我们是如何开展麻醉前宣教的？

本文由“Anesth方舟”授权转载

为什么要在麻醉前宣教？

首先，从医疗行业的服务性质来说，让手术麻醉前的患者尽可能了解麻醉，是优质服务的一种表现；其次，让患者在麻醉科医生访视前了解你的工作，也利于更有效的交流沟通，难不成你每个病人再去介绍一番？第三，如果大多数患者没有主动去了解麻醉，那你就需要主动地灌输给他；最后，如果想提高麻醉中在患者心中的地位，人家都搞不清你干啥的，就以为你打一针了事，那肯定不是好事。

如何宣教？

如果自娱自乐般地在麻醉类公众号里发科普文章，除了麻醉和少数其它医务人员看，你觉得还有几个人会看？你能保证你的麻醉病人会看到？还是麻醉前访视时掏出自己的手机加个好友......? 不过呢，如果你的医院有个公众号，里面有各类 专业的科普介绍，然后患者入院后指导他们选择性看自己关心的知识，倒是也不错，可是这个工程略有点大。那么，貌似大多数医院麻醉科都是在自己手术室门口贴满了各种麻醉介绍，你是准备让所有手术患者术前一天先来手术门口一次呢？还是让人家被推进去的瞬间瞟一眼？其实这种普遍做法毫无意义！

我这里怎么做的？

以前看到ASA网站上有相关的科普介绍，就以那个为蓝本改编了一下。其实在我的《白氏麻醉论》里是有中文版的，今天我将英文版一并贴这里了。

      第一段是关于麻醉的一个总的概说，告诉患者麻醉大致有哪几种麻醉方法，它们大概是什么样的，并为患者勾选出他将接受的麻醉方法。

      后面几段等于是分论，概说几种麻醉方法的大致做法和可能会发生什么不良后果。

      那么每一个具体的患者得到的介绍都是第一段加他将获得的麻醉方法那一段，其它分论将不会出现。

      我的具体工作方式是：当天的患者来了之后，由麻醉护士打好相应文字（中或英文）的A4纸给病人看，然后我再去看患者进行术前谈话。一般我会问：您是否看了这个关于麻醉的介绍？能不能理解呢？您还有什么有关麻醉的问题吗？ 

麻醉

用于手术的麻醉一般分为以下四种方法：

□局部麻醉（局麻）：使用局麻药让手术部位的一小片区域感到麻木，病人可以始终保持清醒。

□区域麻醉：使用局麻药阻滞外周神经或脊椎部位神经根的方法，让躯体的较大一部分区域感到麻木，病人同样保持清醒。

□镇静/镇痛：使用药物（一般是镇静类和镇痛类药物）来对抗较小手术操作导致的疼痛，病人进入药物作用下的或浅或深的睡眠状态，手术之后醒来一般不会对手术操作过程有所记忆。

□全身麻醉（全麻）：使用较镇静/镇痛更大剂量的麻醉药物来使患者完全无意识并可对抗强刺激的手术。

麻醉医生为您选择的麻醉方法取决于具体手术方式和您当前的健康状态。而有时候，可以根据需要将上述方法中的两种进行联合。

*以上勾选麻醉方法适用于您的手术。

镇静/镇痛

一般联合使用镇静类药物和镇痛类药物，使您精神状态处于放松至深睡，有效抑制手术带来的疼痛和不适感，它可以使您在手术后快速恢复正常生理功能并很快回到日常生活状态。它往往用于那些较小创伤、短时间的且不会带来严重问题的手术。

一般是通过静脉注射麻醉药物的方法，可以很快使您感到嗜睡并进入睡眠状态。如果只是浅睡状态，您可以被唤醒并与人交流，但如果进入深睡状态，则不易被唤醒。手术结束醒来后您将不记得手术过程，可能仍有困倦感，但应该很快即能完全清醒。 

镇静/镇痛醒来后早期您将仍有一些困倦感，也可能会有一些头痛头晕感，但一般都可以在手术后1小时内完全恢复。

风险

一般来说，镇静/镇痛对于那些短小手术是有效而安全的，但如果给予过多剂量的药物，也可能会严重影响呼吸功能。麻醉医生和护士会在全程观察您的情况，在需要的时候也会使用专业的方法和设备来避免危险。

区域麻醉包括脊麻、硬膜外麻醉和神经（丛）阻滞。

脊麻和硬膜外麻醉

在您背部消毒之后，在穿刺点先注射少量局麻药，然后通过此点使用较粗些的针进行脊椎穿刺，再直接（脊麻）或通过一根细导管（硬膜外麻醉）注射局麻药在脊髓神经根周围以阻滞神经根，进而使躯体的一部分区域麻木，您将在此阻滞状态下保持清醒。

风险

•   对局麻药的过敏反应

•   脊髓周围的出血（血肿）

•   排尿困难

•   脊椎区域感染

•   神经损伤

•   惊厥（罕见）

•   严重头痛

神经（丛）阻滞

人体的疼痛由神经或神经丛传导而获得感知，可以通过在其周围注射局麻药的方法阻断神经冲动传导而使您不会感觉到疼痛，实施这种麻醉方法时，您在术中也是保持清醒状态的。

风险

•   对局麻药的过敏反应

•   注射部位感染

•   神经损伤

•   注射局部出血形成血肿

•   惊厥（罕见）

全麻

全麻是采用麻醉药物使人体进入一种深度睡眠状态，在手术过程中您不会有任何对手术操作或周围环境的感知，不会产生体动，也不会留下任何记忆。

麻醉医生将通过您的静脉通道给予你药物，同时要求您通过面罩吸入氧气，当您开始入睡，会将一根气管导管插入您气管或一根喉罩置于您的咽喉腔，这样做的目的是为了帮助您在全麻中的呼吸。在整个全麻过程中，您的血压、脉搏和呼吸等多项指标会被麻醉医生和护士严密监测，并随手术进程而改变全麻的深度。

全麻醒来后早期，您可能会感到困乏无力和晕眩，也可能会觉得胃部不适、口干、咽痛、寒冷和心神不宁，这些感受可能会持续若干小时直到麻醉药作用全部退去。有时会有恶心呕吐的现象，需要药物来治疗。

风险

由于有了现代化的机器设备、药物和安全的工作流程，对于健康人来说，全麻一般是安全的，但以下人群可能在全麻中面临较高风险：

•   平素酗酒或药物滥用

•   对麻醉药物的过敏或家族有这种过敏史

•   同时患有心、肺和肾脏等疾病

•   吸烟者

Anesthesia

If you are having surgery, your doctor will give you a drug called an anesthetic. Anesthetics reduce or prevent pain. There are four main types:

□Local anesthesia: numbs one small area of the body. You stay awake and alert.

□Regional anesthesia: blocks pain in an area of the body, such an arm or leg.

□Sedation/analgesia: uses a sedative to relax you and pain medicine to relieve pain. You may stay awake but may not remember the procedure afterwards.

□General anesthesia（GA）: affects your whole body. You go to sleep and feel nothing. You have no memory of the procedure afterwards.

The type of anesthesia your doctor chooses depends on several factors, including the type of procedure you are having and your current health status. Sometimes, two of the above mentioned types may be combined if necessary.

*Above ticked anesthesia type is adapted for your surgery.

Sedation/analgesia

Sedation/analgesia is a combination of drugs to help you relax (sedative) and to relieve pain (anesthetic) during a medical procedure. Sedation/analgesia lets you recover faster and return to your everyday activities soon after your procedure.

Description

An anesthesiologist will give you sedation/analgesia in a hospital or in an outpatient setting. The medicine will wear off quickly, so it is used for short and uncomplicated procedures.

Sedation/analgesics usually are provided through an intravenous line. You will begin to feel drowsy and relaxed immediately.

You may fall asleep, but able to wake up easily and respond to verbal and tactile stimuli. After sedation/analgesia, you may feel sleepy and drowsy, but you should be able to recover fully about an hour after your procedure.

Sedation/analgesia is safe and effective for patients who need minor surgical procedure and/or procedure to diagnose a condition.

Risks

Sedation/analgesia is generally safe. However, if you are given too much, difficulty in  breathing may occur. A doctor or/and nurse will observe and monitor you during the whole procedure. Health care providers always have a special equipment to help you with your breathing, if needed.

Regional anesthesia includes spinal anesthesia, epidural anesthesia and nerve (plexus) block.

Spinal and epidural anesthesia

Spinal and epidural anesthesia uses drugs that numb the parts of your body to block pain. They are given through an injection in or around the spine. You will stay awake under these types of anesthesia.

The area of your back where the needle will be inserted will be cleaned with a special solution. Most of the time, this injection will go in your lower back. This area may also be numbed with a local anesthetic.

Risks

Spinal and epidural anesthesia are generally safe. Possible complications are:

•      Allergic reaction to the anesthesia used

•      Bleeding around the spinal column (hematoma)

•      Difficulty urinating

•      Infection in your spine

•      Nerve damage

•      Seizures (this is rare)

•      Severe headache

Nerve(plexus) block

Nerve or a group of nerves (nerve plexus), that causes pain to a specific organ or body region, can be blocked with the injection of local anesthetic around it. The operation site may be numbed and you will stay awake during the surgery.

Risk

•      Allergic reaction to the anesthetic used

•      Infection at the site of injection

•      Nerve damage

•      Bleeding

•      Seizures (this is rare)

General anesthesia

General anesthesia uses certain medicines that will put you into a deep sleep so you do not feel pain during surgery. When you receive these medicines, you will not be aware of what is happening around you. You will not move, feel any pain, or have any memories of the procedure.

The doctor will administer a medication through an intravenous line. You may be asked to breathe in (inhale) oxygen through a mask. Once you are asleep, the doctor may insert a tube into your windpipe (trachea) or a laryngeal mask into your pharyngolaryngeal cavity to help you breathe. You will be watched very closely while you are asleep. Your blood pressure, pulse, and breathing will be monitored. Your doctor or nurse can change how deeply asleep you are during the surgery. 

You will wake up tired and groggy in the recovery or operating room. You may also experience nausea, dry mouth, sore throat, or feel cold and restless until the anesthesia wears off. Your nurse will monitor these side effects. They will wear off, but it may take a few hours. Sometimes nausea and vomiting can be treated with other medicines.

Risks

General anesthesia is generally safe because of modern equipment, medications, and safety standards. Most people recover completely and do not have any complications. The following people may have a higher risk of problems with general anesthesia:

•      People who abuse alcohol or medications

•     People with allergies or a family history of being allergic to medicine

•      People with heart, lung, or kidney problems

•      Smokers

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