let us translate together

lyb840412

这上面一句好难，不会翻译

lyb840412

Ideally, the anesthetist should take a full history and examine each patient, but for the reasons already identified this is seldom possible. This section concentrates on features of particular relevance to the anesthetist.

lyb840412

These may have occurred in hospitals or dental surgeries. Inquire about inherited or ‘family’ diseases (e.g. sickle-cell disease, porphyria) and difficulties with previous anesthetics (e.g. nausea, vomiting, dreams, awareness, postoperative jaundice). Check the records of previous anesthetics to rule out or clarify problems such as difficulties with intubation, allergy to drugs administered, or adverse reactions (e.g. malignant hyperpyrexia, see below). The approximate date of previous anesthetics, particular if recent, should be identified to avoid the risk of repeat exposure to halothane (see page 59). Details of previous surgery may reveal potential anesthetic problems, for example cardiac or pulmonary surgery.

lyb840412

Cardiovascular system
Specific inquiries must be made about:
        angina (its incidence, precipitating factors, duration, use of anti-anginal medications, e.g. glyceryl trinitrate (GTN) tablets or spray);
        previous myocardial infarction and subsequent symptoms;
        symptoms indicative of heart failure.
Patients with a proven history of myocardial infarction are at a greater risk of perioperative reinfarction, the incidence of which is related to the time interval between infarct and surgery. Elective surgery should be postponed until at least 6 months after the event. Untreated or poorly controlled hypertension (diastolic consistently >110 mmHg ) may lead to exaggerated cardiovascular responses during anesthesia. Both hypertension and hypotension can be precipitated which increase the risk of myocardial ischaemia. Heart failure will be worsened by the depressant effects of anesthetic drugs on the heart, thereby impairing the perfusion valves may be on anticoagulants. These may need to be stopped or changed prior to surgery. Antibiotic prophylaxis will be required during certain types of surgery.

lyb840412

1.     Sleep is an active process generated in the brain.
   2.     Structures in the brainstem, diencephalon, and basal forebrain control the sleep-wake cycle and are directly modulated by general anesthetics.
   3.     Sleep and anesthesia are similar states with distinct traits, with each satisfying neurobiologic features of the other.
   4.     Distinct memory functions are subserved by distinct neural structures.
   5.     Limbic system structures such as the hippocampus and amygdala are critical for memory and play a role in anesthetic-induced amnesia.
   6.     Although brainstem, diencephalon, and basal forebrain structures generate wakefulness, the contents of consciousness are thought to be generated by the cortex.
   7.     Multiple neural correlates of consciousness are thought to be the targets of general anesthetics.
   8.     Consciousness and subsequent explicit recall of intraoperative events—known as “awareness during general anesthesia”—occur in 1 to 2 cases per 1000.
   9.     Monitoring anesthetic depth has evolved to electroencephalographic methods, although limitations still exist.