Anesthesia

Pain - elimination of subjective sensations of pain.
Anesthesia is divided into common, which is achieved by pharmacological effects on the cerebral cortex and subcortical structures of the brain and in which the consciousness of the patient necessarily turned off (see Anesthesia), and local, with which the consciousness of the patient is saved (see Anesthesia, surgery).
Pain relief can be achieved by direction the field of pain solutions of anesthetics. An example is a local anaesthetic by A. C. Vishnevskaya. Fractures or dislocations of bones of the limbs good effect has the introduction of novocaine directly in a hematoma. For this purpose, using 0.5 or 1% solution novokaina in the amount of 20 to 40 ml In the localization of the pain center on the limb pain relief is obtained by applying regional blockages or casing procaine blockade by A. C. Vishnevskaya. If the pain impulse comes from the abdomen or pelvis, is shown holding perirenal procaine blockade by A. C. Vishnevskaya. Besides purely analgesic, novocaine blockade by A. C. Vishnevskaya has a therapeutic effect, since it has a beneficial effect on the trophic of tissues in anestezirutmi region. The disadvantage of anesthesia novocaine is its relative short duration (20-40 minutes). If you need more long-lasting effects, it is advisable or the use of repository drugs, for example polyvinylpyrrolidone, or wiring the spirit-procaine blockade (see Alcoholism). In the last resort is sometimes necessary to perform surgical crossing (strictly medical procedure) of the respective nerve, removal of the cyst, for example gussarova site, or even the crossroads of conducting the pain inside the spinal cord.
For pain relief widespread use of analgesics group of opium (morphine, of pantopon, promedol, Phenoperidine). Opiates can eliminate the pain of any location and any origin; better relieve chronic pain goofy character, significantly weaken acute pain. The action of opiates in therapeutic doses is 2-4 hours. However, the drugs group opium depress respiration (particularly in combination with barbiturates), reduce blood pressure, urejaut pulse. So use these drugs for pain relief should only at good rates of respiration and circulation. The exception is traumatic shock, where pain relief is a necessary component of treatment even when low blood pressure. Analgesic drugs is prohibited to use if the diagnosis of the disease is not delivered, and the treatment plan is questionable. This is especially dangerous syndrome of acute abdomen (see), with suspected acute appendicitis (see), obstruction of the intestines.), because, despite the apparent improvement of the patient and reducing pain, inflammation in the abdomen continues and can lead to peritonitis.
The nurses do not have the right to apply opiates with complaints of pain in the abdomen to the examination of a patient by a doctor. Because of the danger of drug abuse (see), these drugs can appoint for a long time. Salicylic acid derivatives and pyrazolone (acetylsalicylic acid, sodium salicylate, amidopyrine, analgin, phenylbutazone) does not relieve acute pain, but good on the chronic, dull, aching pain, such as scoliosis, chronic arthritis, pulpit , etc. can be applied continuously and systematically; however, long-term use of these drugs act as anticoagulants, reducing the level protrombina.
The most rapid and pronounced analgesic action has analgin. Amidopyrine slightly inferior to him, but acts more long-term because of its low solubility. Therefore, the combination amidopirina and dipyrone allows to achieve fast enough and long enough analgesic actions. Drugs in this group can be combined with any sedatives, in particular with barbiturates.
Now for pain uses a combination of powerful analgesics with neuroleptics, i.e., substances that cause indifference of the patient to the surrounding world. This method is called neyroleptanalgezii. As neuroleptic use of the drug by dehydrobenzperidol and its analogues, and as an anesthetic substance fentanyl - very strong analgesic exceeding potency morphine. Neuroleptanalgesia makes patient's immune to pain, provides him with the state of mental calm, allows to provide stable hemodynamics. It is necessary to consider that the action of fentanyl short-term (20 - 30 minutes), and fentanyl can cause reduction of blood pressure, bradycardia and respiratory depression. Especially dangerous is the use of fentanyl in patients with bronchial asthma and emphysema of the lungs.
In order to reduce bronchospastic action of fentanyl, it is good to combine with antispasmodic drugs type of aminophylline.

  • Epidural anesthesia