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Methodical pointing to work of students on practical employment

Semantic module 3.

The general anesteziologiya is that reanimation

Practical employment № 12

Theme: inhalation anesthesia. No the inhalation anesthesia

Theoretical questions for the pozaaouditornogo independent study and discussion to practical employment № 12:

1. Determination of notion, terminology, classification and types of the common anaesthetizing.

2. Theories of anesthesia, preparation of patients to anesthesia, chart of premedicatsii.

3. Mechanism of action of narcotic preparations and muscular relacsantiv .

4. Method of conducting of mascovogo anesthesia, his clinical stages, and also methods of conducting of endotrahealnogo, intravenoznogo, vnoutrishnom’yazevogo narcopharynx.

5. Vehicles and instruments for anesthesia, instruments for intoubatsii of trachea and method of implementation of her.

6. Complication of anesthesia, care of patients under time and after anesthesia.

7. Method of introduction of rotoglotcovogo povitrospryama.

8. Method of sanatsii of overhead respiratory tracts by means эlectrovidsmoctouvacha.

Literature:

Basic:

1. Cherenco M.P., Vavric G.M. General surgery. – Kiev: "Health", 1999.

2. Gouchenno S.P., Geliba M.D., Himich S D. Zagalna surgery. – Kiev: "Health", 1999

3. Gostishev V.C. Obshaya hirourgiya. – Moscow: "Medicine", 1993.

4. Petrov V.S. Obshaya hirourgiya. - S. Petersburg, 1999.

Additional:

  1. Chepciy L.A., Galco-Titarenco V.F. Anesteziologiya and reanimatologiya. – Kiev: "High school", 1983.

Distributing of marks, that are appropriated to the students:

At mastering of theme № 12 from rich in content to the module № 4 for educational activity to the student the estimation for 4th is proposed by a mark (traditional) scale which are after converted in marks as follows:

Estimation

Marks

“5”(fine)

6 marks

“4” (well)

4 marks

“3”(satisfactorily)

2 marks

“2” (unsatisfactorily)

0 marks

Tests and tasks for verification of initial level of knowledges

1 Indirect actions of fentanilou:

a 1 oppression of breathing

2 oppressions of cashlovogo reflex

a 3 sharp kidney insufficiency

a 4 sharp hepatic insufficiency

a 5 hemorrhage in a brain

2 Which are to the stage of ether anesthesia:

1 analgezii

2 peredozouvannya

a 3 braking

4 excitations

a 5 renewal

3 To inhalations anesteticiv belong:

a 1 nitrous oxide

2 gecsenal

3 ftorotan

a 4 tiopental sodium

5 cetamin

4 To no the inhalations anesteticiv belong:

a 1 nitrous oxide

2 ftorotan

a 3 ether

a 4 tiopental sodium

5 cetamin

a 5 Purpose of premedicatsii is:

a 1 reduction of analgetichnoi action of anestetica

2 reductions of metabolism, that to lower a necessity in oxygen

a 3 providing of sedativnogo effect

4 increases of salivatsii

a 5 reduction of protective action of analgezii

6 For intoubatsii of trachea use:

1 bronhoscop

2 stetoscop

a 3 laryngoscope

a 4 intoubatsiynou tube

a 5 inhalation mask

7 For introductory anesthesia use :

a 1 tiopental sodium

a 2 nitrous oxide

3 ftorotan

a 4 ether

a 5 sodium of ocsiboutirat

a 8 Destroying from anesthesia consists in stopping of serve of anestetica to ending of operation after :

1 3 minutes

2 10 minutes

3 15 minutes

4 20 minutes

5 30 minutes

9 it is needed to apply Before intoubatsieyo:

a 1 giperventilyatsiyo by a mask

2 analgetici

3 sedativni preparations

4 protizapalni preparations

5 antibacterialni preparations

6 miorelacsanti

10 For premedicatsii the following preparations are used:

a 1 tiopental sodium

a 2 atropine the sulfate

a 3 sodium of ocsiboutirat

4 droperidol

5 ftorotan

6 cetamin

11 For premedicatsii the following preparations are used:

1 aminazin

a 2 phenobarbital

3 protizapalni preparations

4 fentanil

5 cetamin

a 6 tiopental sodium

a 12 Purpose of premedicatsii is:

a 1 increase of metabolism, that to lower a necessity in oxygen

2 removals of sedativnogo effect

3 increases of analgetichnoi action of anestetica

4 reductions of salivatsii

a 5 reduction of protective action of analgezii

a 13 Contra-indication for conducting of cetaminovogo anesthesia is:

1 gipertenziya

a 2 shock

a 3 bleeding

a 4 eclampsia

a 5 introductory anesthesia

a 6 anaesthetizing of births

no a 14 Inhalation anestetici it is possible to enter:

1 hypodermic

2 vnoutrishnoshcirno

3 endotrahealno

4 nazotrahealno

5 intravenously

6 vnoutrishnom yazevo

a 15 Inhalation anestetici it is possible to enter:

1 nazotrahealno

2 hypodermic

3 intravenously

4 vnoutrishnom yazevo

5 vnoutrishnoshcirno

6 endotrahealno

Situation tasks

a 1 Patient 58 years, operated concerning the cancer of blind gut – executed pravobichna gemicolectomiya. Concomitant illness – stenosis to the mitralnogo valve. After awakening there was the frequent breathing from ouchastyo auxiliary muscles, cyanosys developed. From a trachea began to be selected rose suds. What complication arose up? What exigent measures need to be conducted?

2 Sick S., 46 years, it is operated concerning peritonitis. It is exposed during ftorotanovogo anesthesia, that pupils are narrow, the reaction on light is weak, absent rogivcoviy and glotochniy reflexes, arterial pressure, bradicardiya, went down. What stage of anesthesia at a patient?

.

3 Sick T., 65 years, hospitalized concerning the perforation of ulcer of 12-falling bowel. At a patient hypertensive illness is also exposed. To what type of anesthesia you will you give advantage?

4 To the induction centre a patient, 38 years, is delivered, with complaints about intensive pain on all stomach, general weakness, that increases at inhalation. At a review: the state of middle weight. Skin pocrovi are pale. Temperature of body 36,9°S. Breathing superficial with frequency 16 in a 1 minute. Pulse 102 oud. in a 1 minute, rhythmic, weak filling. AT 110/70 mm of rt item A stomach is symmetric, in the act of breathing of participation does not take. At palpatsii is tense in all departments, on the type of "doshcopodibnogo", sharply sickly. Positive symptoms of irritation of peritoneum. Hepatic dullness is absent. A patient has the suspected perforativna gastric ulcer or 12-falling bowel. What method of anaesthetizing you will you offer?

a 5 Patient 45 years, delivered to the induction centre with complaints about a general weakness, dizziness, nausea and vomit by "coffee-grounds". At the inspection: skin covers are pale. Pulse 110 in 1 hv., threadlike. AT 80/40 mm of rt item General blood test: NV - 80 g/l, eras.- 2,8h1012/l, Nt – 25%. The diagnosed sharp shlouncovo-cishcova bleeding. Conservative therapy during 4 o'clock of effect did not give. On a nazogastralnomou probe continued to flow out "coffee-grounds", blood clots. The shown ecstrenna operation.

Which from the types of anaesthetizing it is better to apply during the operation at the given patient?

6 Sick L., 65 years, acted with complaints about peremignou lameness, senses of cold and parestezii in feet, pain in the first finger of right foot, rise of temperature of body to 38,3°. Considers itself a patient during 5 years, when pains in litcovih muscles at walking appeared. In connection with worsening of the state appealed on the reception hospitalized. Suffers by hypertensive illness by atherosclerotic coronaro-cardiosclerozom, blinking arrhythmia, N2a. At a review: the common state of middle weight. The lowered feed. Skin pocrovi are pale, acrotsianoz. Breathing is loosened vezicoulyarne - single dry wheezes. Pulse 86 on 1 hv, unrhythmical. AT 140/90 mm of rt item A stomach takes part in breathing, symmetric. At palpatsii soft, painless on all departments. Locally: the first finger of right foot of black. A foot was swollen, hyperemia of skin, local gipertermiya. A pulsation on femoral arteries is lowered, on popliteal - is weakened, on the arteries of feet is not determined. Muscles of lower extremities of gipotrofichni, skin pocrovi are pale, the tourgor lowered, hair cover zbidneniy sharply, nail plates are turbid, thickened. The conducted conservative therapy of effect did not give - the phenomena of intoxication grew, the phlegmon of foot and lower third of shin developed. Vital testimonies are produced to amputation of right lower extremity at the level of middle third of thigh.

Which from the types of anesthesia it is better to apply?

7 During conducting of operative interference (opening of postin'ectsiynogo abscess) under masochnim anesthesia motive activity in extremities appeared at a patient.

What stage of anesthesia came at a patient?

8 From an operating-room in the chamber of intensive therapy translated sick Sh., 62 years, that carried under the combined anesthesia of gastrectomiyo, drenouvannya of abdominal region. In 15 minutes the independent breathing was halted, cardiac activity is well-kept. By a doctor-anaesthetist the lower jaw shown out, through a mouth entered povitrovid - the independent breathing is absent. After conducting of artificial respiration mouth the independent breathing recommenced to the mouth. Which from complications developed at the given patient?

9 Sick C., 67 years, entered clinic on the first-aid concerning sharp impassability of bowels. It is ill on saccharine diabetes.

Choose the ob–rountouyte method of anaesthetizing, make the chart of the anaesthetic providing.

10 sick P., 47 years acted In the surgical separation, with a diagnosis the carbuncle of the back of head. The state heavy. Temperature of body 38,8°. 5 Days are ill.

What anaesthetizing it is necessary to expose gnoyac under? The Ob–rountouyte choice of method of anaesthetizing.

concerning sharp appendicitis it was decided to conduct a 11 Operation under vehicle mascovim anesthesia. What respiratory contour you will apply: reversible or unreversible? Why? Transfer failing and advantages of each of them.

12 Sick C., a 51 year, entered permanent establishment with the signs of dislocation of the left shoulder. What method of anaesthetizing expediently to apply in this case?

13 In the surgical separation it is delivered the victim F., 40 years, which got the vognepalne wound of thorax. What method of anaesthetizing you will you apply for conducting of operative interference?

14 Sick C., 57 years, conducting of resection of stomach for Bilrot-II is planned. What introductory and base the anesthesia can be applied?

15 Sick S., 34 years, setting of dislocation of thigh is planned. The method of anaesthetizing what, in your opinion, needs to be applied in this case?

answers:

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