Endotracheal anesthesia: He aha ia mea, nāʻikepili, ai '

I kēia lā, e meaʻaʻohe mea hou ma keia hana iaoia meaʻoki kino. A ma hope o kekahi mau kenekulia aku nei ka hana ua like i ka make, ka hapanui e hoomanawanui i make, mai ka ola kŰia a sepsis. No ka lōʻihi manawa i ke kanaka ka lawelawe ana i kaʻoki lāʻau lapaʻau moe koe kekahi Herculean hana o ka laau lapaau. Me ka like ana o kemika kaʻina ua hele wikiwiki. E aho anei kā nā mea huihuina, a hoʻomākaukau no ka anesthesia, a, eia hoi, ua manawa lawe mai i loko o na aoao. Kekahi o ia mea i ka endotracheal anesthesia. He aha ka mea? Pehea ka mea, ua hoʻohana 'ia a me ka wā e ua pono ai? Mau a me na mea he nui nā nīnau e pane i loko o kēia 'atikala.

Mai ka mōʻaukala o ka endotracheal anesthesia

No ka mea manawa mua ua hookolokoloia kēia 'ano o ka anesthesia i loko o ka XIV-XV kenekulia, i ka wa a ke kauka Paracelsus Hawaiian hoʻolauna i loko o ka trachea şarkı ke kanaka ma mua o mālama i kona ola. Ma hope oʻekolu kenekulia ma keia ala hoolaia kanaka ma muli o ka lewa. I ka 1942, he anesthesiologist, mai Canada hoʻohana mua Muscle relaxants - he waiwai e ho'ēmi i kā skeletal Muscle leo mai e ke hoʻokō 'immobilization. Mahalo i kēia loaʻa o ka anesthesia ua lilo lua pele a me ka hemolele loa, hiki 'Oihana piha mana hoʻomalu ma luna o kaʻoki lāʻau lapaʻau moe iʻoki kino.

Ma ka waena o ka XX kenekulia endotracheal anesthesia Ua ulu koke, kōkua pū ma ka Soviet kauka. I kēia lā ka mea, o ka loa e like me ka hana ana i mau anesthesia, hoʻohana 'ia i loko o ka papa o ka hapanui o na hana.

Endotracheal anesthesia: He aha ka mea?

I mea e hoʻopale ai i ke kino, mai ka nui stress o keʻoki kino, anesthesia ua hoʻohana. Ua hiki e kūloko, 'āina' a mau. Ka hopeʻano ua kapaia anesthesia. Ua Ua wehewehe aku ma ka piha "aku" ike paka i o ka hoʻomanawanui me ka hoouka kaua oʻoki lāʻau lapaʻau hiamoe. Ma kēia anesthesia ua lawelawe intravenously, ke ea paha a hui anesthesia. Hope hiehie i nā kiʻina hana mau a me ka waiwai e komo aku ai i ke koko, a me ka ÷ naehana hanu'āpana. Kēiaʻano o ke kahea a me endotracheal anesthesia.

Poe akamai i ponoʻoe iā ia e like me ka loa palekana pono a me ka hana o ka eha ana: ka mea, e leie aku oe e hoopau ai i ke kū i ke ano o ka hoomanawanui, e hoʻokō hiamoe nuiʻoki lāʻau lapaʻau, a me ka skeletal Muscle hoʻomaha a me ka pale aku i na kaʻawaʻawa loa complications e like me wehena a me ka ÷ naehana hanu ole.

hoike

Endotracheal anesthesia ua ālai 'o ka hoʻomanawanui mai ka eha a me ka hawewe naehana hanu' ole, ka mea hiki ke hoʻohana i ana a me ka mālama nui malama. Mawaena o na nāʻikepili no ka anesthesia hiki ke hui:

• ana ma mediastinum, pharynx, i ka loko pepeiao, ka waha a me ke poo;
• uao, ma i ka pono e hoʻohana Muscle relaxants;
• malfunction i loko o ka'emi ko kahua;
• piha'ōpū maʻi pale;
• ka pilikia o ka airway iaʻi.

Endotracheal mau anesthesia ua pinepine hoʻohana no ka lōʻihi-manawa ana i ka waiwai nui o ka oi mamua o 30 minuke. Ua hiki ke hoʻohana 'ia ma kekahi mau makahiki i loko o kekahi mau Hawaii o ka hoomanawanui,' ole. To, He 'aʻole e kiʻi i ka naau, a me ka' ē aʻe mea nui emiʻawahia ano o ka anesthesia.

Contraindications

Kohoʻoki kino (e laʻa me, no kona wehe 'ana mediastinal hikoko) ukali e akahele study o ka hoʻomanawanui ka kulana. Ke kauka i ka mea e pono ai manawa, e nānā i ka 'inikua mōʻaukala, mālama' e hoʻomaulia i ka hiki ka pilikia a me ke kuhikuhi contraindications i ka kekahi iaoia o anesthesia. Alu anesthesia ua ole e waiho no ka mea ma lalo nei:

• infectious maʻi;
• ake maʻi, hakuʻala;
• kēia myocardial infarction;
• Airlines maʻi;
• physiological hiʻona o ka 'ole o ka pharynx;
• loa endocrine kāna hana.

Pakahi aku la ia pilikia e hoʻohana endotracheal anesthesia me ka hoaka o ka naehana'āpana nā mea palahēhē, 'ole. K. A kiʻekiʻe kamepiula o ke akemāmā maʻiʻaʻai.

Ke kahua hui anesthesia

No laila, endotracheal anesthesia. He aha ka mea no ke kauka? Anesthesiologist hanaʻia ekolu ka mea i hahai ana ka mea mamuli o kekahi kahua o ka hoʻonaʻauao o ka hana: i ka hoike o keʻoki lāʻau lapaʻau hiamoe, ka malama ana i ka hale hānai moku'āina, a hoala mai la. Ka mua ke kahua me ka ia? He oluolu hoʻokomo o ka anesthesia. Ke hoomanawanui intravenously launa mai i ka ai 'ole ana kinoea ukuhiia. I ka wā o nā nāʻiʻo i loa nanea wale, ka anesthetist e ukuhi i loko o tracheal lumen endotracheal Tube. Ua 'oi aku mechanical e hoʻokomo ea a me ka inhalation o ka o oxygen me ka gaseous anesthetics.

Once surgeons Ua pau kā lākou hana, ma laila hele mai kekahiʻano nui koke no ka anesthesiologist - auoiaea o ka mea hoʻomanawanui anesthesia. Ua hoemiia ke kiʻekiʻe o ka laʻau heluna o ka ai '. Ma hope iho o ka hoihoi hou ia ana o ka noho'na makaainana i ulu hanu extubated - ana o ka endotracheal şarkı i loko o ka trachea. Ke hoomanawanui Ua kaʻi aku i ka ICU, e kiai ana nui na hoailona a me postoperative ke ola kaʻina.

hoʻokomo o ka anesthesia

Easy ka loiloi mua anesthesia ua koi 'ia no ka painless a me ka maluhia intubation, i mea ole me ka manaʻo o ka endotracheal anesthesia. E hoʻokō e like me ka moku'āina o ka hoʻohana 'ia o inhalation a intravenous anesthetics. Ma ka hihia mua, i ke ahonui hanu ana ma ka ea paha hui "Etra", "Foran", "halothane" 'ole' ē aʻe like nā mea huihuina o anesthetics. I kekahi manawa ka mea, Ua lawa ka nitrous'okesaside a me ka oxygen.

Like medicaments lawelawe intravenously, olelo hoʻohana barbiturates a me neuroleptics (droperidol, fentanyl). Ka mea, i hoʻohana 'ia me ka pāʻoihana (i kā mākou 1%). Mahele lāʻau anesthesiologist wae pākahi no kēlā me kēia hoʻomanawanui.

Ma hope o ka malamalama anesthesia Kanawai, e hana tracheal intubation. E hana i kēia, hoʻohana o ka Muscle relaxants e hoʻonānea i ka'ā'ī nāʻiʻo. Ke Tube Ua wahahee ma ke kumu o ka laryngoscope, ma hope i ka hoʻomanawanui ua hoolilo i kaʻimi hoʻopunipuni akemāmā hoʻokomo ea. Ke kahua hoʻomaka hohonu anesthesia.

Droperidol: ke aʻo

Droperidol - antipsychotic, ua pinepine ia i loko o endotracheal anesthesia. Ke Nine Inch 'ole i ka waiwai o ka tertiary Amine. Kela manawa, i ke kiaha dala ia 3 minuke ma hope o hooponopono. Ka paleʻana dopamine receptors, ma o na la neurovegetative ke peleki pāʻana. Eia kekahi, hypothermic a paʻa antiemetic 'ole. Hanu e loli iki.

I hōʻike mai no ka premedication, hoʻokomo o ka anesthesia, myocardial infarction, kŰia, loa angina, pulmonary edema a me hypertensive hoʻoponopono ulia. Ua paipaiʻia me ka lāʻau, eliminates nausea a me ka luaʻi. Ua haʻahaʻa kaʻawahia, ka mea hiki ke hoʻohana 'ia i loko o pediatricʻoki kino a me ka obstetrics.

ʻano hana o ka pono o ka antipsychotics i hoʻokomo o ka anesthesia

Aia i kekahi mau nā kinolau o ka neyroleptanalgezii. Hoʻokomo ana i lawe mai ma ka kēia noaia: droperidol, a alakai i ua noʻonoʻo ma luna, ma ka nui o ka 2-5 ml me 6-14 ml o ka fentanyl lawelawe i ka hoʻomanawanui intravenously. Ka poʻe makakiʻi hānai me ka läÿau, o nitrous'okesaside a me ka oxygen ma loko o ka lākiō o ka 2: 1 a me 3: 1. Ma hope o suppression o ka ike paka i a me ka Muscle relaxants ka lawelaweia ana e hoomau aku intubation.

Droperidol me neuroleptic kanawai no ka 4-5 hora, nae, ka mea, ua lawelawe i ka hoʻomaka o ka anesthesia lako. Ua he pōpilikia e lawe i ka mooolelo kino kaupaona: 0.25-0.5 mg / kg. Hai hooponopono o ka lāʻau manawa lōʻihi hana pono wale.

Fentanyl mea i loko o ka huina o 0,1 mg lawelawe iho la no na 20 minuke, a me kona lako ua papani iho la no 30-40 minuke ma mua o ka pauʻana o keʻoki kino. Ka loiloi mua mahele lāʻau mea 5-7 mg / kg.

intubation

Ma hope o suppression o ka ike paka i lawe ʻimi hoʻopunipuni hoʻokomo ea me ka o oxygen ka hoʻohana 'ana i ka anesthetic ea paha. Ma hope o ia, ke kauka hanaʻia intubation ma ka waha (i kekahi manawa ma ka ihu). Ka Wailele O hoʻi i kona poʻo, me kona waha hamama. Direct injected laryngoscope huhui ma ka midline ma waena o ka lani, a me ka olelo, ua e ka hope keu. Ka paepaeʻana mea paahana no hoi, e hooikaika i ka maka o ka epiglottis. Hōʻike 'ia glottis, i loko i ka endotracheal Tube. Ka mea, e hele aku i loko o ka trachea ma kahi o 2-3 knm. A ma hope iho holomua intubation şarkı Lokomaikaʻi a hoʻohui i ka hoʻomanawanui i ka ventilator.

Emi mau hoʻohana laryngoscope me ka uma huhui. Ua Ua hoʻolauna ma waena o ke kumu o ka epiglottis a me ke kumu o ke alelo, otdavlivaya mau mai noʻu iho. Inā he mea hiki ole hookomo o ka Tube ma ka waha ka hoʻohana 'ana i ka lalo nasal meatus. No ka laʻana, he hana e wehe i na cysts ku una lua.

Malama a me ke ola, mai anesthesia

Ma hope o intubation a hoʻohui i ka hoʻomanawanui i ka ventilator ia lŘlŘ ma ka puke Paipala. 'Imi hana me ka surgeon, ka anesthesiologist pono aku nā kahu nānā i hiki' nā hoailona. Kela a me keia 15 minuke, kaha i ka naau ana, ke koko, a me ke kōkua o nā kahu nānā malama i ka hoʻomanawanui i ka cardiac haʻawina.

General anesthesia ua mālama 'ia e nā nā māhele o antipsychotic ai', Muscle relaxants, a me nā mea huihuina inhalation anesthetics. Hana ma lalo o anesthesia hui 'ano e leie aku ka anesthesiologist e hoʻomaʻa i na pono o ke kino ma ka eha ana ma ka hoʻolako i kaʻoi loa kiʻekiʻe o lakou e malu ai.

Ma hope iho o ka pau ana oʻoki lāʻau lapaʻau kaʻina hana i ka hope kahua - mai o ka narcotic hiamoe. A hiki i ka manawa i ka ke kiʻekiʻe o emi i ka laʻau heluna o ka ai '. E hoihoi ha atropine a me Neostigmine maʻanuʻu o 5 minuke. E hoolilo ana iʻoiaʻiʻo i ka hoʻomanawanui mea hiki ke hanu ma luna o lākou iho, extubated. E hana i kēia, hoʻomaʻemaʻe i ka wahi o ka tracheobronchial laau. Ma hope o ana o ka Tube, a me ka like me ke kaʻina hana no ua hana me ka moʻolelo o ka lua.

postoperative hoʻomakākiu

Ma hope o ka waiho ana i ka pae'ōnaehana lumi, ke ahonui ua hoʻonoho ma ka mālama nui malama pa alima, kahi e pili loa kanaka hoʻoponopono i kona kulana. Ma hope o kekahi mau anesthesia ulu discomfort, emi complications. IeAUPIIe, IAa IO, lāʻau kū-operative hoʻomanawanui iki mai ohumu o:

• eha;
• discomfort i loko o ka'ā'ī;
• nausea;
• nawaliwali, a me ka Muscle luhi;
• drowsiness;
• hilahila;
• ole;
• makewai a me ka nele o kona'ōpū.

Mau symptoms i hookuu nalo loko o ka mua 2-48 hola ma hope oʻoki kino. E hoʻopau i ka eha analgesics kauoha.

No laila, e ka hōʻuluʻulu. Endotracheal anesthesia - He aha ka mea? Kēia hana o ke kanaka a hiki i kaʻoki lāʻau lapaʻau hiamoe i hoʻolaunaʻia ma, e leie aku oe e hana luna 'ana, ka mālamaʻana i ka ha awina o ka naehana nenoaiu. Alu anesthesia Ua emiʻawahia, a me ka oluolu i ka mana i ka hohonu o ka anesthesia i loko o ka 'uao wā. Ma lalo o endotracheal anesthesia kuhikuhi ano o intubation, ukali ma ka ai pili aku i ka hoʻomanawanui i ka ventilator. A pau keia ua hoʻohana 'like ana a me ka anesthetic lapaʻauʻia, i mea nō kāu hui.