Risk Factors Associated with General Anesthetic 全身麻醉的风险因素
General anesthesia involves the administration of a combination of several different general anesthetic agents to achieve the following goals: analgesia, or loss of pain perception; unconsciousness, or loss of awareness of one’s surroundings; and amnesia, or inability to recall what took place. Ideally, the drugs are combined to achieve the best effects with the fewest adverse effects. In addition, general anesthesia also blocks the body’s reflexes. Blockage of autonomic reflexes prevents involuntary reflex response to bodily injury that might compromise a patient’s cardiac, respiratory, gastrointestinal (GI), and immune status. Blockage of muscle reflexes prevents jerking movements that might interfere with the success of the surgical procedure.
Widespread CNS depression, which is not without risks, occurs with general anesthesia. In addition, all other body systems are affected. Because of the wide systemic effects, patients must be evaluated for factors that may increase their risk. These factors include the following:
l CNS factors: Underlying neurological disease (e.g., epilepsy, stroke, myasthenia gravis) that presents a risk for abnormal reaction to the CNS-depressing and muscle-relaxing effects of these drugs. CNS 因素：基础性神经系统疾病（如癫痫、中风、重症肌无力），这些因素可导致对药物CNS抑制和肌肉放松效应的异常反应危险l
Cardiovascular (CV) factors: Underlying vascular disease, coronary artery disease, or hypotension, which put patients at risk for severe reactions to anesthesia, such as hypotension and shock, dysrhythmias, and ischemia. 心血管（CV）因素：基础性血管病、冠状动脉疾病、低血压，这些疾病可使患者出现严重麻醉反应危险，如低血压和休克、节律异常、局部缺血。
l Respiratory factors: Obstructive pulmonary disease (e.g., asthma, chronic obstructive pulmonary disease, bronchitis), which can complicate the delivery of gas anesthetics, as well as the intubation and mechanical ventilation that must be used in most cases of general anesthesia. 呼吸系统因素：阻塞性肺病（如，哮喘、慢性阻塞性肺病、支气管炎），这些可能危害气体麻醉药的输送以及插管和机械通气，多数全身麻醉病例需要插管和机械通气。
l Renal and hepatic function: Conditions that interfere with the metabolism and excretion of anesthetics (e.g., acute renal failure, hepatitis) and could result in prolonged anesthesia and the need for continued support during recovery. Toxic reactions to the accumulation of abnormally high levels of anesthetic agents may even occur. 肾和肝功能：影响麻醉药代谢和排泄的情况（如急性肾衰、肝炎），可能导致麻醉延长及恢复期间继续支持需要。甚至可能出现异常高浓度麻醉药积累卖到的毒性反应。
★Vocabulary ★
analgesia – n. 麻醉
pain perception – 痛觉，疼痛感觉
amnesia – n. 遗忘（症），健忘
recall – v. 回忆，召回
involuntary reflex – 不随意反射
bodily injury – 身体损伤
compromise – v. 危害，让步
jerking movement – 急跳运动，急动
myasthenia gravis – 重症肌无力
complicate – v. 使错综复杂，使更严重
gas anesthetics – 气体麻醉药
accumulation – n. 积累，蓄积
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★Video★
Risk Factors
★Test ★
1. Mr. Baltazar will be undergoing surgery with general anesthesia. The client should be given which of the following instructions preoperatively?
A. Eat big breakfast
B. Expect to be incontinent of urine postoperatively
C. Double your medication doses
D. Expect nausea, vomiting, shivering, and pain postoperatively. 2. Geneva is reviewing for her upcoming quiz in Pharmacology. She should be aware that local and regional anesthesia act by:
A. Inhibiting depolarization.
B. Increasing depolarization.
C. Producing a semiconscious state.
D. Inhibiting motor movement.
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答案 Answers
1. D. Expect nausea, vomiting, shivering, and pain postoperatively.
Rationale: These responses should be expected, and the client should be prepared for them. Food is contraindicated before surgery. Urinary retention, not incontinence is likely. Medication is more likely to be held on the day of surgery. 2. A. Inhibiting depolarization.
Rationale: When local anesthesia is used, sensation is removed and the area anesthetized by inhibition of depolarization. Choice B is incorrect because the opposite is true. Choices C and D do not occur with local anesthesia.
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