Anesthesia

Narcosis is artificially caused by Central nervous system depression, characterized by temporary loss of consciousness, pain sensitivity and some of reflexes. Narcosis is the responsibility of a specially trained physician-anesthesiologist or, in his absence, any other doctor. Representatives of the nurses have no right to give anesthesia alone, however, they may give pain relief under the guidance of a doctor (usually the operating surgeon). In this case, a nurse or medical assistant performs all necessary for anaesthesia manipulation, informing the doctor about the condition of the patient, and conducts anesthesia. Currently, there are more than ten major drugs (see). Gas (nitrous oxide, cyclopropane) or volatile drugs in the form of vapour (ether, Trilon, halothane, chloroform , and other) are served in the light of the patient (the so-called inhalation narcosis). Any other route of administration anesthesia called neingaltine (intravenous, intramuscular, intra-abdominal, pryamokishechnye and so on). Currently, the most widely anaesthesia provided concomitant introduction of several pharmacological agents (combined anaesthesia). Among them the greatest is the role of muscle relaxants (see), allowing surface anaesthesia. However, their use requires mandatory intubation of the trachea, lung ventilation and only a qualified anesthesiologist.
Even short-term anesthesia always be approached as the procedure is fraught with dangerous for the life of the patient complications. Basics of safe anesthesia: the ability to determine the stage of narcosis and to maintain it is not deeper than the level required to perform this operation; the preservation of patency of the pneumatic ways; careful monitoring of patients.
Indications and contraindications for narcosis - see Narcotic drugs.
under anaesthesia Under anaesthesia (Fig). I stage (analgesia, addiction) from the moment of submission drugs before loss of consciousness. The characteristic feature of this stage is the loss of orientation and pain sensitivity. Breathing, heart rate, blood pressure little change, reflexes active. In this stage of anaesthesia only very short and non-traumatic operations (opening abscesses, stitches on the skin).
II stage (excitation) is characterized by motor and speech disturbance, passing sometimes in a riot with convulsions, singing, shouting, and so on, the Patient can jump up from the table, rip the mask. Activity reflexes and muscle tone improves, pupils dilated and well react to light, breathing unevenly. In this stage cannot operate.
III stage (surgical) begins with the date of termination of excitation and establish a rhythmic breathing without visible symptoms. This stage is divided into three levels (stages). For the first level III stage (indicated III1) is characterized by a narrowing of a pupil to its normal size when saved reaction to light, watery discharge, slow motion ("floating") eyeballs or reject them from a Central location. Corneal reflex saved, muscle limbs relaxed. In the stage III1 valid operations on the extremities, plastic surgery , etc. At the second level III stage III2) the pupil is reduced, eyeballs are fixed in a Central position (the patient looks straight ahead), reduces the Department of tears, gradually disappears corneal reflex. Breathing deepened and accelerated begins to dominate the abdominal breathing. The abdominal wall muscles are relaxed. Stage Appears optimal level of anesthesia, which can be done most of the operations. With the deepening of anesthesia to the third level (III3) breathing becomes shallow, the pupil starts to expand and ceases to respond to light, eyelids slightly open, corneal reflex is not called. Prevails abdominal breathing, low blood pressure, increases the heart rate, reduced its content. This stage is valid only for a short time. Further deepening of narcosis (III4 and stage IV - agonal) is an error and should be treated as a complication (see below). In these cases, the required resuscitation - see the Revival of the body.
The maintenance of gas exchange in the lungs. During anaesthesia necessary to watch, that in the mixture of asbestos contained less than 20% of oxygen, was not severe inhibition of ventilation and abnormalities of the airway caused zapadenia language, accumulation of mucus in the mouth or throat, aspiration of vomitus. Calm quiet breathing is a sufficient guarantee of patency of pneumatic ways.

  • Monitor patients during anaesthesia
  • Preparation for anaesthesia
  • Narcosis
  • Poslenarkoznogo period and complications
  • Features of anesthesia in children