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    《ISPN学习》总第506期
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    《ISPN学习》总第683期
    日期:2020-09-18 09:46:00    
     
    《ISPN学习》2020年09月18日总第683期
      
    ISPN/RN Review
     
    Stages of Anesthesia 麻醉分期

    General anesthesia is delivered by a physician or nurse anesthetist trained in the delivery of these potent drugs along with intubation, mechanical ventilation, and full life support. During the delivery of anesthesia, the patient can go through predictable stages, referred to as the depth of anesthesia:
    全身麻醉由医生施行,也可以由受过这些强效药物输送训练、具有插管、机械通气和完全生命支持能力的麻醉护士施行。施行麻醉期间,患者可能经历几个可预测的麻醉分期,通指为麻醉深度。
     
     
    Stage 1, the analgesia stage, refers to the loss of pain sensation, with the patient still conscious and able to communicate.
    1期:痛觉缺失阶段,指痛学丧失,患者仍有意识,能够沟通。

    Stage 2, the excitement stage, is a period of excitement and often combative behavior, with many signs of sympathetic stimulation (e.g., tachycardia, increased respirations, blood pressure changes).
    2期:兴奋阶段,为兴奋期,经常有好斗行为,伴交感神经刺激症状(如,心动过速、呼吸增加、血压变化)。

    Stage 3, surgical anesthesia, involves relaxation of skeletal muscles, return of regular respirations, and progressive loss of eye reflexes and pupil dilation. Surgery can be safely performed in stage 3.
    3期:为外科麻醉,包含骨骼肌放松、恢复规则呼吸、眼反射进行性丧失和瞳孔散大。3期时,手术可安全实施。

    Stage 4, medullary paralysis, is very deep CNS depression with loss of respiratory and vasomotor center stimuli, in which death can occur rapidly. If a patient reaches this level the anesthesia has become too intense and the situation is critical.
    4期:为延髓麻痹期,CNS深度抑制,伴呼吸和血管舒缩中枢刺激丧失,此时,有可能迅速出现死亡。如果患者达到这一程度,说明麻醉太强,情况危急。

    General anesthesia administration also is divided into three phases: Induction, maintenance, and recovery.
    全身麻醉的施行也分为3个阶段:诱导、维持和恢复。

    Induction 诱导期

    Induction is the period from the beginning of anesthesia until stage 3, or surgical anesthesia, is reached. The danger period for many patients during induction is stage 2 because of the systemic stimulation that occurs. Often a rapid-acting anesthetic is used to move quickly through this phase and into stage 3. NMJ blockers may be used during induction to facilitate intubation, which is necessary to support the patient with mechanical ventilation during anesthesia.

    诱导期指开始麻醉至第3阶段或外科麻醉期。很多患者在诱导期的危险期是第2阶段,因为该阶段出现系统性刺激。经常采用速效麻醉以快速通过该期进入第3阶段。诱导期可使用NMJ阻断剂,以方便插管,这对麻醉期间支持机械通气患者是有必要的。

    Maintenance 维持期

    Maintenance is the period from stage 3 until the surgical procedure is complete. A slower, more predictable anesthetic, such as a gas anesthetic, may be used to maintain the anesthesia once the patient is in stage 3.
    维持期指从3期到外科手术完成这一时期。此时,可能使用缓慢、更可预测的麻醉,如气体麻醉,以维持3期患者的麻醉。

    Recovery 恢复期

    Recovery is the period from discontinuation of the anesthetic until the patient has regained consciousness, movement, and the ability to communicate. During recovery the patient requires continuous monitoring for any adverse effects of the drugs used, and ensure support of the patient’s vital functions as necessary.

    恢复期指麻药停止至患者恢复意识、运动和沟通能力这一阶段。恢复期间,患者需要继续监护是否出现药物不良效应,确保必要时的患者生命功能支持。

     
    Vocabulary
     
    nurse anesthetist – 麻醉护士
    potent – a. 有力的,有效的
    life support – 生命支持
    go through – 通过,经历
    predictable – a. 可以预测的
    depth of anesthesia – 麻醉深度
    analgesia stage – 痛觉缺失阶段
    excitement stage – 兴奋阶段
    combative – a. 好斗的,杀气腾腾的
    surgical anesthesia – 外科麻醉阶段
    eye reflexes – 眼反射
    pupil dilation -- 瞳孔散大
    medullary paralysis – 延髓麻痹阶段
    vasomotor center – 血管运动中枢
    induction – n. 诱导期
    maintenance – n. 维持期
    recovery – n. 恢复期
    NMJ blockers – 神经肌肉阻断剂
    discontinuation – n. 停止,停药
    regain – v. 恢复,复得


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      Video
     
    Stages of Anesthesia
     
    Test
     
    1. Early signs and symptoms of local anesthetic toxicity include ALL BUT ONE of the following. Indicate the exception:
    A. Tinnitus
    B. Perioral numbness
    C. Dizziness
    D. Hypertension
    2. During induction of anesthesia, the nurse notes the client becomes hyperactive and physically resists the treatment. The nurse concludes what interventions are needed?
    A. Anesthesia must be discontinued.
    B. An intravenous drug will be given to calm the client.
    C. Anesthesia must be discontinued.
    D. The surgery will need to be rescheduled.

     
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     答案 Answers
     
    1. D. Hypertension
    Rationale: Manifestations of local anesthetic toxicity typically appear 1-5 minutes after the injection, but onset may range from 30 seconds to as long as 60 minutes. Initial manifestations may also vary widely. Classically, patients experience symptoms of central nervous system (CNS) excitement such as the following: Circumoral and/or tongue numbness, metallic taste, lightheadedness, dizziness, visual and auditory disturbances (difficulty focusing and tinnitus), disorientation and drowsiness.
    2. B. An intravenous drug will be given to calm the client.
    Rationale: Stage 2 is the stage of excitement and hyperactivity. Medications may be given IV to calm the client.

     
     

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