Preparing the patient for general anesthesia algorithm. Preparing the patient for general anesthesia

The anesthesiologist is directly involved in preparing the patient for anesthesia and surgery. The patient is examined before the operation, and not only is attention paid to the underlying disease for which the operation is to be performed, but the presence of concomitant pathology is also clarified in detail. If the patient is operated on as planned, then, if necessary, treatment of concomitant diseases and sanitation of the oral cavity are carried out. The doctor finds out and evaluates the patient’s mental state, allergy history, clarifies whether the patient has undergone surgery and anesthesia in the past, pays attention to the shape of the face, chest, neck structure, and the severity of subcutaneous fat. All this is necessary to choose the right method of pain relief and narcotic drug.

An important rule in preparing a patient for anesthesia is cleansing the gastrointestinal tract (gastric lavage, cleansing enemas).

To suppress the psycho-emotional reaction and suppress the functions of the vagus nerve, the patient is given special medication before surgery - premedication. The purpose of premedication is to reduce the incidence of intra- and postoperative complications through the use of medications. A sleeping pill is given at night; patients with a labile nervous system are prescribed tranquilizers (for example, diazepam) 1 day before surgery. 40 minutes before surgery, narcotic analgesics are administered intramuscularly or subcutaneously: 1 ml of 1-2% trimepedine solution or 2 ml of fentanyl. To suppress the functions of the vagus nerve and reduce salivation, 0.5 ml of a 0.1% atropine solution is injected. In patients with a burdened allergic history, premedication includes antihistamines. Immediately before the operation, the oral cavity is examined and removable dentures are removed.

In case of emergency interventions, the stomach is washed out before the operation, premedication is carried out on the operating table, and medications are administered intravenously.

Intravenous anesthesia

The advantages of intravenous general anesthesia are quick induction of anesthesia, lack of excitement, and a pleasant fall asleep for the patient. However, narcotic drugs for intravenous administration create short-term anesthesia, which makes it impossible to use them in their pure form for long-term surgical interventions.

Barbituric acid derivatives- sodium thiopental and hexobarbital cause rapid onset of narcotic sleep. There is no arousal stage, awakening is quick. The clinical picture of anesthesia when using sodium thiopental and hexobarbital is identical. Hexobarbital causes less respiratory depression.

Use freshly prepared solutions of barbiturates. To do this, the contents of the bottle (1 g of the drug) are dissolved in 100 ml of isotonic sodium chloride solution (1% solution) before starting anesthesia. The vein is punctured and the solution is slowly injected at a rate of 1 ml in 10-15 s. After injecting 3-5 ml of solution within 30 seconds, the patient’s sensitivity to barbiturates is determined, then the administration of the drug is continued until the surgical stage of anesthesia. The duration of anesthesia is 10-15 minutes from the onset of narcotic sleep after a single administration of the drug. To increase the duration of anesthesia, fractional administration of 100-200 mg of the drug is used. Its total dose should not exceed 1000 mg. At this time, the nurse monitors pulse, blood pressure and respiration. To determine the level of anesthesia, the anesthesiologist monitors the condition of the pupils, the movement of the eyeballs, and the presence of the corneal reflex.

Barbiturates, especially sodium thiopental, are characterized by respiratory depression, and therefore, when using it for anesthesia, a breathing apparatus is required. When apnea occurs, you need to start mechanical ventilation using a breathing apparatus mask. Rapid administration of sodium thiopental can lead to a decrease in blood pressure and depression of cardiac activity. In this case, it is necessary to stop administering the drug. Sodium thiopental is contraindicated in acute liver failure. In surgical practice, barbiturate anesthesia is used for short-term operations lasting 10-20 minutes (opening abscesses, cellulitis, reducing dislocations, repositioning bone fragments). Barbiturates are also used for induction of anesthesia.

Sodium hydroxydione succinate used at a dose of 15 mg/kg, the total dose on average is 1000 mg. The drug is often used in small doses together with dinitrogen oxide. With large doses, arterial hypotension may develop. In order to prevent complications such as phlebitis and thrombophlebitis, the drug is recommended to be administered slowly into the central vein in the form of a 2.5% solution. Sodium hydroxydione succinate is used for induction of anesthesia, as well as for endoscopic examinations.

Sodium hydroxybutyrate administered intravenously very slowly. The average dose is 100-150 mg/kg. The drug creates superficial anesthesia, so it is often used in combination with other narcotic drugs, such as barbiturates. Most often used for induction of anesthesia.

Ketamine can be used for intravenous and intramuscular administration. The estimated dose of the drug is 2-5 mg/kg. Ketamine can be used for mononarcosis and induction of anesthesia. The drug causes shallow sleep, stimulates the activity of the cardiovascular system (blood pressure rises, pulse quickens). Ketamine is contraindicated in patients with hypertension. Widely used for shock in patients with arterial hypotension. Side effects of ketamine include unpleasant hallucinations at the end of anesthesia and upon awakening.

Propofol- short-acting intravenous anesthetic agent. Available in ampoules of 20 ml of 1% solution. It is a milky-white, water-isotonic emulsion containing propofol (10 mg in 1 ml) and a solvent (glycerin, purified egg phosphatide, sodium hydroxide, soybean oil and water). Causes a rapid (within 20-30 s) onset of narcotic sleep when administered intravenously at a dose of 2.5-3 mg/kg. The duration of anesthesia after a single injection is 5-7 minutes. Sometimes short-term apnea is observed - up to 20 s, and therefore mechanical ventilation is necessary using an anesthesia machine or an Ambu-type bag. In rare cases, allergies and bradycardia may occur. The drug is used for induction of anesthesia, as well as for pain relief during minor surgical operations (opening of phlegmons, abscesses, reduction of dislocations, reposition of bone fragments, laparostomy sanitation of the abdominal cavity, etc.).

Inhalation anesthesia

Inhalation anesthesia is achieved using easily evaporating (volatile) liquids (halothane, isoflurane, etc.) or gaseous drugs (dinitrogen oxide).

Halothane- colorless liquid with a sweetish odor. Boiling point 50.2° C. The drug is highly soluble in fats. Stored in dark bottles, non-explosive. It has a powerful narcotic effect: the introduction of anesthesia is very fast (3-4 minutes), the stage of excitation is absent or weakly expressed, awakening occurs quickly. The transition from one stage of anesthesia to another is rapid, and therefore an overdose of the drug is possible. Influencing the body, halothane inhibits cardiovascular activity, leads to a slowdown in heart rate and a decrease in blood pressure. The drug is toxic to the liver, but does not irritate the respiratory tract, dilates the bronchi, and therefore can be used in patients with respiratory diseases. It increases the sensitivity of the heart muscle to epinephrine and norepinephrine, so these drugs should not be used during halothane anesthesia.

Diethyl ether, chloroform, and cyclopropane are not used in modern anesthesiology.

Isoflurane- colorless liquid that does not decompose in light. The same applies to fluoride-containing anesthetics. The surgical level of anesthesia can be maintained with 1-2.5% of the drug in a mixture of oxygen - dinitrogen oxide. Potentiates the effect of all muscle relaxants. During spontaneous ventilation it causes dose-dependent respiratory depression. The use of the drug in an anesthetic concentration leads to a slight decrease in cardiac output, while a slight increase in heart rate is noted. Isoflurane is less likely than other fluorinated anesthetics to sensitize the myocardium to catecholamines. In small concentrations it does not affect blood loss during caesarean section, and therefore it is widely used in obstetrics. When using the drug, even with prolonged anesthesia, there are no cases of toxic effects on the liver and kidneys.

Sevoflurane It was registered in Russia recently, but in the USA, Japan and the European Union it has been used for about 10 years. Anesthesia is more manageable; introductory mask anesthesia is possible, which is convenient in pediatrics and outpatient practice. Toxic reactions when using the drug are not described.

Dinitrogen oxide- “laughing gas”, colorless, odorless, non-explosive, but in combination with diethyl ether and oxygen it supports combustion. The gas is stored in gray metal cylinders, where it is in a liquid state under a pressure of 50 atm. Dinitrogen oxide is an inert gas, does not interact with any organs or systems in the body, and is released by the lungs unchanged. For anesthesia, dinitrogen oxide is used only in combination with oxygen; in its pure form it is toxic. The following ratios of dinitrogen oxide and oxygen are used: 1:1; 2:1; 3:1; 4:1. The latter ratio is 80% dinitrogen oxide and 20% oxygen. Reducing the oxygen concentration in the inhaled mixture below 20% is unacceptable, as this leads to severe hypoxia. Under the influence of dinitrogen oxide, the patient quickly and calmly falls asleep, bypassing the stage of excitement. Awakening occurs immediately as soon as the supply of dinitrogen oxide stops. The disadvantage of dinitrogen oxide is its weak narcotic effect; even in the highest concentration (80%) it gives superficial anesthesia. There is no muscle relaxation. Under anesthesia with dinitrogen oxide, small, low-traumatic surgical interventions can be performed.

Muscle relaxants

Muscle relaxants: short-acting (suxamethonium chloride, mivacurium chloride), relaxation time 5-20 minutes, medium-acting (20-35 minutes) - atracurium benzilate, rocuronium bromide; long-acting (40-60 min) - pipecuronium bromide.

Anesthesia devices

To carry out inhalation anesthesia with volatile and gaseous narcotic substances, special devices are used - anesthesia machines. The main components of the anesthesia machine: 1) cylinders for gaseous substances (oxygen, dinitrogen oxide); 2) dosimeters and evaporators for liquid drugs (for example, halothane); 3) breathing circuit (Fig. 21). Oxygen is stored in blue cylinders under a pressure of 150 atm. To reduce the pressure of oxygen and dinitrogen oxide at the outlet of the cylinder, reducers are used that reduce it to 3-4 atm. Vaporizers are designed for liquid narcotic substances and consist of a jar into which the narcotic substance is poured. Vapors of the narcotic substance are directed through the valve into the circuit of the anesthesia machine; the concentration of the vapors depends on the ambient temperature. The dosage, especially of diethyl ether, is carried out imprecisely, in arbitrary units. Currently, evaporators with a temperature compensator are common, which allows you to dose the narcotic substance more accurately - in volume percentages.

Rice. 21.Anesthesia apparatus (diagram): a - cylinders with gaseous substances; b - block of dosimeters and evaporators; c - respiratory system.

Dosimeters are designed for precise dosing of gaseous drugs and oxygen. Rotational dosimeters - float-type rotameters - are most often used. The gas flow inside the glass tube rushes from bottom to top. The displacement of the float determines the minute gas flow rate in liters (l/min).

The breathing circuit consists of a breathing bellows, a bag, hoses, valves, and an adsorber. Through the breathing circuit, the narcotic substance is directed from the dosimeter and evaporator to the patient, and the air exhaled by the patient is sent to the device.

The narcotic respiratory mixture is formed in the anesthesia machine by mixing gases or vapors of narcotic substances with oxygen.

Oxygen, having passed through the dosimeter, is mixed in a special chamber with dinitrogen oxide and cyclopropane, which also passed through the dosimeter, in certain proportions necessary for anesthesia. When using liquid drugs, the mixture is formed when oxygen passes through the evaporator. Then it enters the respiratory system of the device and then into the patient’s respiratory tract. The amount of incoming drug mixture should be 8-10 l/min, of which oxygen should be at least 20%. The ratio of narcotic gases and exhaled air to atmospheric air may be different. Depending on this, there are four methods of circulation (breathing circuits).

1. Open method (circuit). The patient inhales a mixture of atmospheric air that has passed through the evaporator of the anesthesia machine, and exhales into the surrounding atmosphere of the operating room. With this method, there is a large consumption of narcotic substances and their pollution of the operating room air, which is breathed by all medical personnel participating in the operation.

2. Semi-open method (circuit). The patient inhales a mixture of oxygen and a narcotic substance from the apparatus and exhales it into the atmosphere of the operating room. This is the safest breathing circuit for the patient.

3. Semi-closed method (circuit). Inhalation is made from the apparatus, as in the semi-open method, and exhalation is partly into the apparatus, and partly into the atmosphere of the operating room. The mixture exhaled into the device passes through the adsorber, where it is freed from carbon dioxide, enters the respiratory system of the device and, mixing with the resulting narcotic mixture, is again supplied to the patient.

4. The closed method (circuit) involves inhalation and exhalation, respectively, from device to device. The inhaled and exhaled gas mixtures are completely isolated from the environment. The exhaled gas-narcotic mixture, after being released from carbon dioxide in the adsorber, again enters the patient, combining with the newly formed narcotic mixture. This type of anesthesia circuit is economical and environmentally friendly. Its disadvantage is the danger of hypercapnia for the patient if the chemical absorber is not changed in a timely manner or its quality is poor (the absorber must be changed after 40 minutes - 1 hour of operation).

Inhalation anesthesia

Inhalation anesthesia can be performed using mask, endotracheal and endobronchial methods. First of all, you should prepare the anesthesia machine for use. To do this, it is necessary: 1) open the valves of the cylinders with oxygen and dinitrogen oxide; 2) check the presence of gas in the cylinders according to the pressure gauge of the gearbox; 3) connect the cylinders to the device using hoses; 4) if anesthesia is carried out with liquid volatile narcotic substances (for example, halothane), pour them into evaporators; 5) fill the adsorber with a chemical absorber; 6) ground the device; 7) check the tightness of the device.

Mask anesthesia

To perform mask anesthesia, the doctor stands at the patient’s head and places a mask on his face. The mask is secured to the head using straps. Fixing the mask with your hand, press it tightly to your face. The patient takes several breaths of air through the mask, then it is attached to the device. Oxygen is allowed to be inhaled for 1-2 minutes, and then the drug supply is turned on. The dose of the drug is increased gradually, slowly. At the same time, oxygen is supplied at a rate of at least 1 l/min. At the same time, the anesthesiologist constantly monitors the patient’s condition and the course of anesthesia, and the nurse monitors blood pressure and pulse levels. The anesthesiologist determines the position of the eyeballs, the condition of the pupils, the presence of a corneal reflex, and the nature of breathing. Upon reaching the surgical stage of anesthesia, they stop increasing the supply of the narcotic substance. For each patient, an individual dose of the narcotic substance in volume percentage required for anesthesia at the first or second level of the surgical stage (III 1 -III 2) is established. If the anesthesia has been deepened to stage III 3, it is necessary to bring the patient’s lower jaw forward.

To do this, press the angle of the lower jaw with your thumbs and move it forward until the lower incisors are in front of the upper ones. In this position, the lower jaw is held with the third, fourth and fifth fingers. You can prevent tongue retraction by using air ducts that hold the root of the tongue. It should be remembered that during anesthesia at stage III 3 there is a danger of drug overdose.

At the end of the operation, the supply of the narcotic substance is turned off, the patient breathes oxygen for several minutes, and then the mask is removed from his face. After finishing work, close all valves of the anesthesia machine and cylinders. The remaining liquid drugs are drained from the evaporators. The hoses and bag of the anesthesia machine are removed and sterilized in an antiseptic solution.

Disadvantages of mask anesthesia

1. Difficult to control.

2. Significant consumption of narcotic drugs.

3. Risk of developing aspiration complications.

4. Toxicity due to depth of anesthesia.

The anesthesiologist takes a direct and often primary role in preparing the patient for anesthesia and surgery. It is mandatory to examine the patient before surgery, but not only the underlying disease for which surgery is to be performed is important, but also the presence of concomitant diseases, which the anesthesiologist asks about in detail. It is necessary to know how the patient was treated for these diseases, the effect of treatment, duration of treatment, the presence of allergic reactions, and the time of the last exacerbation. If a patient undergoes surgical intervention as planned, then, if necessary, correction of existing concomitant diseases is carried out. Sanitation of the oral cavity is important in the presence of loose and carious teeth, as they can be an additional and unwanted source of infection. The anesthesiologist determines and evaluates the patient’s psychoneurological condition. For example, in schizophrenia, the use of hallucinogenic medications (ketamine) is contraindicated. Surgery during psychosis is contraindicated. If there is a neurological deficit, it is first corrected. An allergy history is of great importance for the anesthesiologist; for this purpose, intolerance to drugs, as well as food, household chemicals, etc. is clarified. If the patient has a burdened allergic anemnesis, not even to medications during anesthesia, an allergic reaction may develop, up to anaphylactic shock. Therefore, desensitizing agents (diphenhydramine, suprastin) are introduced into premedication in large quantities. An important point is whether the patient has had previous operations and anesthesia. It turns out what kind of anesthesia was used and whether there were any complications. Attention is paid to the somatic condition of the patient: face shape, shape and type of chest, structure and length of the neck, severity of subcutaneous fatty tissue, presence of edema. All this is necessary in order to choose the right method of anesthesia and narcotic drugs. The first rule of preparing a patient for pain relief during any operation and when using any anesthesia is cleansing the gastrointestinal tract (the stomach is washed through a probe, cleansing enemas are performed). To suppress the psycho-emotional reaction and inhibit the activity of the vagus nerve, before surgery, the patient is given medicinal preparation - premedication. Phenazepam is prescribed intramuscularly at night. Patients with a labile nervous system are prescribed tranquilizers (Seduxen, Relanium) a day before surgery. 40 minutes before surgery, narcotic analgesics are administered intramuscularly or subcutaneously: 1 ml of 1–2% solution of promolol or 1 ml of pentozocine (Lexir), 2 ml of fentanyl, or 1 ml of 1% morphine. To suppress the function of the vagus nerve and reduce salivation, 0.5 ml of a 0.1% atropine solution is administered. Immediately before the operation, the oral cavity is examined for the presence of removable teeth and dentures, which are removed.

There are three stages of anesthesia.

1. Introduction to anesthesia. Induction of anesthesia can be carried out with any narcotic substance, against the background of which a fairly deep anesthetic sleep occurs without a stage of excitement. They mainly use barbiturates, fentanyl in combination with sombrevin, and promolol with sombrevin. Sodium thiopental is also often used. The drugs are used in the form of a 1% solution and administered intravenously at a dose of 400–500 mg. During induction of anesthesia, muscle relaxants are administered and tracheal intubation is performed.

2. Maintaining anesthesia. To maintain general anesthesia, you can use any narcotic that can protect the body from surgical trauma (fluorotane, cyclopropane, nitrous oxide with oxygen), as well as neuroleptanalgesia. Anesthesia is maintained at the first and second levels of the surgical stage, and to eliminate muscle tension, muscle relaxants are administered, which cause myoplegia of all groups of skeletal muscles, including respiratory ones. Therefore, the main condition of the modern combined method of pain relief is mechanical ventilation, which is carried out by rhythmically compressing the bag or fur or using an artificial respiration apparatus.

Recently, neuroleptanalgesia has become most widespread. With this method, nitrous oxide with oxygen, fentanyl, droperidol, and muscle relaxants are used for anesthesia.

Intravenous induction anesthesia. Anesthesia is maintained by inhalation of nitrous oxide with oxygen in a ratio of 2: 1, fractional intravenous administration of fentanyl and droperidol, 1–2 ml every 15–20 minutes. If the pulse increases, fentanyl is administered, and if blood pressure increases, droperidol is administered. This type of anesthesia is safer for the patient. Fentanyl enhances pain relief, droperidol suppresses autonomic reactions.

3. Recovery from anesthesia. Towards the end of the operation, the anesthesiologist gradually stops administering narcotics and muscle relaxants. The patient regains consciousness, spontaneous breathing and muscle tone are restored. The criterion for assessing the adequacy of spontaneous breathing is the indicators PO 2, PCO 2, pH. After awakening, restoration of spontaneous breathing and skeletal muscle tone, the anesthesiologist can extubate the patient and transport him for further observation to the recovery room.

42. Anaphylactic shock (see 39)

43. Rights and responsibilities of nurses. Ethics and deontology in the work of a nurse (see 1)

Mask anesthesia

Anesthesia masks They are easy to use, but with them a lot of the drug is lost through evaporation. Therefore, they do not meet the requirements of modern anesthesiology. As an exception, masks can be used for short-term anesthesia during minor operations. The anesthetist's table must have the necessary instruments and medications: an injection syringe, a mouth dilator, a tongue holder, a forceps, sterile gauze balls, caffeine, adrenaline, strychnine, pillows with oxygen and carbon dioxide.

Intubation (intratracheal) anesthesia- entry through a tube inserted into the trachea of ether vapor or ether with oxygen, or another gas mixture. The idea of intratracheal anesthesia belongs to N.I. Pirogov (1847).

Intubation anesthesia is carried out using special equipment, where it is possible to regulate external respiration, up to controlling the rhythm and volume of the suppressed mixture (the so-called breathing control), ensuring ventilation of the lungs and pressure in them. Tracheal intubation eliminates the possibility of retraction of the tongue, epiglottis, aspiration of saliva and vomit. Disadvantages include the need for tracheal intubation, the presence of complex equipment and experienced anesthesiologists.

The circulation system for administering anesthesia is designed in such a way that the inhaled and exhaled mixtures are isolated from one another using valves, hoses and a tee. The gas mixture moves in one direction in a closed circle. The patient's breathing is monitored by the movements of the valves and dative sac.

The gas mixture from the cylinders enters the mixing chamber through dosimeters, then through the inhalation valve and the airbox through the hose into the tee and into the mask (or endotracheal tube). The disadvantage is the possibility of developing hypercapnia.

Reversible (pendulum) system characterized by the fact that the inhaled and exhaled mixtures pass through the absorber 2 times (during inhalation and exhalation). To reduce the “harmful” space, the chamber with the absorber is located near the patient’s head.

The advantage of the reverse system is the simplicity of the device, reducing the possibility of hypercapnia and the possibility of control breathing. The disadvantage is breathing resistance on inhalation and exhalation.

Preparing the patient for anesthesia is that indications and contraindications are analyzed based on the individual characteristics of the structure and functions of all organs and systems. It is divided into 2 stages:

■ preliminary preparation;

■ preparation immediately before anesthesia.

Preliminary preparation includes examination of the oral cavity and, if indicated, its sanitation. Attention is paid to the neuropsychic status, and if necessary, sedatives are prescribed.

Immediately before the operation, the patient is reassured and reassured that the operation will be successful. At night they give sleeping pills and tea with crackers. In the morning, if the stomach is full, lavage is prescribed. The patient's removable teeth are removed and he is asked to visit the toilet.

Premedication is given before the operation. 40-50 minutes before surgery, 1-2 ml of 1% promedol and 0.5-1 ml of 0.1% atropine solution and an antihistamine are administered.

Lecture 24. Anesthesia: nitrous oxide, ether

General anesthesia is an artificially induced, reversible state of the body in which mental reactions are turned off and the reaction to pain and other harmful irritations is reduced or absent.

Patient preparation

Preparation for anesthesia begins with meeting the patient, examining him, followed by the appointment of appropriate additional examinations and drug therapy. The anesthesiologist bears equal responsibility with the surgeon for the fate of the patient. Together with the surgeon, he determines the indications and contraindications for anesthesia and surgery, and chooses the method of pain relief. Depending on the timing of the operation, planned or emergency, preparation for it can last from several minutes to many days. From the patient's medical history, it is important for the anesthesiologist to know:

about previous diseases, operations, anesthesia and their complications;
about the medications used (corticosteroids, insulin, antihypertensive drugs, tranquilizers, digitalis preparations, antidepressants, anticoagulants, barbiturates, diuretics);
about drug allergies;
about concomitant diseases of the respiratory system (chronic pneumonia, bronchitis, bronchial asthma);
about concomitant diseases of the cardiovascular system (coronary insufficiency, arrhythmias, hypertension);
about liver and kidney diseases;
about bad habits (smoking, alcoholism, drug addiction, substance abuse);
about pregnancy and menstruation on the day of the expected operation;
about mental illness;
about complications with blood transfusion in the past.

Data on the patient’s age, weight and build make it possible to correctly select the type of anesthesia, dose of drugs, and prepare in a timely manner to combat respiratory disorders during surgery and in the postoperative period, in particular in obese patients.

The nose and eyes should be carefully examined to identify possible abnormalities.(pupillary abnormalities, deviated nasal septum, difficult nasal breathing), which can be misleading and cause complications during anesthesia.

The anesthesiologist pays attention to the shape of the patient's face(to select a suitable mask in advance), condition of the oral cavity and pharynx, anomalies of the trachea and bronchi.

It is important to correctly assess the shape and size of the chest, its compliance and rigidity, the development of muscles and subcutaneous fat to choose the most rational tactics while ensuring the adequacy of external respiration during anesthesia and in the postoperative period. It is necessary to conduct external respiration studies. If there is a disorder in the bronchopulmonary system, before planned operations it is necessary to teach the patient to breathe in a lying, sitting, or standing position. The nurse anesthetist must be proficient in this method; In addition, it is necessary to prescribe expectorants - aminophylline.

It must be remembered that any anesthetic affects the function of the brain, heart and blood vessels, lungs, liver, kidneys, and the degree of impact depends, among other things, on the initial state of the organs. Therefore, it is important to identify violations of vital organs for subsequent selection of anesthetic management tactics.. The anesthesiologist must carry out a minimum examination (history, examination, auscultation, palpation) even in the most unfavorable situations.

The nurse is directly involved in preparing the patient. On the eve of the operation, it is necessary to weigh the patient, since some anesthetics are administered taking into account body weight, especially in children. A strict rule when preparing a patient for anesthesia is to cleanse the gastrointestinal tract.. Anesthesia should be administered on an empty stomach.. A cleansing enema should be done in the evening, on the eve of the operation, then the patient takes a hygienic bath or shower with a full change of linen. From this time on, the nurse should ensure that the patient does not take any food due to the danger of vomiting and aspiration of vomit during anesthesia. In the morning, two to three hours before anesthesia, you can give only half a glass of tea.

It is imperative to find out if the patient has dentures and ensure that he removes them before entering the operating room.. Before induction of anesthesia, the anesthesiologist must once again examine the oral cavity and make sure that there are no dentures.

In the morning, before being taken to the operating room, the patient must urinate. If there is no spontaneous urination, urine should be drained with a soft catheter.

Before emergency surgery, it is usually necessary to empty the stomach through a tube.. Neglect of this extremely important procedure often causes severe complications, including death, due to the entry of stomach contents (vomiting and regurgitation) into the lungs or airways at various stages of anesthesia, especially during induction and awakening.

See Fundamentals of Anesthesiology

Saenko I. A.

Sources:

Nurse's Handbook for Care/N. I. Belova, B. A. Berenbein, D. A. Velikoretsky and others; Ed. N. R. Paleeva. - M.: Medicine, 1989.
Zaryanskaya V. G. Fundamentals of resuscitation and anesthesiology for medical colleges (2nd ed.) / Series "Secondary vocational education". - Rostov n/D: Phoenix, 2004.

You will need

– complete preoperative examination of the body;
– consultation with an anesthesiologist;
– preparation for anesthesia

Instructions

Preliminary preparation for surgery and the anesthesia procedure consists of a comprehensive examination of the body’s condition. This is a whole complex of laboratory analyzes and instrumental studies. Concomitant diseases must, if not cured, then be transferred to the stage of compensation.

Even before consulting with an anesthesiologist, think through the conversation with him. Remember if you have had surgery under anesthesia before and how you handled it; are you allergic to anything? which ones do you accept? This information is necessary for the anesthesiologist to select and dosage drugs, which are selected purely individually.

One day before surgery, women with manicures should remove nail polish. You need to remove makeup from your face and not use cosmetics or perfumes.

On the eve of the operation, you can eat your last meal not late in the evening, and preferably solid rather than liquid food. At night, you need to cleanse your intestines by taking a laxative or doing an enema. Laxative anal suppositories "Bisacodyl" are effective.

On the day of the operation you cannot eat or drink anything, you must be patient. But, if you are very thirsty, you can drink water at least four hours before going to the operating unit. A quarter glass, no more.

Before the operation, the patient usually takes off all his clothes and is given sterile shoe covers and a gown. First you need to remove watches, beads and other jewelry. Turn off your mobile phone and give it to your loved ones. If you wear dentures, be sure to remove them too.

The most difficult thing is the restrictions on drinking and eating. They are almost the same as . Infants can be breastfed four hours before surgery, artificial babies - six hours. Water should not be given to all children four hours before anesthesia.

The small patient’s intestines should also be emptied, especially if surgery is to be performed on it. For three days, the child should not be given meat dishes or foods that contain a lot of plant fiber.

With the consent of the surgeon, it is advisable for the mother to be next to the child until he falls asleep from anesthesia. If after the operation he is transported not to the intensive care unit, but to the ward, you should be on duty near him, especially the first day after the operation.

note

Anesthesia should not cause severe side effects (vomiting, memory loss, etc.). Sometimes there are mild disturbances of attention and thinking, but they soon pass. Mild nausea, dry throat, dizziness, and general weakness are considered common symptoms.

Two to three days before surgery, you should not take alcohol or drugs.

Overweight people and smokers tolerate anesthesia worse, so before surgery it is recommended to lose excess weight and at least temporarily not smoke.

It is not necessary to interrupt the intake of medications prescribed for continuous use (for example, diabetics, hypertensive patients) either before or after anesthesia.

Helpful advice

Pain relief can be general or local. The general thing is anesthesia, i.e. anesthesia with loss of consciousness. Therefore, it is incorrect to say “under general anesthesia”, since there is no “local anesthesia”. The second type is local anesthesia, i.e. local, partial, in which consciousness is completely preserved. If surgery is possible under local anesthesia, it is better to choose it instead of anesthesia.

If you have had surgery before and standard doses did not work for you, be sure to tell your anesthesiologist!

Typically, anesthetic drugs are administered in two ways: intravenously and inhalation, through a breathing mask. Inhalation anesthesia is preferable, as it provides a state of sleep with a smaller dose of the drug. The stronger the dosage of anesthesia, the more likely complications are. But don’t believe the stories that anesthesia “takes away five years of life” or “undermines the heart.”

Sources:

Website DoctorSafonova.ru/Interview with an anesthesiologist
Website Malysh-nash.ru/How to prepare a child for anesthesia
Video: How anesthesia works