Ether for anesthesia: features of use for general anesthesia.

In modern medicine, doctors use many types of anesthesia, including ether for anesthesia. The first use of such a drug occurred in the middle of the 19th century by a group of scientists who used it for general analgesia during surgery. Since then, ether for anesthesia has undergone many changes, but to this day it is used for local application or anesthetic inhalation.

Description of the drug

The medical name of the drug is diethyl ether. It is highly flammable, absolutely clear liquid. It evaporates very quickly, filling everything around with its vapors. It has a sharp, burning taste and is quite Strong smell(since evaporation occurs quickly, the concentration of the substance when inhaled is quite high).

Honored Surgeon of Russia N.I. Pirogov widely uses this anesthesia to perform surgical operations. Diethyl ether is also used in dentistry when removing teeth or installing fillings. Less widely, this drug is used by therapists to relieve patients from severe hiccups or vomiting.

As a powerful muscle relaxant and analgesic, ether anesthesia has proven itself well in surgical intervention. Application this drug It is performed during short operations, since its period of action ranges from 20 to 40 minutes, after which the patient awakens. Complete depression of the patient's condition occurs 2-3 hours after anesthesia.

Indications and contraindications for use

The peculiarity of this drug is its wide range therapeutic effects. Anesthesia ether is used for:

• decreased sensitivity to epiniphrine and norepinephrine;
• temporary (up to 24 hours) decrease in circulating blood volume by 10%, slowdown of the liver, kidneys, and intestinal motility;
• relaxation of skeletal muscles;
• increasing the level of catecholamines in the blood, compensating for the decrease in myocardial contractions;
• easy control of the patient's sleep depth (during surgery).

This drug is used when it is necessary to use closed or semi-open inhalation anesthesia. The use of ether anesthesia is contraindicated for patients:

• diabetes mellitus;
• acidosis;
• liver, heart or kidney failure;
• cachexia;
• intracranial or arterial hypertension;
• hypersensitivity to ether;
• acute forms of the disease respiratory tract.

Such anesthesia cannot be used if an electric knife is used during the operation or electrocoagulation is performed. The patient may experience pulmonary hypersecretion, vomiting, nausea, increased blood pressure, coughing attacks, psychomotor agitation.

After surgery under diethyl ether, you may experience:

• peripheral neuropathy of the extremities;
• tracheitis;
• headache;
• bronchitis;
• central hyperthermia;
• bronchopneumonia;
• severe vomiting;
• laryngitis.

The principle of action of ether on the body

Important! Diethyl ether is a low-risk substance for human health if it is used for medical purposes. When used non-medically, the drug can cause profound depression of the nervous system.

There are four stages of the effect of ether on the body:

1. Agonal stage. It occurs with an overdose of the drug. In this case, the patient experiences a weak pulse, shallow breathing, depression of the vasomotor and respiratory function. As a result of respiratory depression and cardiac arrest, the agonal stage ends in death.
2. Surgical anesthesia. At this stage, all manifestations of excitation disappear - the pressure stabilizes, the muscles return to normal tone, nervous system oppressed. This stage of anesthesia can be ultra-deep, deep, medium and light.
3. Excitement stage. At this stage, the patient’s blood pressure rises and the pulse quickens. The patient at this stage is highly excited, muscle tone is increased, speech and physical activity, loss of consciousness is observed, coughing, sometimes a gag reflex.
4. General anesthesia. At this stage, intoxication with diethyl ether occurs - the patient’s physical indicators are normal, clear consciousness, however pain sensitivity is lost.

Possible consequences of ether anesthesia

Ether anesthesia can cause poisoning of the body, which has negative consequences for the patient:

• failure of the liver and kidneys;
• increase in pressure;
• hepatitis (toxic);
• neuropsychiatric diseases;
• increased heart rate, upset of cardio-vascular system;
• paranoia, general personality degradation;
• memory impairment;
• uncontrollable panic attacks.

Along with this, ether anesthesia can cause hallucinations. Everything that happens around a person seems to him to be reality; in fact, these are all hallucinations of both visual and auditory types. He tries to contact an imaginary world that only he can see, so such patients need control from other people. This state lasts for 10-15 minutes.

With the help of additional premedication, experienced anesthesiologists remove a number of unwanted manifestations dimethyl ether. For an unprepared person, ether anesthesia can have a dissociative effect, which will be expressed in a disturbance in the perception of consciousness.

Conclusion

Like others medicines, anesthesia drugs undergo rigorous clinical testing before they are approved for use on patients. Dimethyl ether has side effects, and in fact, it poisons the body, but not critically, since with proper use, a person quickly recovers from anesthesia. Therefore, it is prescribed only in cases of extreme necessity, which means that side effects are a necessary measure. With skill and the right combination various anesthetics, doctors perform anesthesia as comfortable and safe as possible for human body.

"The Divine Art of Destroying Pain" for a long time was beyond the control of man. For centuries, patients were forced to endure suffering patiently, and doctors were unable to stop their suffering. In the 19th century, science was finally able to conquer pain.

Modern surgery uses for and A who first invented anesthesia? You will learn about this as you read the article.

Anesthesia techniques in ancient times

Who invented anesthesia and why? Since the dawn of medical science, doctors have tried to solve important problems: how to make surgical procedures as painless as possible for patients? In cases of severe injuries, people died not only from the consequences of the injury, but also from the experience painful shock. The surgeon had no more than 5 minutes to perform the operations, otherwise the pain would become unbearable. The aesculapians of antiquity were armed with various means.

IN Ancient Egypt crocodile fat or alligator skin powder were used as anesthetics. An ancient Egyptian manuscript dating back to 1500 BC describes the pain-relieving properties of the opium poppy.

IN Ancient India healers used substances based on Indian hemp to produce painkillers. Chinese doctor Hua Tuo, who lived in the 2nd century. AD, suggested that patients drink wine laced with marijuana before surgery.

Methods of pain relief in the Middle Ages

Who invented anesthesia? In the Middle Ages miraculous effect attributed to the mandrake root. This plant from the nightshade family contains potent psychoactive alkaloids. Drugs with the addition of mandrake extract had a narcotic effect on a person, clouded consciousness, and dulled pain. However, incorrect dosage could lead to fatal outcome, and frequent use caused drug addiction. The analgesic properties of mandrake were first discovered in the 1st century AD. described ancient Greek philosopher Dioscorides. He gave them the name “anaesthesia” - “without feeling.”

In 1540, Paracelsus proposed the use of diethyl ether for pain relief. He repeatedly tried the substance in practice - the results looked encouraging. Other doctors did not support the innovation and after the death of the inventor they forgot about this method.

To turn off a person’s consciousness to carry out the most complex manipulations, surgeons used a wooden hammer. The patient was hit on the head and temporarily fell into unconsciousness. The method was crude and ineffective.

The most common method of medieval anesthesiology was ligatura fortis, i.e. infringement nerve endings. The measure made it possible to slightly reduce painful sensations. One of the apologists of this practice was the court physician of the French monarchs, Ambroise Paré.

Cooling and hypnosis as pain relief methods

At the turn of the 16th-17th centuries, the Neapolitan physician Aurelio Saverina reduced the sensitivity of the operated organs using cooling. The diseased part of the body was rubbed with snow, thus being slightly frozen. Patients experienced less suffering. This method has been described in the literature, but few people have resorted to it.

Pain relief using cold was remembered during the Napoleonic invasion of Russia. In the winter of 1812, the French surgeon Larrey carried out mass amputations of frostbitten limbs right on the street at a temperature of -20... -29 o C.

In the 19th century, during the period of the mesmerization craze, attempts were made to hypnotize patients before surgery. A when and who invented anesthesia? We'll talk about this further.

Chemical experiments of the 18th-19th centuries

With development scientific knowledge scientists began to gradually approach a solution complex problem. At the beginning of the 19th century, the English naturalist H. Davy established, based on personal experience that inhaling nitrous oxide vapor dulls the sensation of pain in humans. M. Faraday found that a similar effect is caused by vapors sulfuric ether. Their discoveries did not find practical application.

In the mid-40s. 19th century dentist G. Wells from the USA became the first person in the world to undergo surgical manipulation while under the influence of an anesthetic - nitrous oxide or “laughing gas”. Wells had a tooth removed, but he did not feel any pain. Wells was inspired by the successful experience and began to promote a new method. However, repeated public demonstration of the action chemical anesthetic ended in failure. Wells failed to win the laurels of the discoverer of anesthesia.

Invention of ether anesthesia

W. Morton, who practiced in the field of dentistry, became interested in the study of analgesic effects. He carried out a series of successful experiments on himself and on October 16, 1846, put the first patient into a state of anesthesia. An operation was performed to painlessly remove a tumor in the neck. The event received wide resonance. Morton patented his innovation. He is officially considered the inventor of anesthesia and the first anesthesiologist in the history of medicine.

The idea was picked up in medical circles ether anesthesia. Operations using it were performed by doctors in France, Great Britain, and Germany.

Who invented anesthesia in Russia? First Russian doctor, who risked testing the advanced method on his patients was Fedor Ivanovich Inozemtsev. In 1847 he produced several complex abdominal operations over patients immersed in Therefore, he is the pioneer of anesthesia in Russia.

Contribution of N. I. Pirogov to world anesthesiology and traumatology

Other Russian doctors followed in Inozemtsev’s footsteps, including Nikolai Ivanovich Pirogov. He not only operated on patients, but also studied the effects of ethereal gas, tried different ways its introduction into the body. Pirogov summarized and published his observations. He was the first to describe the techniques of endotracheal, intravenous, spinal and rectal anesthesia. His contribution to the development of modern anesthesiology is invaluable.

Pirogov is the one. For the first time in Russia, he began to fix damaged limbs using plaster cast. The doctor tested his method on wounded soldiers during Crimean War. However, Pirogov cannot be considered a pioneer this method. Gypsum was used as a fixing material long before (Arab doctors, the Dutch Hendrichs and Matthiessen, the Frenchman Lafargue, the Russians Gibenthal and Basov). Pirogov only improved the plaster fixation, making it light and mobile.

Discovery of chloroform anesthesia

In the early 30s. Chloroform was discovered in the 19th century.

A new type of anesthesia using chloroform was officially presented to the medical community on November 10, 1847. Its inventor, Scottish obstetrician D. Simpson, actively introduced pain relief for women in labor to ease the process of childbirth. There is a legend that the first girl who was born painlessly was given the name Anasthesia. Simpson is rightfully considered the founder of obstetric anesthesiology.

Chloroform anesthesia was much more convenient and profitable than ether. It put a person to sleep faster and had a deeper effect. It did not require additional equipment; it was enough to inhale the vapor from gauze soaked in chloroform.

Cocaine is a local anesthetic used by South American Indians.

Forefathers local anesthesia are considered to be South American Indians. They have been using cocaine as a painkiller for a long time. This plant alkaloid was extracted from the leaves of the native Erythroxylon coca shrub.

The Indians considered the plant a gift from the gods. Coca was planted in special fields. Young leaves were carefully picked from the bush and dried. If necessary, the dried leaves were chewed and saliva was poured over the damaged area. It lost sensitivity and traditional healers started the operation.

Koller's research in local anesthesia

The need to provide pain relief in a limited area was especially acute for dentists. Tooth extraction and other interventions in dental tissue caused unbearable pain in patients. Who invented local anesthesia? In the 19th century, in parallel with experiments on general anesthesia searches were carried out effective method for limited (local) anesthesia. In 1894, the hollow needle was invented. Dentists used morphine and cocaine to relieve toothache.

A professor from St. Petersburg, Vasily Konstantinovich Anrep, wrote in his works about the properties of coca derivatives to reduce sensitivity in tissues. His works were studied in detail by the Austrian ophthalmologist Karl Koller. A young doctor decided to use cocaine as an anesthetic during eye surgery. The experiments turned out to be successful. The patients remained conscious and did not feel pain. In 1884, Koller informed the Viennese medical community about his achievements. Thus, the results of the experiments of the Austrian doctor are the first officially confirmed examples of local anesthesia.

History of the development of endotrachial anesthesia

In modern anesthesiology, endotracheal anesthesia, also called intubation or combined, is most often practiced. This is the safest type of anesthesia for humans. Its use allows you to keep the patient’s condition under control and perform complex abdominal operations.

Who invented endotrochial anesthesia? The first documented case of the use of a breathing tube for medical purposes is associated with the name of Paracelsus. An outstanding doctor of the Middle Ages inserted a tube into the trachea of ​​a dying man and thereby saved his life.

In the 16th century, Andre Vesalius, a professor of medicine from Padua, conducted experiments on animals by inserting breathing tubes into their tracheas.

The occasional use of breathing tubes during operations provided the basis for further development in the field of anesthesiology. In the early 70s of the 19th century, the German surgeon Trendelenburg made a breathing tube equipped with a cuff.

The use of muscle relaxants in intubation anesthesia

The widespread use of intubation anesthesia began in 1942, when Canadians Harold Griffith and Enid Johnson used muscle relaxants - drugs that relax muscles - during surgery. They injected the patient with the alkaloid tubocurarine (intokostrin), obtained from the famous poison of the South American Indians, curare. The innovation made intubation procedures easier and made operations safer. Canadians are considered to be the innovators of endotracheal anesthesia.

Now you know who invented general anesthesia and local. Modern anesthesiology does not stand still. Traditional methods are successfully used, and the latest medical developments are introduced. Anesthesia is a complex, multicomponent process on which the health and life of the patient depends.

For the first time, Faraday (1818) drew attention to the “intoxicating” properties of diethyl ether vapor and the probable possibility of using them for pain relief. The first operation under ether anesthesia was performed in 1842 by the American surgeon Long, but he did not report his observation. On October 16, 1846, dentist Morton, with the participation of chemist Jackson, successfully demonstrated ether anesthesia in Boston. This date is considered the birthday of anesthesiology.

In Russia, the first operation under ether anesthesia was performed at the Moscow University clinic by F.I. Inozemtsev on February 7, 1847. A week later, his experience was repeated by N.I. Pirogov. From then until the mid-1970s, ether was the most commonly used anesthetic.

Ether anesthesia has been well studied. These circumstances, as well as the pronounced phase nature of the course, served as the basis for the fact that ether anesthesia in anesthesiology is considered to be the “standard”, comparing all other inhalational anesthetics in terms of strength, toxicity, and phase character of the course of anesthesia with ether. Due to its pronounced toxicity, the presence of an excitation phase during anesthesia, and flammability, ether has completely fallen out of use in modern anesthesiology. However, due to its wide range of therapeutic effects, it continues to be one of the safest inhalational anesthetics. It is included in the “List of vital and essential medicines”, approved by order of the Government of the Russian Federation of April 4, 2002 No. 425-r.

To understand the genesis of symptoms developing during ether anesthesia, it is necessary to remember that various functions and reflexes are carried out by various structures and systems of the brain. The clinic of anesthesia, in fact, consists of a sequence of inhibition and sometimes activation of reflexes, the centers of which are localized in specific anatomical structures. How can we explain that different parts of the brain are not simultaneously subject to inhibition caused by the anesthetic?

Numerous studies conducted by the schools of Jackson and I.P. Pavlov have shown that phylogenetically young structures of the central nervous system are less resistant to the action of any irritants, including anesthetics, than more ancient ones. Thus, inhibition of brain structures during anesthesia occurs as if from top to bottom. - fromyoung to older in the following sequence:

subcortical centers

brain stem

At the same time, it should be noted that young brain structures have greater “plasticity” - they respond faster and differentiate (that is, with a larger set of reflexes) to any irritation. As an example, we can compare the innumerable set of functions of the cerebral cortex and the small arsenal of centers medulla oblongata. At the same time, the most sophisticated functions of the cortex, such as intellect, are subject to rapid fatigue, and not a single researcher has been able to subject the vasomotor center to fatigue, even in an experiment.

Ether (diethyl ether) is a colorless transparent liquid with a boiling point of 35ºC. When exposed to light and air, it decomposes to form toxic products, so it is stored in a dark, airtight container. It and its vapors are highly flammable and explosive. The ether has high narcotic activity and great breadth therapeutic action. Under the influence of ether, the secretion of the salivary and bronchial glands increases, the tone of the bronchial muscles decreases, and irritation of the membranes of the respiratory tract occurs, accompanied by cough, laryngospasm, and bronchospasm. The drug also irritates the mucous membrane of the stomach and intestines, which leads to nausea and vomiting in the postoperative period. Inhibition of peristalsis contributes to the development of postoperative intestinal paresis

As already mentioned above, ether anesthesia has a pronounced phasic flow, reflecting the sequence of distribution of inhibition through the structures of the brain. Currently, the classification of phases by Guedel, developed by him in 1920 - 1937, is generally accepted. He was the first to propose a graphical display of the phases of the course of anesthesia.

First phase - analgesia (I)- characterized only by partial inhibition of the cerebral cortex, leading to loss of pain sensitivity and retrograde amnesia. The complete absence of neurovegetative blockade and reliable methods of stabilizing anesthesia at this level (attempts were made by Artusio, McIntosh) make the analgesia phase practically unsuitable for any lengthy and traumatic surgical procedures. The presence of analgesia and neurolepsy (the first two components of anesthesia) allows for short-term, low-traumatic interventions (reduction of a dislocation, opening of a superficial abscess, etc.).

The analgesia phase begins from the moment the inhalation of ether vapor begins, the concentration of which in the inhaled gas mixture is 1.5-2% by volume. There is a gradual darkening of consciousness, loss of orientation, speech becomes incoherent. The skin of the face is hyperemic, the pupils are of normal size and actively react to light. Breathing and pulse are increased, blood pressure is slightly increased. Tactile and temperature sensitivity and reflexes are preserved, pain sensitivity gradually fades away. In the normal course of anesthesia, its duration is 3–8 minutes, after which loss of consciousness occurs and the second phase of anesthesia begins.

Second phase - excitation(II)- characterized by progressive depression of the cerebral cortex, which is manifested by a lack of consciousness and motor-speech excitation due to the absence of the inhibitory influence of the cortex on the subcortical centers. Surgical manipulations are impossible due to motor-speech agitation.

Skin sharply hyperemic, eyelids are closed, pupils are dilated, the reaction to light is preserved, lacrimation and involuntary swimming movements of the eyeballs are noted. The muscles, especially the chewing ones, are sharply tense (trismus). Cough and gag reflexes are strengthened. The pulse is increased, arrhythmias are possible, blood pressure is increased. Involuntary urination and vomiting may occur. The concentration of ether in the gas mixture during the excitation phase is increased to 10-12% by volume in order to quickly saturate the body with anesthetic vapors. The average duration depends on the age and physical condition of the patient and is 1-5 minutes. Motor-speech excitation lasts longer and more actively in physically strong individuals and alcoholics (persons sensitized to neurotropic poisons).

The third phase is surgical- divided into 4 levels: III 1, III 2, III 3, III 4. It comes in 12-20 minutes. After the start of inhalation of ether vapor. With its onset, the concentration of anesthetic in the gas mixture is reduced to 4-8 vol.%, and subsequently - to maintain anesthesia - to 2-4 vol.%

Level 1 - movements of the eyeballs – III 1 – got its name from the characteristic clinical manifestation – eyeballs make slow, smooth, uncoordinated movements. This level is characterized by the spread of inhibition to subcortical structures (globus pallidus, caudate body, etc.) and complete inhibition of the cortex, as a result of which motor-speech excitation ends.

Coming restful sleep. The breathing is even, somewhat rapid, the pulse is also somewhat rapid, even. BP at baseline. The pupils are evenly constricted and react to light. Skin reflexes disappear.

At the same time, the preservation of the corneal and pharyngeal reflexes (see below) indicates that the brain stem has not yet been affected by the inhibition process, i.e. There is no neurovegetative blockade. These data allow us to characterize level III 1 as superficial anesthesia, the depth of which (in the absence of potentiation means, i.e. mononarcosis) is insufficient to perform traumatic operations.

Level 2 - corneal reflex – III 2 - got its name from the disappearance of the corneal reflex, which is an important anesthetic symptom. The reflex is that when the cornea is irritated (touched with a thread from sterile gauze), the eyelids close.

To understand the importance of this clinical sign, it is necessary to become familiar with the reflex arc. The afferent part is carried out by the first branch of the trigeminal nerve. The nuclei of the V pair of cranial nerves are located along almost the entire trunk. Sensitive nuclei lie in the anterior part of the pons and medulla oblongata. The efferent part of the reflex - the closing of the eyelids is carried out by contraction m. orbicularis oculi which is innervated by motor fibers n. facialis(VII pair of cranial nerves). The source of these fibers is the motor nucleus nucl. motorius VII, located in the dorsal part of the bridge. The disappearance of the corneal reflex indicates that inhibition has reached the brain stem, that is, the Thalamus and Hypothalamus are blocked by the anesthetic. The influence of pain impulses on the autonomic nervous system is eliminated, which indicates the achievement of the third most important component of anesthesia - neurovegetative blockade. At this level, traumatic and prolonged operations on “shockogenic” areas and organs become possible.

Breathing is even, slow. Pulse and blood pressure are at the initial level. The mucous membranes are moist. The skin is pink. The eyeballs are fixed. The pupils are of normal width, the reaction to light is preserved. Muscle tone is significantly reduced. At the same time, already at this level there is a tendency to accelerate heart rate and decrease blood pressure; breathing becomes more superficial, which indicates the beginning of the influence of the anesthetic on the deeper structures of the brain, in particular on the regulatory systems of the vasomotor and respiratory centers of the medulla oblongata.

Level 3 - pupil dilation III 3 - characterized by inhibition of the pupillary reflex.

The afferent part of the reflex is represented by the optic nerve, along which impulses travel to the superior quadrigeminal, where they switch to the paired small-cell parasympathetic nucleus of Yakubovich, which gives rise to n.oculomatorius fibers that contract the circular muscle of the iris. Inhibition of the pupillary reflex indicates a further spread of inhibition down the brain stem. The appearance of a symptom of pupil dilation and a decrease in its reaction to light is an alarm signal for the anesthesiologist, indicating that inhibition has already affected most of the brain stem. It has been established experimentally and clinically (for brainstem strokes) that blockade of the brainstem at the level of the pons leads to cessation of breathing and circulation. Signs of inhibition of the medulla oblongata centers at this level are already completely obvious. Tachycardia and a tendency to hypotension indicate an increasing deficit of blood volume due to vasoplegia. Breathing becomes increasingly shallow and is maintained mainly through the diaphragm. External respiration function on level III 3 is decompensated, which requires auxiliary ventilation. At this level, the laryngeal reflex is completely inhibited, making intubation possible without the use of muscle relaxants.

Among other symptoms of the third level, dry mucous membranes (conjunctiva) and a sharp decrease in muscle tone should be noted.

Level 4 - diaphragmatic breathing – III 4 - characterized by extreme depression of all vital functions, complete areflexia, requiring immediate cessation of the anesthetic supply, oxygen ventilation, use of vasopressors and compensation for the deficit of blood volume. Should not be allowed in anesthesiological practice.

The pupils are dilated and do not react to light. The cornea is dry and dull. Breathing is shallow, arrhythmic, only due to the diaphragm. Pulse is thready, blood pressure is low. The skin is pale, acrocyanosis. Sphincter paralysis occurs.

Fourth phase - awakening (IV) characterized by the reverse development of the described symptoms within 5-30 minutes, depending on the depth of anesthesia achieved. The stage of excitement is short-lived and weakly expressed. The analgesic effect persists for several hours.

Complications of ether anesthesia are mainly associated with the development of asphyxia of various origins. Phases II and II may develop laryngeal and bronchospasm under the influence of irritating ether vapors. Reflex apnea of ​​the same origin is less common. Described isolated cases vagal cardiac arrest under the influence of ether vapor ( nervus vagus innervates part of the epiglottis). Asphyxia can develop as a result of vomiting and aspiration of gastric contents (reflexively, in phases I and II) or passive regurgitation of gastric contents and retraction of the root of the tongue at level III 3-4.

MASK FOR NARCOSIS- an independent device or part of a device that is placed on the patient’s face for inhalation anesthesia and (or) artificial ventilation. Masks are divided into two main groups: non-sealed (open) - for drip anesthesia and sealed (closed) - for general anesthesia and artificial lung ventilation (ALV) using an inhalation anesthesia machine and (or) a ventilator. Masks of the second group are, therefore, a necessary element that ensures tightness between the patient's lungs and an anesthesia machine or ventilator. According to their purpose and design, masks are divided into facial, oral and nasal.

The creation of the first prototypes of modern anesthesia-respiratory masks was carried out much earlier than the discovery of inhalation anesthesia and is associated with the discovery of oxygen and its inhalation - masks of Chaussier (1780), Menzies (1790), Girtanner (1795). Directly for anesthesia, masks appeared only in the mid-19th century - a mouth mask was proposed by W. Morton in 1846, face masks - by N. I. Pirogov, J. Snow and S. Gibson in 1847. 1862 K. Schimmelbusch proposed a simple wire mask, the frame of which is covered with 4-6 layers of gauze before anesthesia (Fig. 1, 1). The masks of Esmarch (Fig. 1, 2) and Vancouver are similar in design. Schimmelbusch, Esmarch and similar masks are non-hermetic masks. So-called suffocating masks (for example, the Ombredanna-Sadovenko mask) have only historical significance. Unsealed masks, due to their simplicity and general availability, were widely used in anesthesia practice in the past, with diethyl ether, chloroform, and, less commonly, fluorothane, trichlorethylene and chloroethylene used. Special attention when using these masks, pay attention to protecting the patient’s facial skin, conjunctiva and cornea from irritating effect volatile anesthetics. For protection, lubricate the facial skin with Vaseline, cover the eyes and face around the mouth and nose with a towel, drip the anesthetic evenly over the entire surface of the mask, etc. However, due to the disadvantages of this technique (less accurate than in cases of using anesthesia machines and evaporators with a dosage anesthetic), the impossibility of performing mechanical ventilation in these conditions, as well as severe pollution of the operating room atmosphere with vapors of volatile anesthetics, non-hermetic masks are practically not used. However, their use may be the only possible method carrying out general anesthesia in difficult conditions. In modern anesthesia practice, sealed masks are used.

Basic requirements for modern masks: minimum volume of the so-called. potential harmful space (volume of the mask dome after pressing it to the patient’s face; Fig. 2); tightness due to the tight fit of the mask to the patient’s face; absence of toxic impurities in the material from which the mask is made; simple sterilization. The dome of masks is most often made of gigabyte. antistatic rubber or various types plastics A close fit is ensured by the presence of an inflatable rim (cuff) or flange along the edge of the mask. Some masks are made from two layers of rubber, with air between them (Fig. 3). In the center of the dome of the mask there is a fitting for connecting it to the adapter of the anesthesia machine. For general anesthesia in ophthalmology, a mask is proposed, the connector (fitting) cut towards the patient’s chin (Fig. 4). Nasal masks (Fig. 5) are most often used in dentistry; they allow fairly free manipulation in oral cavity patient. An example of an oral mask is the flat Andreev mask (Fig. 6) with the parietal direction of the applied fixation force, in contrast to the nature of fixation of conventional sealed masks. Fixation lower jaw carried out using additional straps. Unobstructed airway patency is ensured using a special oropharyngeal airway, which is inserted after strengthening the mask on the face (after induction of anesthesia against the background of total muscle relaxation). The advantages of such masks are the reduction of potential harmful space and the ability to tightly fix the mask to the patient’s face.

To prevent infection of patients, it is recommended either to use disposable masks or to thoroughly disinfect and sterilize them. Typically, mechanical cleaning and washing of the mask with water and soap are carried out, followed by sterilization (disinfection) and secure storage to eliminate or reduce the likelihood of re-contamination of the mask. It is possible to use both physical (heat, radiation, ultrasound, UV rays) and chemical methods sterilization (disinfection): 0.1 - 1% aqueous or alcohol solution chlorhexidine, 0.5-1% water solution peracetic acid, 0.1% alcohol solution of chloramphenicol, 0.02% aqueous Furacilin solution, 0.05% aqueous diocide solution; vapors of formaldehyde, ethylene oxide, etc. The use of phenol derivatives for disinfection is considered dangerous, since phenol can penetrate the rubber and cause chemical reactions during subsequent use of masks. facial skin burn.

Save masks in plastic bags, glass desiccators, etc.

Bibliography Andreev G. N. Modern features solving the main problems of the mask method of inhalation anesthesia and artificial ventilation, Anest. and resuscitation, No. 1, p. 3, 1977, bibliogr.; Vartazaryan D.V. Sterilization and disinfection of anesthesia-respiratory equipment, ibid., No. 4, p. 3, bibliography; Sipchenko V.I. Microbial contamination and sterilization of anesthesia equipment, Surgery, No. 4, p. 25, 1962, bibliogr.; S 1 a t t e g E. M. The evolution of anaesthesia, Brit. J. Anaesth., v. 32, p. 89, 1960, bibliogr.; Wylie W. D. a. Churchill-Davidson H. C. A practice of anaesthesia, L., 1966.

This substance began a new era in surgical medicine. It was ether anesthesia (aether pro narcosi) that allowed scientists to perform the first operations using general anesthesia. Having begun its life's journey back in the mid-nineteenth century, stabilized anesthesia ether is still used in anesthesiology.

Despite the variety of anesthesia drugs, medicine still continues to use ether for anesthesia.

Currently, anesthesiology has stepped far forward, having formed into a separate science. The arsenal of anesthesiologists has been replenished with new, more effective and safe drugs, but doctors will not be able to completely abandon ether yet long time. This has important reasons: wide therapeutic range and ease of anesthesia with ether. In modern anesthesia, the drug is not used for monocomponent anesthesia, but is successfully used in combination with other narcotic drugs.

• A wide therapeutic range, allowing you to easily adjust the depth of narcotic sleep, as well as reducing the risk of overdose.
• It is a muscle relaxant, so ether is convenient for most operations.
• Does not enhance the effect of adrenaline on myocytes.
• It can be used both by mask and by intubation.
• Allows the patient to simultaneously inhale a high concentration of oxygen.

Disadvantages of Ether

• A long time is required for drug saturation (up to twenty minutes). This period is often accompanied by a feeling of fear and suffocation, up to the development of laryngospasm.
• Significantly increases the secretion of mucus in the lungs, which can lead to the development of complications from the respiratory system.
• The stage of excitation is sharply expressed, accompanied by motor and speech disinhibition.
• The awakening stage lasts up to thirty minutes after the end of the substance supply, during which time respiratory depression, increased secretion of saliva and gastric juice, which often leads to vomiting with the development of aspiration (throwing stomach contents into pulmonary tree).
• Impairs insulin sensitivity to glucose, thus may increase blood sugar levels.

How modern anesthesiologists use ether

Due to side effects and possible complications, in modern medicine, stabilized anesthesia ether is more often used for the maintenance stage combined anesthesia. Anesthesiologists use different schemes combinations of ether with oxygen, fluorotane and nitrous oxide. For induction of anesthesia, intravenous forms are usually used. narcotic drugs, developing drug saturation within a few seconds, for example, barbiturates. The use of ether anesthesia requires the mandatory administration of muscle relaxants, atropine; tranquilizers and analgesics are also used in low concentrations.

The ether is used for the maintenance stage of combined anesthesia with muscle relaxants and atropine.

For anesthesia use only dosage form: stabilized ether for anesthesia. The substance is a transparent liquid that evaporates easily, creating high concentration narcotic vapors. Vapors are flammable and explosive, especially when joint use with oxygen.

Indications and contraindications for the use of ether

As part of combined general anesthesia, stabilized anesthesia ether is used for various operations V general surgery, urology, traumatology, proctology, gynecology and other types surgical care. However, its use is limited in neurosurgery, maxillofacial surgery, as well as for other surgical interventions where it is planned to use electric tools (due to explosion hazard). Explosion hazard is one of the factors limiting the use of ether for monocomponent anesthesia.

Stabilized ether for anesthesia is used with caution in pregnant and lactating women (there is no reliable data on the effect of the substance on the fetus, and the degree of penetration of the drug into breast milk has not been studied).

The ester is used with caution in pregnant and lactating women

Ether anesthesia is contraindicated in patients with serious pathology of the lungs, as well as the cardiovascular system, and is not advisable in patients with diabetes mellitus and metabolic disorders.

Conclusion

Medicines for general pain relief, like other medicines, undergo rigorous study (clinical trials) before they are approved for use in people. However, narcotic drugs are used for general anesthesia; they all have side effects and are, in fact, poison for the human body. But general anesthesia is not a prophylactic course of vitamins; it is carried out only in case of emergency and, therefore side effect anesthesia is a necessary measure. With the correct and skillful combination of different anesthetics, specialists perform anesthesia as safely and comfortably as possible for the patient. Short-term introduction narcotic drugs does not lead to development drug addiction and irreversible side effects.