Slaid 1 A General anesthesia.

Modern methods of pain relief include not only eliminating pain, but also control of basic body functions during surgery and soon after it.

Slaid 2 Anesthesia, or General anesthesia is induced by pharmacological deep sleep or is it reversible inhibition of CNS cells, accompanied: the shutdown of consciousness, analgesia, relaxation of skeletal muscles and inhibition of reflex activity. Slaid 3

Slaid 4 Classification depending on the method of administration of drugs for anesthesia are distinguished:

a) Inhalation anesthesia is the anesthetic enters the body in the form of a vapor or gas by diffusion through the alveoli get into

the body and distributed throughout the body. Gaseous or volatile liquid drugs inhaled anesthetic through a mask or endotracheal tube; Slaid 5

b) Noninhalation anesthesia (intravenous anesthesia) is carried out by introducing into a vein of one or more anesthetics. To noninhalation methods of anesthesia are also ways when the anesthetic is injected intramuscularly

Slaid 6 In the use of the drug :

1. Mononarkoz – anesthesia achieved with one drug

2. Mixed – at the same time introduced a mixture of 2-3 or more drugs (anesthesia, achieved by halothane + nitrous oxide). Slaid 7

3. Combined anaesthesia (or multicomponent anesthesia)

Slaid 8 Combined anaesthesia includes: introductory, supporting and basal – anesthesia.

A) Induction of anesthesia is short-lived, rapidly advancing without excitement phase. Used for quick soothing the patient , as well as to reduce the number of basic drugs.

B) Supporting or main (main) anesthesia is the anesthesia that is used during the entire period of the operation.

In) Basis-anesthesia - surface at which, simultaneously with the main tool of anesthesia administered anesthetic agent for reducing the dose of the main drug drug.

Slaid 9 Modern anesthetic consists of several components components of General anesthesia are:

1)inhibition of mental perception (narcolepsy, sleep);

2)the blockade of pain (afferent) impulses (analgesia);

3)inhibition of autonomic reflexes (autonomic nervous blockade, hyporeflexia)

4)management of gas exchange

5)managing the circulation;

6)off of motor activity (muscle relaxation, diplegia);

7)control of metabolism.

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Inhalation anesthesia. This type of anesthesia, which is achieved by the introduction of drugs through the respiratory tract. While drug substance enters through the mask due to the self-breathing patient or mechanically pumped through anesthetic machine through the inserted into the trachea of the patient, the incubation tube.

For inhalation anesthesia is applied, a pair of liquid drugs, as well as volatile gaseous substances.

Slaid 11 Drugs for inhalation anesthesia.

A) Liquid inhalation anesthetics:

1. Halothane (fluoran) is a liquid with a boiling point of about 50 ° C not flammable, not explosive. Its action is 4-5 times stronger than the influence of ether and 50 times – nitrous oxide.

Positive properties explosion, fast and pleasant for the patient, the introduction of anaesthesia and the rapid awakening, a powerful analgesic effect (after 3-4 minutes already analgesia), there is no stage of excitement, the ability to produce good muscle relaxation, suppression of secretion of salivary and bronchial glands, bronchodilatation effect, no irritation of the upper respiratory tract.

Negative properties of the drug are small therapeutic width, inhibition of sympathoadrenal system

the inhibitory effect on the heart and respiration, the cardiovascular system,

the decrease in the sensitivity of cardiac muscle to catecholamines and the ability to cause arrhythmia, hepatotropic action, therefore, halothane used for short surgical procedures under anesthesia mask. Often used to enhance the effects of nitrous oxide in the form of an azeotropic mixture (2 parts of halothane +1 part of nitrous oxide during endotracheal anesthesia.

2. Methoxyflurane has a powerful analgesic effect, non-toxic.

3.Enflurane-fluorinated ether, has a strong narcotic effect, depressing respiration, expressed myorelaxing action

4.Isoflurane, Sevoflurane-isomers of enflurane less toxic than enflurane and forotan; less toxic effects.

B) To gaseous inhalation anesthetics: nitrous oxide – (cylinder grey) – indifferent gas, in unaltered from the body through the lungs.

Positive properties: explosion, not irritating to the respiratory system, the rapid introduction of anaesthesia does not affect vital organs and parenchymal organs, cheap, pronounced potentiating effect with other anesthetics.

Disadvantages: small anesthetic capacity cannot be achieved with surgical stages of anesthesia and muscle relaxation, expressed excitement in children and alcoholics. Therefore, use short-term for painful manipulation or in combination with other anesthetics.

Cyclopropane is 7-10 times stronger than nitrous oxide. Used only in a mixture with oxygen.

Positive properties: wide therapeutic, not there is toxic to parenchymal organs, adequate muscle relaxation, does not irritate the respiratory tract.

Disadvantages: explosion hazards, respiratory depression, occurrence of arrhythmias, laryngospasm, dear, psychosis after anesthesia cyclopropane used very rarely.

Slaid 12 Types of inhalation anesthesia.

Mask inhalation anesthesia is indicated for short-term surgical interventions (with labor pain relief, for painful dressings), when contraindications for endotracheal anesthesia, when it is not possible to intubate the trachea. Mask anesthesia may be performed by using one mask or using anesthetic apparatus. Hardware mask anesthesia, allows the use of oxygen, accurately dosed introduction of anesthetics and safer. Nevertheless, by conducting mask anesthesia there are many contraindications: cardiovascular insufficiency, hypertension, respiratory diseases, liver disease, various disorders, renal failure, anemia, shock.

Endotracheal (intubation) anesthesia differs from mask the fact that in this method the drug mixture passes through the tracheal tube introduced into the trachea or bronchus, thus creating the possibility of managed and support breathing with great efficiency; the Airways remain freely traversable when any position of the patient (just to be sure that is not kinked endotracheal tube); creates an opportunity for continuous suction of mucus, secretions, blood and pus from the trachea and bronchi; disappears the risk of complications such as retraction of the tongue, lower jaw, aspiration of vomit; significantly reduced "dead space"; the anesthesiologist does not interfere with the surgeon during operations performed on the face, neck, brain.

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The sequence of the anesthesia. Premedication before a planned operation applies the most common pattern: at night sleeping pills (phenobarbital 2 mg/kg) and a tranquilizer (fenozepam 0.2 mg/kg).

In the morning 2-3 hours before surgery – droperidol (0.07 mg/kg), diazepam (0.14 mg/kg). 30 minutes before surgery – promedol (2% solution-1,0)atropine(0.01 mg/kg), diphenhydramine (0.3 mg/kg)

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Phase I– introduction of anaesthesia. Induction of anesthesia may be implemented in any narcotic substance, which comes rather deep sleep, without the stage of initiation. Mainly used barbiturates, fentanyl, in combination with sobrevinas. Drugs used in the form of a 1% solution, administered in/in the dose of 400-500 mg.. On the background induction of anesthesia is administered muscle relaxants and carried intubation.

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Phase II – maintenance of anesthesia. To maintain General anesthesia can be used any narcotic drug, which can create the body's defense against surgical trauma (halothane, cyclopropane, nitrous oxide, oxygen), and neuroleptanalgesia. Anesthesia support at I – level II surgical stage, and to eliminate muscle tension muscle relaxers injected that cause people you all groups of skeletal muscles, including respiratory. Therefore, the basic condition of modern combined method of anesthesia is the ventilator.

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Phase III – excretion of anesthesia. By the end of the surgery, the anesthesiologist gradually stop the introduction of drugs and muscle relaxants. The patient regained his consciousness, restored spontaneous breathing and muscle tone. After waking up, recovery of spontaneous breathing and the tone of the skeletal muscles, the anesthesiologist excuberant patient.

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For the implementation of endotracheal anesthesia performed tracheal intubations. Using a laryngoscope and endotracheal tubes. Laryngoscope - an instrument for the implementation of direct laryngoscopy it can be equipped with straight or curved blade on the end, which include a light source. For insertion of the tube into the trachea using the method of indirect laryngoscopy is necessary to relax the muscles, injected curare-like agent.

Muscle relaxants do not possess sedative and analgesic effects, they cannot be applied without loss of consciousness.

Slaid 18

A schematic diagram of a universal anaesthetic apparatus

Narcotic breathing mixture is formed in the anesthetic apparatus by mixing gases, drugs and oxygen.

Depending on the relationship of inhaled and exhaled by patients anesthetic mixture to atmospheric air there are 4 ways of anesthesia:

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1. Open method – the patient inhales a mixture of atmospheric air with the anesthetic and exhales to the atmosphere of the operating

2. Semi – inhales a drug compound that is isolated from atmospheric air, and exhales into the environment

3. Semi – inhales only drug mixture, and exhales partially into the apparatus, partly in the environment

4. Closed method – inhale and exhale completely isolated.

Drugs cause characteristic changes in all organs and systems. There is some regularity (stages) in the change of consciousness, breathing and circulation.

Slaid 20 The main clinical signs that allow to assess the dynamics of anesthesia are:

a) consciousness, General appearance of the patient, the color of his skin

b) response to painful stimuli

b) muscle tension, motor response

g) eye symptoms – the pupil size, reaction to light, corneal reflex, the movement of the eyeballs

d) pharyngeal reflexes and respiratory rate

e) pulse and blood pressure

It is very important at this stage to assess the condition of the pupil if the pupil is narrow and does not react to light, it is an indication of the correct course of anesthesia. Pupil dilation with increasing reaction to light indicates the awakening of the patient. Pupil dilation in the absence of reaction to light is a terrible symptom of respiratory arrest.