I In nt tr ro od du uc ct ti io on n o of f C Cl li in ni ic ca al l A An ne es st th he es si ia aDepartment of Anesthesiology Cui Xiao GuangC Co on nc ce ep pt tUsing Drugs or other methods Central Nerve System or peripheral nerve system Losing sense, painless and comfortable, temporarilyWWh ha at t c ca an n y yo ou u d do o f fo or r y yo ou ur r f fu ut tu ur re e? ?expertise in resuscitation fluid replacement airway management oxygen transport operative stress reduction postoperative pain control ICU近近代代麻麻醉醉学学发发展展的的三三个个重重要要阶阶段段麻麻醉醉：1 19 9世世纪纪4 40 0年年代代算算起起，近近1 10 00 0年年的的发发展展历历程程。 临临床床麻麻醉醉学学（c cl li in ni ic ca al l a an ne es st th he es si io ol lo og gy y）：初初步步形形成成临临 床床麻麻醉醉学学的的五五大大组组成成。 麻麻醉醉与与危危重重病病医医学学（a an ne es st th he es si io ol lo og gy y a an nd d c cr ri it ti ic ca al l c ca ar re e mme ed di ic ci in ne e）： 从从2 20 0世世纪纪5 50 0年年代代末末至至今今，一一次次作作用用要要的的飞飞跃跃，特特别别 是是近近3 30 0余余年年的的发发展展法法国国、日日本本等等麻麻醉醉复复苏苏科科（d de ep pa ar rt tmme en nt t o of f a an ne es st th he es si io ol lo og gy y a an nd d r re es su us sc ci it ta at ti io on n）； 美美国国等等麻麻醉醉与与危危重重病病医医学学科科（d de ep pa ar rt tmme en nt t o of f a an ne es st th he es si io ol lo og gy y a an nd d c cr ri it ti ic ca al l c ca ar re e mme ed di ic ci in ne e）。A Ar rc ch ha ai ic c a an ne es st th he es si ia aStone Age: spicula analgesia Acupuncture Traditional medicine Pressure Cryotherapy And othersH Hi is st to or ry y o of f a an ne es st th he es si io ol lo og gy y1846 public demonstration of ether anesthesia by William T. G. MortonM Mo or rt to on n s s e et th he er r i in nh ha al le er r ( (1 18 84 46 6) )J Jo oh hn n S Sn no ow w, , t th he e f fi ir rs st t a an ne es st th he es si io ol lo og gi is st t （1 18 84 46 6）M Ma ac ch hi in ne e o of f I In nh ha al la at ti io on na al l a an ne es st th he es si ia a i in n 1 18 84 47 7Face mask (1847)H Hi is st to or ry y o of f i in nh ha al la at ti io on nA An ne es st th he es si ia a mma ac ch hi in ne e ( (1 19 93 30 0) )I In nt tr ra av ve en no ou us s a an ne es st th he et ti ic cs s1934: thiopental 1959: diazepam 1960: hydroxybutyrates, r-OH 1970: ketamine 1972: etomidate 1976: midazolam 1983: propofolO Ot th he er rs sOpioids Morphine, fentanyl, sufentanil, alfentanil, remifentanil Relaxants Curare(1942), succinylcholine, pancuronium, vecuronium, atracurium, rocuronium, mivacurium, at al.L Lo oc ca al l a an ne es st th he et ti ic cs s1884：Cocaine as ophthalmic anesthesia, nerve block 1885：Epidural anesthesia 1898: Spinal anesthesia 1901：Caudal anesthesia 1905：Procaine 1930：Dibucaine 1932：Dicaine 1943：Lidocaine 1963: bupivacaine 1996: ropivacaine More new: levobupivacaineH Ho ow w a ab bo ou ut t o ou ur r d de ep pa ar rt tmme en nt t o of f a an ne es st th he es si io ol lo og gy y? ?1956：surgeon 1957：anesthesia group 60-70：epidural, spinal, nerve block 70-80：CPB, intravenous anesthesia, and inhalational anesthesia 80-85: intravenous anesthesia, inhalational anesthesia, ECG, arterial blood pressure, CVP 80-90：inhalational anesthesia with timing injection of volatile anesthetics 90-present：depth of anesthesia, balance anesthesiaP Po op pu ul la ar r a an ne es st th he es si ia a w wo or rd ds sASA physical status classification system TOF: train of four BIS: bispectral index CVP neurostimulator SG: Swan Ganz catheter MAC: minimum alveolar concentration TEE: transesophageal echocardiographyT Th he e w wo or rk ki in ng g f fi ie el ld d o of f A An ne es st th he es si io ol lo og gi is st ts sClinic anesthesia Operating room, PACU, outpatient, CPCR (cardiopulmonary cerebral resuscitation) CCM (critical care medicine) Analgesia Pain clinic, postoperative analgesia, others Others Research, education, trainingH Ho ow w c ca an n y yo ou u b be ec co omme e a a r re ea al l a an ne es st th he es si io ol lo og gi is st tpurpose Basic knowledge Profile of whole body systems Using your potential Renew and update, uninterruptedly CommunicationA An ne es st th he es si ia a mme et th ho od ds sgenerallocalinhalationintravenousmucosamusclespinalepiduralNerve blockLocal infiltrationtopicalbalanceS Su ub bs sp pe ec ci ia al lt ty y o of f a an ne es st th he es si io ol lo og gy yCardiac surgery Vascular surgery Thoracic surgery Neurosurgical anesthesia Organ transplantation Pediatric surgery Obstetric anesthesia And othersP Pr ro oc ce ed du ur re e o of f c cl li in ni ic ca al l a an ne es st th he es si ia aP Pr re e- -o op pe ep pr re ep pa ar re ei in nt tr ro od du uc ct ti io on nS Sp pe ec ci ia al l mmo on ni it to or ri in ng gMMa ai in nt ta ai in n P PA AC CU UP Pr re eo op pe e. . P Ph hy ys si ic ca al l a as ss se es ss smme en nt tP Pu ur rp po os se e o of f P Pr re eo op pe e. . P Ph hy ys si ic ca al l a as ss se es ss smme en nt tTo receive the patient history data To relieve patients worrying status Review of current drug therapy Physical examination, interpretation of laboratory data Find out risk factor Propose