Intravenous anesthesia

The advantages of intravenous general anesthesia are quick introduction to anesthesia, lack of arousal, pleasant falling asleep for the patient. However, narcotic drugs for intravenous administration create short-term anesthesia, which makes it impossible to use them in their pure form for long-term surgical interventions.

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Derivatives of barbituric acid - sodium thiopental and hexobarbital, cause rapid onset of narcotic sleep. There is no arousal stage, quick awakening. The clinical picture of anesthesia with sodium thiopental and hexobarbital is identical. Hexobarbital causes less respiratory depression.

Freshly prepared barbiturate solutions are used. To do this, the contents of the vial (1 g of the drug) are dissolved in 100 ml of isotonic sodium chloride solution (1% solution) before the onset of anesthesia. The vein is punctured and the solution is slowly injected at a rate of 1 ml for 10-15 seconds. After the injection of 3-5 ml of the solution for 30 s, the patient's sensitivity to barbiturates is determined, then the administration of the drug is continued until the surgical stage of anesthesia. The duration of anesthesia is 10-15 minutes from the onset of narcotic sleep after a single injection of the drug. To increase the duration of anesthesia, fractional administration of 100-200 mg of the drug is used. Its total dose should not exceed 1000 mg. During this time, the nurse monitors the pulse, blood pressure and respiration. The anesthesiologist monitors the condition of the pupils to determine the level of anesthesia,

For barbiturates, especially sodium thiopental, respiratory depression is characteristic, and therefore, when using it for anesthesia, a breathing apparatus is required. When apnea appears, it is necessary to start ventilation with the help of a breathing apparatus mask. The rapid introduction of sodium thiopental can lead to a decrease in blood pressure, depression of cardiac activity. In this case, it is necessary to stop the administration of the drug. Thiopental sodium is contraindicated in acute liver failure. In surgical practice, anesthesia with barbiturates is used for short-term operations lasting 10-20 minutes (opening of abscesses, phlegmon, repositioning of dislocations, reposition of bone fragments). Barbiturates are also used for induction of anesthesia.

Sodium hydroxydione succinate is used at a dose of 15 mg / kg, the total dose is on average 1000 mg. The drug is often used in small doses together with dinitrogen oxide. At high doses, arterial hypotension may develop. In order to prevent complications such as phlebitis and thrombophlebitis, the drug is recommended to be injected slowly into the central vein in the form of a 2.5% solution. Sodium hydroxydione succinate is used for induction of anesthesia, as well as for endoscopic studies.

Sodium oxybutyrate is administered intravenously very slowly. Average dose is 100-150 mg / kg. The drug creates surface anesthesia, so it is often used in combination with other drugs, such as barbiturates. Most often used for induction of anesthesia.

Ketamine can be used for intravenous and intramuscular administration. The estimated dose of the drug is 2-5 mg / kg. Ketamine can be used for mononarcosis and induction anesthesia. The drug causes superficial sleep, stimulates the activity of the cardiovascular system (blood pressure rises, pulse quickens). Ketamine is contraindicated in hypertension. It is widely used for shock in patients with arterial hypotension. Side effects of ketamine are unpleasant hallucinations at the end of anesthesia and upon awakening.

Propofol is a short-acting intravenous anesthetic. Available in ampoules of 20 ml of 1% solution. It is a water-isotonic milky-white emulsion containing propofol (10 mg in 1 ml) and a solvent (glycerin, purified egg phosphatide, sodium hydroxide, soybean oil and water). Calls out

rapid (after 20-30 s) onset of narcotic sleep when administered intravenously into

dose 2.5-3 mg / kg. The duration of anesthesia after a single injection is 5-7 minutes. Sometimes there is a short-term apnea - up to 20 s, in connection with which mechanical ventilation is necessary using an anesthesia machine or a bag of the "Ambu" type. In rare cases, allergies and bradycardia may occur. The drug is used for induction anesthesia, as well as for anesthesia during minor surgical operations (opening of phlegmons, abscesses, reduction of dislocations, reposition of bone fragments, laparostomy sanitation of the abdominal cavity, etc.).