The methodical pointing for work of students on practical employment

Semantic module 3.

A general anesthesiology and intensive therapy

Practical employment # 11

Theme: local anesthesia.

Theoretical questions are for a study and discussion:

1. Value of local anesthesia during surgiacal operations and bandaging of patients.

2. Sensations and the state of the patient during conduction of local anesthesia.

3. Differentiate local from general anesthesia.

4. Types of local anesthesia.

5. Medicines (drugs) which are used for local anesthesia.

6. Indications and contraindications for local anesthesia, and also advantages over other methods of anaesthetizing.

7. Technique of conduction of infiltration anesthesia.

8. Method of conducting of exploratory anesthesia by Oberst-Lukashevich.

Literature:

1.Butursky A. “General surgery”. (Simferopol 2004)

2.S. I. Shevchenko; A. A. Tolkoglas and etc. “Surgery” (Kharkov 2004)

3.Methodological Instruction.

Distributing of marks which are appropriated students:

At mastering of theme 11 from rich in content the module # 3 for educational activity an estimation is proposed a student for traditional scale which converted to points as follows:

Estimation	Points
“5”(fine)	6 points
“4” (well)	4 points
“3”(satisfactorily)	2 points
“2” (unsatisfactorily)	0 points

local anesthesia.

1. In which diseases is local anesthesia used according to Lukashevich-Oberst method?

1. nephritis

2. ingrown toe-nail

3. paraproktitis

4. pancreonecrosis

5. panaris

6. asphyxia

2. What solutions can be used for local anesthesia?

1. Furagine

2. Dikaine

3. Ftorotan

4. Gemodez

5. Novocain

6. Poliglyukin

3. How does pain influence basic exchange

1. the selection of adrenalin is multiplied

2. the selection in the blood of thyroxin diminishes

3. the selection of histamine diminishes

4. the selection of serotonin diminishes

5. the selection prostaglandin is multiplied

6. the selection of quinine diminishes

4. What solution of Novocain is used in intraosteal anesthesia?

1. 0,5 %

2. 2%

3. 3%

4. 1%

5. 0,25%

6. 5%

5. Indications for retro-mammary gland anesthesia?

1. phlegmonic phase of mastitis

2. infiltration phase of mastitis

3. gangrenous phase of mastitis

4. behind mammary gland abscess

5. serous phase of mastitis

6. underareolaris abscess

6. What is Vishnevsky blockade used for?

1. for the prophylaxis of reflex asphyxia

2. for the removal of paresis of intestine

3. for the medical treatment pleuro-pulmonary shock

4. for the prophylaxis of tetanilla of ventricles of heart

5. for the prophylaxis plevro pleuropulmonary shock

6. for abatement of musculature and prophylaxis of paraplegia

7. How soon does anesthesia appear after a peridural anesthesia?

a. 5 minutes

b. 10 minutes

c. 15 minutes

d. 20 minutes

e. 25 minutes

f. 30 minutes

8. In which type of local anesthesia is it necessary to initially use a tourniquet?

1. anesthesia by cooling

2. intravascular anesthesia

3. peridural anesthesia

4. intraosteal anesthesia

5. combined anesthesia

6. spinal anesthesia

9. To reposition a break of the lower third of the radial bone, what anesthesia is used?

1. infiltration anesthesia

2. case blockade

3. anesthesia by greasing

4. introduction of a 2% Novocaine to the haematoma in the place of fracture

5. peridural anesthesia

6. blockade by Kulen-Kampf

10. What complication(s) can be meet with the use of paranephron Novocain blockade?

1. necrosis of fabrics

2. allergic reaction

3. injury of kidney

4. vomiting

5. overdose

6. injury of ureter

11. Signs of poisoning of local anesthetics.

1. dyspnea

2. violation of cerebral circulation of blood

3. bradicardia

4. anurea

5. dilation of pupils

6. dizziness

12. Which of the following methods of local anesthesia are exploratory?

1. anesthesia by cooling

2. anesthesia by smearing (topical)

3. peridural anesthesia

4. intra-arterial anesthesia

5. spinal anesthesia

6. intraosteal anesthesia

13. What complication(s) can arise with the use of Novocain?

1. over dose

2. anaphylactic shock

3. accidental introduction into the artery

4. nettle-rash

5. accidental introduction into the vein

6. chemical irritation of tissue-necrosis

14. What solutions of Novocain can be used for a paranephral blockade?

1. 1%

2. 5%

3. 10%

4. 2%

5. 0,25%

6. 0,5%

15. What medications are used in case of poisoning by anesthetic drugs?

1. Antibiotics

2. cordials

3. protease enzymes

4. dimedrol

5. Anticoagulants

6. muscular relaxation drugs

1. Patient L., 37 years, works in a mine, entered in the clinic with an inguinal scrotal hernia. For three years he has been ill. During the last three months the hernia was twice compressed however the restriction quickly has passed. Operative medical treatment is shown. It is definite, that expediently to execute the operation under the local anaesthetizing. Hallmarked on a sensitiveness to Novocain, the result of which is considered as sharply positive. Whether possible implementation of interference under the local anaesthetizing?

2. A patient 35 years, seamstress, entered clinic concerning chronic paraproctittis. At the inspection other diseases are not exposed. The executed spinal-cerebral anesthesia at the level of L lV-V 1% by solution of Sovkain. What anatomic educations are passed by a needle in the area of spine, between the L IV-V vertebrae, to be before included in a spinal-cerebral channel? Why is it impossible to conduct spinal-cerebral anesthesia at a level higher than the D-XII vertebra?

3. Patient acted with complaints on pain in the area of the left subaxillary cavity, general weakness, indisposition, rise of temperature of body to 38 degrees. Considers itself a patient about 24 hours, when pain in the area of the left subaxillary cavity appeared . At examination in this area - inflamated tissues are determined by sizes 3х2 sm. Hyperemia of skin are present, fluctuation. What testimonies to operative interference? What type of local anesthesia will you offer?

4. Patient T., entered proctologic department with complaints about pain in the area of anus, which increases during the act of defecation, festering excretions near a rectum, general weakness. At outward examination: in 2 sm from an anal edge, on 9 hours the outward opening of fistula is determined, by a diameter to 0,2 mm. Palpation of it is sickly. Diagnosis is back rectal fistula. Surgical medical treatment is shown - deleting of fistula on the first method of Gabrial. What type of local anesthesia must be applied?

5. A patient entered surgical to the department with a diagnosis: abscess of postoperative scar of front abdominal wall, the state after taking of ileostome in. At examination in the right half of stomach, in the area of postoperative scar, dense moderately sickly infiltrate is determined 10х15 sm with softening influence in a center. Under local infiltration anesthesia, opening of abscess is done. During conducting of anesthesia by a mistake a 10% solution of Lidokain was used, as a result at a patient there had the symptoms of the acute poisoning. What will be clinical picture of display of poisoning by the anaesthetic matter?

6. Patient with L., entered clinic with complaints on pain in the area of anus, selection of bright red blood from a rectum during the act of defecation. At finger research of rectum megascopic internal haemorrhoidal knots are determined. On 6 o'clock of conditional clock-face - chronic crack of anal channel with hard edges, long to 1 sm. In the planned order a patient is operated. For anaesthetizing epidural-sacral anesthesia is used. In 15 minutes, after the beginning of operation, a patient suddenly lost consciousness, there were cramps. What it is necessary to take measures for the fight against complication which arose up?

7. In patient N., on the third days after appendectomy, the displays of intestinal impassability appeared. For differential diagnostics there is the shown pararenal Novocain blockade. Where to execute punction, how to enter anestethic?

8. At patient N., 28 years, with the hypodermic panariciy of middle phalanx of the ІІ finger of right brush the temperature of body to 38 degree. Patient feels pulsating pain, edema of finger. What your tactic? Choose the type of anaesthetizing.

9. Patient T., 74 years, entered clinic on the first-aid concerning the hurt right-side inguinal hernia. It is ill concomitant illnesses: by bronchial asthma, diabetes. What your actions? What type of anaesthetizing will you use and why? What concentration of solution of Novocain will you apply in this case?

10. After successful implementation of operation of apendectomy concerning acute appendicitis (under infiltration anesthesia) at a patient the hyperemia, dermatitis, appeared in 3 hours, edema of fabrics in the area of operative interference, signs of cardiovascular collapse (pallor, sticky death-damp, drop in the temperature of extremities, acute decline of arterial pressure). About development, what complication it is possible to think? Appoint medical treatment.

ANSWERS

Tests:

1 – b, e;

2 – b, e;

3 – a, e;

4 – a, e;

5 – b, e;

6 –c, e;

7 – e, f;

8 – b, d;

9 – d, f;

10 – c, f;

11 – a, f;

12 – c, e;

13 – b, d;

14 – e, f;

15 – b, d;

Tasks:

1. Answer: Implementation of operation it is possible under the local anaesthetizing, as an allergic reaction of organism behaves to Novocain only. Consequently, it is necessary to find drug, which the allergic displays of organism of patient will not be present to .

2. Answer: In the process of implementation of spinal-cerebral anesthesia a punction needle passes through a skin, hypodermic cellulose, megostistie copulas, yellow copula, hard brain-tunic. Spinal-cerebral anesthesia higher the XII pectoral vertebra is not conducted, as a diaphragm and proper intercostal muscles is turned off from breathing. The stop of breathing can come.

3. Answer: at a patient absolute testimonies to operative medical treatment – acute purulent surgical disease (abscess). The shown infiltration anesthesia by Vishnevskiy.

4. Answer: spinal anesthesia.

5. Answer: Dizziness, nausea, weakness, death-damp, frequent pulse of the weak filling, decline of arterial pressure.

6. Answer: It is necessary to enter cardiac facilities, glucose, poliglyukin. For the removal of cramps in a rectum barbiturates is entered. Necessary inhalation by oxygen.

7. Answer: Punction at the level of bisector of corner between long muscles and costal arc, conducting of needle without a blood and liquid to feeling of failure.

8. Answer: at a patient there is the acutepurulent disease of finger – panariciy. Coming from that the state of patient became worse, it follows to consider that at a patient the stage of abscess of this disease. To the patient the shown urgent operative interference – opening and drinage of abscess. The operation needs to be conducted under anesthesia by Oberst-Lukashevich.

9. Answer: the hurt inguinal hernia is a testimony to the exigent surgical operation. As a patient declining years, with the present heavy concomitant diseases, common anaesthetizing to him contra-indicated. By the method of anaesthetizing it is needed to choose local anesthesia, namely – peridural.

10. Answer: the symptoms of poisoning to local anestethic developed at a patient. For getting a patient out of this state we appoint antihistaminic, cardiac, anaesthetic preparations.