Anesthesia 2021.Чепиvdfbvdffgbvк (1).ppt

anesthesia

1. КАФЕДРА ОБЩЕЙ ХИРУРГИИ

2. The doctrine of pain & anaesthesia

3. emotional excitement
pain
neurovegetative and
neuroendocrinal abnormality
hemorrhage
metabolic imbalance
water and electrolyte
imbalance
blood supply disturbance

4. Pain’s neurophysiology
Perceptionnvnnn
Modulation
Transmission
Transduction
Cortex
Thalamocortical
projection
Thalamus
Spinothalamic pathway
Primary afferent receptor
Injuring action

5. History of anaesthetics
In 1275 a volatile,
flammable liquid known as
sweet vitriol was seen to put
chickens to sleep and dull
their sensitivity to pain. This
was to become known as
ether.
Paracelsus

6. In 1799, British
Chemist Humphry
David decided to test
the effects of the gas
on himself. Rather
than killing him the
gas made him laugh.

7. Forty Five years later
a United States
dentist named Horace
Wells attended a
demonstration of
nitrous oxide. Horace
Wells was the first
who applied the
nitrous oxide in
practice.

8. October 16, 1846-- in the Boston
hospital, surgeon John Warren
performed an operation under ether
anesthesia, which was given by
U.Morton

9. General anesthesia
Regional (local)
anesthesia
Combined
anesthesia

10. General anesthesia involves a state of
unconsciousness with analgesia, amnesia,
and immobility.
This goal can be accomplished with
intravenous and inhalational medications or
combination of intravenous and inhalational
medications.

11. Analgesia — loss of response to pain.
Amnesia — loss of memory,
Immobility — loss of motor reflexes.
Loss of consciousness.
Skeletal muscle relaxation.

12. The biochemical mechanism of action of
general anaesthetics is not yet well
understood.
To induce unconsciousness, anaesthetics
affect the GABA and NMDA systems.
For example, halothane is a GABA
(gamma-Aminobutyric acid) agonist, and
ketamine is an NMDA (N-Methyl-D-aspartic
acid) receptor antagonist.

13. 
Stage 1 anesthesia, also known as
the "induction“
 Stage 2 anesthesia, also known as
the "excitement stage“
 Stage 3, "surgical anesthesia".
 Stage 4, also known as "overdose"

14. 
Stage 1 anesthesia, also known as the
"induction“ - is the period between the
initial administration of the induction
agents and loss of consciousness. During
this stage, the patient progresses from
analgesia without amnesia to analgesia
with amnesia. Patients can carry on a
conversation at this time.

15. 
Stage 2 anesthesia, also known as the "excitement stage“ - is the period following loss of consciousness and marked by excited and delirious
activity. During this stage, respirations and heart rate may become irregular. In addition, there may be uncontrolled movements, vomiting, breath
holding, and pupillary dilation. Since the combination of spastic movements, vomiting, and irregular respirations may lead to airway compromise,
rapidly acting drugs are used to minimize time in this stage and reach stage 3 as fast as possible.

16. Stage 3, "surgical anesthesia“
During this stage, the skeletal muscles relax, and the patient's breathing becomes regular.
Eye movements slow, then stop, and surgery can begin.
It has been divided into 4 planes:
eyes initially rolling, then becoming fixed
loss of corneal and laryngeal reflexes
pupils dilate and loss of light reflex
intercostal paralysis, shallow abdominal respiration, dilated pupils

18. 
Stage 4 anesthesia, also known as "overdose“ - is the stage where too much medication has been given relative
to the amount of surgical stimulation and the patient has severe brain stem or medullary depression.
This results in a cessation of respiration and potential cardiovascular collapse.
This stage is lethal without cardiovascular and respiratory support.

19.  terminal (blockade of receptors),
 
 
infiltration (blockade of receptors and small nerves)
 
 
conduction (blockade big nerves and nerve plexus),
 
 
epidural and spinal anesthesia (blockage at the level of the
roots of the spinal cord)
 
 
Intraosseous
 
 
Intravenous regional (not used)

20. ADVANTAGES OF LOCAL ANESTHESIA
 Security
 Does not require the presence of complex equipment
 Cheapness

21. DISADVANTAGES OF LOCAL ANESTHESIA
 Impossibility to achieve complete anesthesia
 Saving consciousness (undesirable in patients with unstable
mentality)
 Inability to manage body functions during surgical interventions
 Absence of relaxation

22. Epidural and spinal anesthesia interrupt
afferent neural impulses by depositing drugs close
to the spinal cord.
Epidural anesthesia is most often accomplished by
epidural space cannulation and subsequent infusion
of local anesthetic agents and/or opioids.
The epidural space is a potential space above the
dura and is identified through a loss of resistance
technique with a large-bore (17- or 18-gauge)
hollow needle.
Epidural space may be cannulated at lumbar,
thoracic, or cervical levels depending on the site of
the surgical procedure.

23. Spinal anesthesia involves the placement of
anesthetic drugs into the subarachnoid space
through puncture of the dura mater with a small-
bore needle (24- to 28-gauge).
Usually this allows the use of smaller (tenfold)
doses of drugs than those used epidurally, a
quicker onset of analgesia, and perhaps a denser
block in the sacral fibers.
Usually spinal anesthesia is given as a one-time
bolus through a needle placed in the
subarachnoid space, but catheters can be passed
into this space for repetitive dosing.

24. Puncture of the cavitas epiduralis and
spatium subdurale

25.  Superior part of abdomen: Th 7-Th 8;
 Lower part of abdomen: Th10-Th11;
 Pelvis L1-L2;
 Lower extremities, perineum L3-L4.
Levels for peridural block

26. Puncture of the peridural space
1. Infiltrational anesthesia of the skin
and soft tissues

27. Puncture of the peridural space
2. аdministration of the anesthetic
into peridural space

28. The major risks of an epidural anesthesia are a
spinal headache from dural puncture with a large
needle, adverse hemodynamic alterations,
bleeding, total spinal anesthesia, intravenous
injection of local anesthetic, and minor back
pain postoperatively.
The major risks of a spinal anesthesia are similar
to those for an epidural anesthesia but may also
include cauda equina syndrome or arrhythmia

29. •
"freezing" with chloroethane
• electroanalgesia of nerves
• electroacupuncture
The types of local anaesthesia,
based on physical factors

30. • Rapid analgesic effect at a minimal of
concentration
• Full anesthesia for the duration of the
operation
• Safety for neural structures
• Non-toxic for organism
• Stability during sterilization
Local anaesthetic requirements

31. There are 2 groups of the local anesthetics
according to the chemical structure
I. esters of amino acids with alkamines
II. amides of xylidine line

32. Esters of amino acids with alkamines
1. Cocaine
2. Novocaine
0,25-0,5%,1-2%,5-10%
solutions
3. Dicain
0,25%,0,3%,0,5%,1%,2 %
solutions

33. Amides of xylidine line
Lidocaine (Kxilocaine, xycain, lignocaine)
0,25%,0,5%,1%,2 %,10 % solutions.
threemecaine (mesocaine)
0,25%,0,5%,1%,2 % solutions
Sovcaine (butylcaine).
0,5%,1% solutions
Bupivacaine
0,5% solution
Ultracaine
1%, 2 % solutions

34. Periods of the local anesthesia
1- period – аdministration of the medicine
2- period –expectancy
3- period –total anesthesia
4- period –recovery of the sensitiveness
operation

35. Infiltrational anesthesia

36. Infiltrational anesthesia for thyroid gland
resection

37. Condaction block by
Lukashevich-Oberst

38. Anesthesia of the humeral plexus by
Culenkampf

39. Condaction block

40. Condaction block

41. • Minor operations
• Outpatient [ambulatory] surgery
• Necessity of the contact with patient
• High risk for common anesthesia
• Absence of the anaesthesiologist
Indications for local anesthesia

42. Contraindications to the local anesthesia
 intolerance to anaesthetics
 at an early age (less then 10)
 increased nervous excitability
 nervous disorders
 local inflammatory process or scars
 internal hemorrhage

43. Complications of condaction (except for epidural and
spinal anesthesia) and infiltrational anesthesia
Local complication
• Haematoma - by reason of vessels damage
• Tissues necrosis – tissues overpressure by the solution of
anesthetics
• Paresis and paralysis – nerve compression or damages by
needle.
General complication
•allergic reactions
•toxic effect

44. introduction of medicines(novocaine) into the
tissues for nerve blocking
Goal – treatment

45. Circular block of the extremity

46. Retromammary block

47. Paranephric [pararenal] block

48. Unspecific inflammatory process (initial stage)
Neurogenic pain
Spasm and atony of bowel, stomach, ureter
Vessels diseases

49. inflammatory process near the place of block
intolerance to anaesthetics
collapse, unconscious state

50. Premedication– it is special
pharmacological preparation of the
patient for the purpose of prophylaxis
of the negative influence of operation
and anaesthesia
Premedication

51. protect of the mental health of the
patient
exponentiation of the basic anaesthetic
Inhibition of the undesirable vagal reaction
decrease secretion mucous membranes
prophylaxis allergic complications

52. soporific
(pentobarbital natrium, phenobarbital,
radedorm, nozepam, tazepam)
Ataractic (tranquillizers) drugs
(elenium, seduxen, diazepam)
neuroleptic drugs
(droperidol)

53. Narcotics
(promedol, morphine)
Cholinergic antagonists
(atropine, methacin, scopolamine)
Antihistamines
(Dimedrol, pipolphen)

54. Promedol 2 % - 1,0;
Atropine - 0,01 мг/кг;
Dimedrol 2%-1,0.

55. 1. before doing to bed - phenobarbital - 2
мг/кг, tazepam -0,02 мг/кг.
2. in the morning 2-3 hours before operation
- droperidol -0,07 мг/кг, diazepam -0,14
мг/кг.
3. 30-40 min before operation - Promedol 2
% - 1,0, Atropine -0,01 мг/кг, Dimedrol 2%-
1,0.