The methodical pointing for work of students on practical employment

Semantic module 3.

A general anesthesiology and intensive therapy

Practical employment # 12

Theme: inhalation anesthesia. Uninhalation anesthesia

Theoretical questions are for a study and discussion:

1. Determination of concept, terminology, classification and types of the general anaesthetizing.

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

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

4. Method of leadthrough of mask narcosis, its clinical stages, and also methods of leadthrough intratracheal, intravenous, intramascular narcoses.

5. Vehicles and instruments for anesthesia, instruments for intubation of trachea and method of implementation of it.

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

7. Method of introduction of air-duct(=III).

8. Method of sanitation of overhead respiratory tracts by electro-exhaust.

Literature:

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

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

6. Methodological Instruction.

Distributing of marks which are appropriated students:

At mastering of theme 12 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

Inhalation anesthesia. Uninhalation anesthesia

1.Indirect actions of Phentanyl:

1. oppression of breathing

2. oppression of cough reflex

3. acute kidney insufficiency

4. acute hepatic insufficiency

5. hemorrhage in a brain

2. What are the stage of ether anesthesia:

1. analgesias

2. overdose

3. braking

4. excitation

5. renewal

3.To inhalation anesthetics belong:

1. Protoxide nitrogen

2. Hexenal

3. Ftorotan

4. Tyopental sodium

5. Ketamine

4.To uninhalation anesthetics belong:

1. Protoxide nitrogen

2. Ftorotan

3. Ether

4. Tyopental sodium

5. Ketamine

5.The purpose of premedication is:

1. diminishing of analgetic action of anesthetic

2. diminishing of metabolism, to reduce a requirement in oxygen

3. providing of сantianxiety effect

4. increase of salivation

5. iminishing of protective action of analgesia

6.For introductory anesthesia use :

1. Tyopental sodium

2. Protoxide nitrogen

3. Ftorotan

4. Ether

5. Oxybutirate sodium

7. For premedication the followings drugs are used:

1. Tyopental sodium

2. Atropine sulfate

3. Oxybutirate sodium

4. Droperidole

5. Ftorotan

6. Ketamine

8.For premedication the followings drugs are used:

1. Aminazine

2. Phenobarbital

3. anti-inflammatory drugs

4. Phentanyl

5. Ketamine

6. Tyopental sodium

9.Uninhalation anesthetics can be entered:

1. hypodermic

2. endermic

3. intratracheal

4. nasotracheal

5. intravenously

6. intramuscular

10. Inhalation anesthetics can be entered:

1. nasotracheal

2. hypodermic

3. intravenously

4. intramuscular

5. endermic

6. intratracheal

1.Patient N., 46 years, it is operated concerning peritonitis. It is discovered during Ftorotan anesthesia, that pupils are narrow, a photoharmose is weak, failure of corneal and pharyngeal reflexes, an arteriotony, bradycardia. What stage of anesthesia has a patient?

2.Patient O., 65 years old, hospitalized concerning the perforation of ulcer of 12-falling bowel. In a patient also found out hypertensive illness. What type of anesthesia will you give advantage?

3.Sick M. 45 years old, delivered to the reception department with complaints about a general weakness, dizziness, nausea and vomit by "coffee-grounds". At an inspection: skin covers are pale. Pulse 110 in 1 min., threadlike. AP 80/40. The acute gastroenteric bleeding is diagnosed. Conservative therapy did not give during a 4 o'clock of effect. On a nasogastric probe "coffee-grounds", blood clots, continued to flow out. A urgent operation is rotined.

What types of anaesthetizing is it better to apply during an operation for this patient?

4.During the leadthrough of operative interference (opening of постін'єкційного abscess) under масочним anesthesia for a patient motive activity appeared in extremities.

What stage of anesthesia did come for a patient?

5.Sick K., 67 years, entered clinic on a first-aid concerning acute impassability of bowels. He is ill diabetes.

Choose the method of anaesthetizing, diagrammatize anaesthetic providing.

6. To surgical separation sick P. entered, 47 years, with a diagnosis there is a carbuncle of the back of head. The state is heavy. Temperature of body is 38,8°. It is ill 5 days.

What anaesthetizing is it necessary to expose for operation?

7.Operation concerning acute appendicitis decided to conduct under vehicle mask anesthesia. What respiratory contour will apply: reversible or unreversible? Why? Transfer failings and advantages each of them.

8.Sick K., 51 year, entered permanent establishment with the signs of dislocation of the left shoulder. What method of anaesthetizing is it expedient to apply in this case?

ANSWERS

Tests:

1 – a,b;

2 – a,d;

3 – a,c;

4 – d,e;

5 – b,c;

6 –a,e;

7 – b,d;

8 – a,b;

9 – e, f;

10 – a,f;

Tasks:

1.Answer: patient has III₃ stage of anesthesia.

2.Answer: a patient had complication of ulcerous illness (perforation of ulcer), urgent operative interference is rotined him. An operation will be conducted in an abdominal region, that is why for its successful implementation intubation anesthesia is needed. Taking into account hypertensive illness, optimum will be implementation of intratracheal anesthesia.

3.Answer: the general anaesthetizing..

4.Answer: the stage of excitation came for a patient.

5.Answer: as for a patient acute surgical disease of organs of abdominal region, namely intestinal impassability, operative interference is rotined him for to the vital shows. As an operation will be conducted in an abdominal region, the method of anaesthetizing will be intubation anesthesia. Taking into account a present for a patient concomitant disease (diabetes), in a preoperative period it is needed it will be to conduct the correction of sugar of blood.

6.Answer: for the leadthrough of adequate necretomy an operation needs to be conducted under a phlebonarcosis. An infiltration local anesthesia will be uneffective from localization, distribution of process; intubation anesthesia needs more difficult vehicle providing, more long leadthrough of operative interference will last, that he is inadvisable.

7.Answer: most expedient is a leadthrough of operative interference under a half-closed respiratory contour, so however much he unlike closed does not cause a hypercapnia in the organism of patient and unlike opened and half-open does not cause the high concentration of anesthesia preparations midair operating-room.

8.Answer: an embole occupies the small interval of time. For the successful leadthrough of manipulation weakening of muscles of humeral belt is needed. Coming from the transferred terms, most expedient in this case there will be a phlebonarcosis.