氧血症 答案：B 2．下列静脉麻醉药中可引起CBF、CPP、CMRO2及ICP增高的药物是（）（18章）A 硫喷妥钠B氯胺酮C异丙酚D咪唑安定E依托咪酯 答案：B 3．临床上可用于降低颅内压的方法有（）（18章） A利尿剂和液体限制B过度通气C局部低温D皮质激素E以上均是 答案：E 4．腋路臂丛阻滞哪一项不正确：（10章） A 针随腋动脉搏动而摆动 B 入腋鞘突破感 C 注药有外溢 D 注药后呈梭形扩散 E 针刺有坚实骨质感 答案：E 5．哪一项不是腋路路丛阻滞的优点：（10章） A 不会引起气胸 B 不会阻滞膈神经 C 不会误入椎管 D 位置表浅，易于阻滞 E 桡神经阻滞完全 答案：E 6．关于颈丛阻滞，哪项错误：（10章） A．颈深丛与颈浅丛均属感觉神经丛B．C2~4神经构成颈丛 C．颈丛阻滞其骨性标志为C4横突D．甲状腺手术应同时阻滞双侧颈浅丛和颈深丛E．颈丛阻滞最易发生喉上神经阻滞 答案：D 7．成人脊髓终止于：(11章) A．胸12椎下缘B．腰1椎下缘C．腰2椎下缘D．腰3椎下缘E．腰4椎下缘答案：B 8．椎管内阻滞血压下降的主要因素是：（11章） A 肌肉麻痹 B 肾上腺阻滞 C 交感神经阻滞 D 副交感神经阻滞 E 中枢交感神经介质释放减少 答案：C 9．腰麻平面达T4，心率减慢的主要原因是：（11章） A 支配心脏交感神经节前纤维阻滞 B 血压下降 C 右房压下降 D 窦弓反射 E 肾上腺素能神经纤维阻滞 答案：A 10．为预防局麻药中毒反应，以下哪项错误：（10章） A 一次用药不超过最大剂量 B 使用最低有效浓度 C 避免注入血管内 D局麻药内都必须加入肾上腺素E 术前给予巴比妥类或地西泮
临床麻醉学试题及答案（2） 一、名词解释（每题2分，共20分） 1、ASA5级：病情危重、频临死亡，手术是孤注一掷。麻醉和手术异常危险。 2、颏甲距离：指在颈部完全伸展从下颌骨下缘到甲状软有切迹的距离。 3、复合麻醉：指在同一次麻醉过程中同时或先后使用两种或两种以上的麻醉药物。 4、联合麻醉：指在同一麻醉过程中同时或先后采用两种或两种以上的麻醉技术。 5、喉痉挛：呼吸道的保护性反射声门闭合反射过度亢进的表现，是麻醉的严重并发症之一，临床表现为吸气性呼吸困难。 6、术中知晓：是指病人在术后能回忆起术中所发生的事，并能告知有无疼痛情况。 7、大量输血：通常为24小时内输入一倍或以上的全身血容量；3小时内输入50%全身血容量和需要输血>150ml/min。 8、体外循环：又称心肺转流术，其基本原理是将人体静脉血经上、下腔静脉引出体外，经人工肺氧合并排出一氧化碳，再将氧合后的血液经人工心脏泵入体内动脉系统。 9、高危妊娠：妊娠期某些病理因素，可能危害孕产妇、胎儿、新生儿安全或导致难产，称为高危妊娠。 10、阻塞性呼吸睡眠呼吸暂停综合征：是以睡眠时上呼吸道塌陷、阻塞而引起严重打鼾甚至呼吸暂停（中止10秒以上）为特征的症候群。 二、填空（每题1分，共15分） 1简单床旁测试病人肺功能的方法，包括屏气试验、吹气试验、吹火柴试验。 2、目前常用的肌松药有维库溴铵、阿曲库铵、罗库溴铵等。 3、对第III度房室传导阻滞的病人施行手术时应考虑安装起搏器，对心胸比值>0.7的病人应视作高危病人。 4、麻醉选择总的原则是在能满足手术要求的前提下尽量选择最为有利的麻醉方法和药物。 5、寰枕关节活动度是否影响头颈前倔后伸，对插管所需口、咽、喉三轴线接近重叠的操作至关重要。
麻醉：是由药物或其他方法产生的一种中枢神经系统和（或）周围神经系统的可逆性功能抑制，这种抑制的特点主要是感觉特别是痛觉的丧失。 Broca指数（肥胖指数）：男性标准体重（kg）=身高（cm）-100，女性标准体重（kg）=身 高（cm）-105。超过标准体重15%~20%这为明显肥胖，超过20%~30% 者为过渡肥胖。 BMI（体重指数）：BMI（kg/m2）=体重（kg）/身高（m）2。标准体重的男性的BMI约为22kg/m2，女性约为20 kg/m2 复合麻醉：指在同一次麻醉过程中同时或先后使用两种或两种以上的麻醉药物 联合麻醉：指在同一次麻醉过程中同时或先后使用两种或两种以上的麻醉技术 气管内插管：通过口腔或鼻孔经喉把特质的气管导管插入气管内，称为气管内插管MAC：肺泡最小有效浓度，指挥发性麻醉药和纯氧同时吸入时在肺泡内能达到50%的病人对 手术刺激不会引起摇头、四肢运动等反应的浓度。 半紧闭式：用循环式麻醉机，对逸气活瓣保持一定程度的开放，在呼气时一部分呼出气体经此活瓣排出，一部分呼气通过CO2吸收器，再与新鲜气体混合后被重复吸入， 故不易产生CO2蓄积。本法优点在于容易控制麻醉药浓度。 局部麻醉：指用局部麻醉药暂时地阻断某些周围神经的传导功能，使受这些神经支配的相应 区域产生麻醉作用。 局麻药的毒性反应：血液中局麻药的浓度超过机体的耐受能力，引起中枢神经系统和心血管 系统出现各种兴奋或抑制的临床症状，称为局麻药的毒性反应。 高敏反应：用小量局麻药即出现毒性反应症状者称为高敏反应。 区域阻滞麻醉：围绕手术区四周和底部注射局麻药，阻滞进入手术区的神经纤维的传导，使 该手术区产生麻醉作用称为区域阻滞麻醉。 神经阻滞：将局麻药注射至神经干、神经丛或神经节旁，暂时地阻断该神经的传导功能，使 受该神经支配的区域产生麻醉作用，称为神经阻滞。 术中控制性降压：指在全身麻醉下手术期间，在保证重要脏器氧供情况下，采用降压药物与技术等方法，人为地将平均动脉血压减低到50-65mmHg，使手术野出血 量随血压的降低而相应减少，不致有重要器官的缺血缺氧性损害，终止降 压后血压可迅速回复至正常水平，不产生永久性器官损害。 体温过低: 围术期体温低于36℃称为体温过低 反常呼吸：剖胸侧肺的膨胀与回缩动作与正常呼吸时完全相反，成为反常呼吸。 纵隔摆动：由于剖胸侧胸膜腔为无法改变的大气压，而健侧胸内压和肺内压均处于增高或降低的不断交替变化之中，此种双侧压力差的变化时纵隔随呼吸相的变动向健 侧和剖胸侧来回摆动。吸气时健侧的负压增大，纵隔移向健侧；在呼气时健侧 肺内压为正压，胸内压的负压值也减小，纵隔又推向剖胸侧。如此左右来回摆 动称为纵膈摆动。 胆心反射：胆道手术病人术中因富有迷走神经分布的胆囊、胆道部位受手术刺激而出现的强烈的迷走神经反射。胆心反射导致血压骤降，心动过缓甚至心脏停博。 脑血管自动调节机制：当MAP波动于50-150mmHg之间时，脑血流量可由于脑血管的自动收 缩与舒张而保持恒定称为脑血管自动调节机制。
中文版电子书索引（不断更新） 点击进入中文版电子书分版 1.【精华】米勒麻醉学6中文版 2.麻醉求生指南电子书 3.临床麻醉手册第四版电子书 4.麻醉和重症监护新进展 5.简明眼科麻醉学:英汉对照 6.最新麻醉技术操作规范与新技术应用实用手册 7.麻醉意外事故预防与应急处理实用手册 8.心血管麻醉及体外循环 9.麻醉科主治医师500问电子书 10.麦克明彩色人体解剖图谱第四版 11.产科麻醉袖珍手册 12.麻醉新概念(汉英对照)/医学专业双语读物 13.美国名医诊疗手册(麻醉学)
14.麻醉苏醒病人的管理 https://www.doczj.com/doc/6d3853947.html,chesis子午麻醉资源共享 16.临床疼痛治疗学（修订版） 17.麻醉中的疑难问题及处理方法 18.现代临床麻醉和重症监测治疗手册 19.麻醉解剖学 20.疼痛治疗麻醉医师培训手册 21.机械通气与临床 (第二版) 22.麻醉恢复室学习班讲义 23.美国最新临床医学问答：麻醉学 24.骨科麻醉学 25.困难气管插管技术 26.起死回生一百例：危重急症抢救经验集 27.临床麻醉实施程序 28.婴幼儿麻醉学 29.心脑血管急症急救程序 30.围手术期心血管药物的应用
31.神经阻滞学：100种神经阻滞术图解 32.体外循环手册(手机版) 33.麻醉信息学 34.实用硬脊膜外腔神经阻滞学（第二版） 35.美国麻省总医院危重监测治疗手册(第三版中文) 36.老年麻醉学与疼痛治疗学 37.临床疼痛治疗学（修订版） 38.实用解剖摄影图谱 39.急救原则与应用 40.麻醉生理学(第1版本科教材) 41.麻醉复苏室 42.麻省总院临床麻醉手册第五版（中文） 43.麻醉技术全书 44.现代麻醉学(第三版.word版) 45.斯坦福临床麻醉全书第3版 46.烧伤麻醉学 47.杨拔贤教授麻醉基础理论
临床麻醉学试题及答案（3） 一、名词解释（每小题2分，共20分） 1、全麻诱导：无论行静脉或吸入麻醉均有一个使病人从清醒状态转为可以进行手术操作的麻醉状态的过程，这一过程称为全麻诱导。 2、呼吸抑制：是指通气不足，它可表现为呼吸频率慢及潮气量减低、PaO2低下、PaCO2升高。 3、蛛网膜下隙阻滞：将局麻药注入蛛网膜下隙，使脊神经前后根阻滞的麻醉方法。 4、静吸复合麻醉：对同一病人静脉麻醉与吸入麻醉同时或先后使用的麻醉方法称静吸复合麻醉。 5、控制性降压：对某些特殊手术，为了减少手术野出血，给手术操作创造良好条件，减少输血量，术中运用各种药物和方法有意识地降低病人的血压，并视具体情况控制降压的程度和作用的时间，这一技术称为控制性降压。 6、静脉麻醉：将药物经静脉注入，通过血液循环作用于中枢神经系统而产生全身麻醉的方法。 7、高血压危象：指收缩压高于250mmHg并持续1min以上的高血压状态。 8、反常呼吸：剖胸后，剖胸侧肺的膨胀与回缩动作与正常呼吸完全相反。 9、双相性呼吸抑制：术中使用麻醉性镇痛药后，术终作用消失，但回病房后30～45min有可能再现呼吸抑制。 10、Apgar评分：系用五项指标（心率、呼吸、肌张力、神经反射、皮肤色泽）作为窒息程度的判断，0～3分为重度窒息，4～6分为轻度窒息，7～10分为正常。 二、单选题（每小题2分，共16分） 1、肾移植病人，充分的血液透析是尿毒症病人术前最重要的一项准备，下列哪一项是透析的目标。（C ） A、纠正贫血 B、改善病人的凝血机制 C、改善术前的血液生化紊乱 D、防止感染 E、避免排斥反应的发生 2、一身高120cm，体重24kg的儿童其体表面积为下列哪一项：（A ） A、0.8㎡ B、1.0㎡ C、0.6㎡ D、1.2㎡ E、0.4㎡ 3、硬膜外麻醉时判断穿刺针进入硬膜外腔的重要解剖标志是下列哪一项：（C ） A、刺间韧带 B、脑脊液流出 C、黄韧带 D、硬脊膜 E、蛛网膜 4、肌松维持应根据手术对肌松的要求而追加肌松药，肌颤搐抑制达到下列哪一项，即可满足一般外科手术要求。（D ） A、75% B、80% C、85% D、90% E、95% 5、关于麻醉前评估，下列述叙哪一项是错误的：（E ） A、肥胖对生理有明显影响 B、对体重过轻者，麻醉剂量需适当减少 C、对贫血、脱水等术前均应适当纠正 D、在近期内体重显著减轻者，对麻醉的耐受性较差 E、成人血红蛋白术前不宜高于10g/l 6、关于糖尿病手术前准备，下列哪项是错误：（E ） A、积极治疗糖尿病，控制并发症 B、控制血糖 C、控制尿糖 D、纠正酮症酸中毒 E、感染不需控制 7、术前用药中，抗胆碱药用量宜增加者，不包括下列哪种病人：（E ） A、病人原有心动过缓 B、小儿 C、施用氯胺酮麻醉
麻醉学试题库 一、名词解释 （1）TCI（2）TOF （3）反常呼吸（4）全脊髓麻醉 （5）低流量吸入麻醉（6）MAC（7）平衡麻醉（8）静脉快速诱导 （9）控制性降压（10）屏气试验(11)静脉全身麻醉 (12)试探剂量 三、填空题 1、剖胸对呼吸的生理影响是、、。 2、气管插管后，听诊双肺呼吸音的目的是：确定、、。 3、氯胺酮肌肉注射法多用于小儿手术的麻醉，首次剂量为，给药 后分钟即可出现麻醉作用，维持分钟。 4、肝和肾是耐受缺血缺氧较差的器官，在常温下阻断血流肝脏不得超 过分钟，肾不得超过分钟。 5、低温时易发生的心律失常是，其原因是。 6、麻醉期间呼吸道梗阻的常见原因为：、、、 、、、。 7、麻醉期间的低血压是指。而麻醉期间的高血压则是指。血压过高是指。 8、脑血管、脑室及气脑造影的麻醉处理原则、、 、。 9、有右室流出通道严重阻塞的紫型心脏病如法洛四联症，耐受缺氧的能力很低，可因恐惧、疼痛、低血压或缺氧等而诱发漏斗部痉挛，出现“”，可致心脏停搏，应引起警惕。 10、冠心病病人施行非心脏手术的死亡率为一般病人的2~3 倍，麻醉和手术的危险取决于、、。 11、双腔支气管插管的主要目的是。 12、临床麻醉学的任务是。 13、心房颤动最常见的原因是风湿性心脏病、冠心病等，可导致严重的血流动力学紊乱、心绞痛、昏厥和心悸不适。麻醉前应将心室率控制在次/分钟左右，至少不应超过次/分钟。
14、正常成人喉头位置在，而小儿则位于。 15、异丙酚静脉麻醉单次注射剂量为，作用时间为，麻醉维持剂量为。 16、开胸对呼吸生理的干扰为、、。 17、在CPB开始前，麻醉处理的目的是要为。在CPB过程中主要应防止和维持。 18、糖尿病病人术前血糖控制：术前空腹血糖应维持在，最好在 范围内，最高不超过。 19、全麻深度的监测应包括、、。 20、全麻后第1小时内的输液速度为，循环稳定后维持速度为。 21、麻醉期间的低血压是指。而麻醉期间的高血压则是指。血压过高是 指。 22、麻醉学专业的主要任务及范围包括：、、。 23、剖胸后对呼吸 的影响是、和。 24、临床上将心功能分为：级；日常活动后明显不适，活动受一定限制应为级。 25、临床常用的复合麻醉技术有、。 26、麻醉前用药的主要目的是、、。 27、经口气管插管时，要求、、三轴线重叠成一条线。 28、氯胺酮肌肉注射法多用于小儿手术的麻醉，首次剂量为，给药 后分钟即可出现麻醉作用，维持分钟。 29、常用非去极化肌肉松弛剂的拮抗剂是。 30、肝和肾是耐受缺血缺氧较差的器官，在常温下阻断血流肝脏不得超 过分钟，肾脏不得超过分钟。 四、简答题 1、为什么要进行麻醉前检诊？