Inhalation anesthesia

For the procedure, rapidly evaporating fluids( fluorotane, ether, chloroform) or gaseous narcotic substances( nitrous oxide, cyclopropane) are used.

Ester for narcosis is a colorless liquid. Stored in tightly sealed vials of dark color. Explosive, therefore it is used with caution. Strong narcotic, causes a deep anesthesia. It is excreted from the body through the lungs, irritating the respiratory tract, increasing the secretion of the bronchial glands.

Fluorotane is a colorless liquid with a sweetish odor. It is stored in dark vials. Has a strong narcotic effect, anesthesia occurs quickly, without the stage of excitement. Fluorotane.acting on the body, inhibits cardiovascular activity, reduces the pulse, lowers blood pressure, toxic effects on the liver, but does not irritate the respiratory tract.

Cyclopropane is a colorless gas with a specific odor. Produced in cylinders of red color. It is used only in a mixture with oxygen. He has a strong narcotic effect. Sleep and awakening occurs quickly. It does not act on the respiratory tract, is not toxic to the liver and kidneys, but can act on the vagus nerve and cause arrhythmias.

Special devices are used for inhalation anesthesia: anesthesia: balloons for gaseous substances( oxygen, nitrous oxide), dosimeters and evaporators for liquid narcotics( ether, fluorotane, pentotrans), respiratory circuit. Respiratory contours are: open( the patient breathes in a mixture of atmospheric air, and exhalation occurs in the environment), semi-closed( inhalation comes from the apparatus, and exhalates partially into the apparatus, partly into the atmosphere), half-open( the patient breathes in oxygen and narcotic from the apparatus,exhales into the atmosphere) - this is the safest kind of contour for the patient, closed( inhaled and exhaled by the patient in the apparatus) - this kind of the most economical and environmentally friendly, but it is possible the development of hypercapnia in the patient.

For indication of inhalation anesthesia, there are indications and contraindications. Inhalation anesthesia is used for all large surgical operations. Contraindications are absolute and relative. Absolute contraindications can lead to a fatal outcome during anesthesia.

Absolute contraindications include:

• pathology of the cardiovascular system in the stage of decompensation, malignant hypertension, pronounced hypotension caused by shock, collapse, intoxication, anemia;

• the pathology of the respiratory system, in which there is a pronounced respiratory failure - acute pneumonia, bronchiectatic disease, severe forms of tuberculosis;

• pathology of the hepatobiliary system with a sharp disruption of liver function, development of hepatic insufficiency - cirrhosis, hepatitis;

• renal pathology with severe impairment of their functions, development of renal failure - severe glomerulonephritis;

• severe endocrine pathologies - diabetes mellitus in the stage of decompensation of metabolic processes;

• severe anemia;

• Severe severe form of cachexia;

• increased intracranial pressure in brain tumors, hematomas.

Relative contraindications are various pathologies of organs and systems, in which the disturbances of their functions are expressed only slightly and are amenable to drug correction.

Inhalation anesthesia can be masked, which is currently rarely used, and endotracheal.

The mask anesthesia is carried out using an anesthetic mask, which the anesthetist puts on the patient's face, the mask is fixed to the head with straps and tightly pressed against the patient's face, so that the narcotic substance completely enters the patient's airways. First the patient breathes through the mask with oxygen, then gradually begin to give the narcotic substance. When the third level of the third stage of anesthesia is reached, it is necessary to bring the patient's jaw forward and so to maintain it until the end of anesthesia. Masque anesthesia is currently used rarely, since its use is associated with the occurrence of various complications and deficiencies. These include complex manageability, a large overuse of narcotic drugs, the risk of aspiration and its complications, the toxicity of anesthesia due to its depth.

When an endotracheal anesthesia is used an anesthesia machine. Narcotic substance with an anesthetic form of anesthesia enters the patient through a special intubation tube, which is introduced into the trachea. This anesthesia keeps free airway during operation, therefore it is used for surgical interventions on the face and neck, it does not allow aspirating by vomit, reduces the amount of narcotic drug, optimizes gas exchange, as it reduces the "dead" space of the lungs.

Endotracheal anesthesia is used for large surgeries, it is also used as a combined anesthetic with the use of muscle relaxants. When combined narcosis, two to three or more narcotic substances are used, which are administered in small doses, so the toxic effect on the body of each of them decreases. Such anesthesia is carried out at the first level of the third stage.

There are three stages of anesthesia.

In the first stage, an anesthesia is administered. For introductory anesthesia, drugs are used, against which comes a deep anesthetic sleep, bypassing the stage of excitement. For this purpose, barbiturates, thiopental sodium are used. Narcotic substances are administered intravenously. With the onset of anesthesia, muscle relaxants are introduced with co-intubation of the trachea.

In the second stage, anesthesia is maintained. For this, narcotic substances are used that provide protection of the body from an operating injury, as well as neuroleptanalgesia. For this purpose, cyclopropane, fluorotane, nitrous oxide with oxygen are used. Anesthesia must be maintained at the first or second level of the third stage, muscle relaxants are prescribed to relax the muscles. Muscle relaxants cause the plethia of all skeletal muscles and even respiratory muscles, so it is necessary to use artificial ventilation, which is performed by rhythmic compression of the bag or fur, or with the aid of an artificial respiration apparatus.

Currently used neuroleptanalgesia. With such anesthesia, nitrous oxide with oxygen, fentanyl, droperidol, muscle relaxants are used. Introductory anesthesia is carried out intravenously. This method of anesthesia is the safest for the patient, since fentanyl improves analgesia, droperidol reduces vegetative reactions.

The third stage - withdrawal from anesthesia. An anesthesiologist near the end of the operation gradually stops the introduction of narcotic substances and muscle relaxants. The patient comes out of anesthesia, consciousness is restored, independent breathing, muscle tone. The anesthetist can extubate the patient after waking up the patient, restoring self-breathing and muscle tone. The patient is transferred for further observation and recovery to the postoperative ward.

When carrying out general anesthesia, you must constantly monitor and monitor the basic parameters of the patient's hemodynamics. The doctor measures blood pressure and pulse every 15 minutes. Also it is necessary to carry out constant monitoring of cardiovascular activity. An acid-base blood condition is monitored to monitor lung ventilation and metabolic changes in the patient. Endotracheal anesthesia has a number of advantages that make it possible to use it for many operations. This is a quick introduction to anesthesia, skipping the stage of excitement, the ability to operate at the first level of the surgical stage, reducing the consumption of narcotics and toxicity of anesthesia, easy control of anesthesia, the possibility of avoiding aspiration and, if necessary, rehabilitate the trachea and bronchi.