Ether for anesthesia purposes: 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 back in the middle of the 19th century by a group of scientists who used it for general anesthesia during a surgical operation. 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 quite Strong smell(since evaporation occurs quickly, the concentration of the substance upon inhalation is quite high).

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

As a powerful muscle relaxant and analgesic agent, ether anesthesia has proven itself well in surgical intervention. Application this drug It is performed during short operations, since the period of its action is from 20 to 40 minutes, after which the patient wakes up. 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 impact. Ether for anesthesia is used for:

• decrease in susceptibility to epiniphrine and norepinephrine;
• temporary (up to 24 hours) decrease in the volume of circulating blood by 10%, slowing down of the liver, kidneys, intestinal motility;
• relaxation of skeletal muscles;
• increase in 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 inhalation anesthesia of a closed or semi-open type. The use of ether anesthesia is contraindicated for patients with:

• 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 fits, 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. With non-medical use of the drug, it can cause deep depression of the nervous system.

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

1. agonal stage. It occurs with an overdose of the drug. In this case, the patient has 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 is ultra-deep, deep, medium and light.
3. Excitation stage. At this stage, the patient's blood pressure rises, the pulse quickens. The patient at this stage is highly agitated, muscle tone is increased, speech and physical activity, there is a loss of consciousness, coughing sometimes gag reflex.
4. General anesthesia. At this stage, intoxication with diethyl ether occurs - the patient has normal physical indicators, a clear mind, however pain sensitivity is lost.

Possible consequences of ether anesthesia

Anesthesia with ether can cause poisoning of the body, which has negative consequences for the patient:

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

Along with this, ether anesthesia can cause hallucinations. Everything that happens around a person seems to him a reality, in fact, it is all hallucinations of both visual and sound types. He is trying to contact an imaginary world that only he sees, 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. On an unprepared person, ether anesthesia can have a dissociative effect, which will be expressed in a violation of perception by consciousness.

Conclusion

Like others medicines Anesthesia drugs undergo rigorous clinical trials before they are allowed to be used on patients. Dimethyl ether has side effects, and in fact, it poisons the body, but not critical, since with proper use, a person quickly recovers from anesthesia. Therefore, it is prescribed only in case of emergency, it follows that side effects are a necessary measure. With skillful and the right combination various anesthetics, doctors perform anesthesia as comfortably and safely as possible for human body.

"The Divine Art of Destroying Pain" for a long time was beyond human control. For centuries, patients have been forced to patiently endure torment, and healers have not been able to end 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 in the process of reading the article.

Anesthesia techniques in antiquity

Who invented anesthesia and why? Since the dawn of medical science, physicians have tried to solve important issues: how to make surgical manipulations as painless as possible for patients? With severe injuries, people died not only from the consequences of the injury, but also from the experienced pain shock. The surgeon had no more than 5 minutes to perform the operations, otherwise the pain became unbearable. The Aesculapius of antiquity were armed with various means.

IN Ancient Egypt used crocodile fat or alligator skin powder as anesthetics. One of the ancient Egyptian manuscripts, dated 1500 BC, describes the analgesic properties of the opium poppy.

IN ancient india healers used substances based on Indian hemp to obtain painkillers. Chinese physician Hua Tuo, who lived in the 2nd century BC. AD, offered patients to drink wine with the addition of marijuana before the operation.

Anesthesia methods 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 an extract from the mandrake had a narcotic effect on a person, clouded the mind, dulled the pain. However, incorrect dosage could lead to lethal outcome and frequent use led to addiction. The analgesic properties of mandrake for the first time in the 1st century AD. described ancient Greek philosopher Dioscorides. He gave them the name "anesthesia" - "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, this method was forgotten.

To turn off a person's consciousness for the most complex manipulations, surgeons used a wooden hammer. The patient was struck on the head, and he temporarily fell into unconsciousness. The method was crude and inefficient.

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

Cooling and hypnosis as methods of pain relief

At the turn of the 16th and 17th centuries, the Neapolitan physician Aurelio Saverina reduced the sensitivity of operated organs with the help of cooling. The diseased part of the body was rubbed with snow, thus being subjected to a slight frost. Patients experienced less pain. This method has been described in the literature, but few people have resorted to it.

About anesthesia with the help of 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 ° C.

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

Chemical experiments of the XVIII-XIX centuries

With development scientific knowledge scientists began to gradually approach the solution difficult problem. At the beginning of the 19th century, the English naturalist H. Davy established on the basis of personal experience that inhalation of nitrous oxide vapors dulls the sensation of pain in a person. M. Faraday found that vapors cause a similar effect sulfuric ether. Their discoveries have not found practical application.

In the mid 40s. XIX century dentist G. Wells from the USA became the first person in the world who underwent surgical manipulation while under the influence of an anesthetic - nitrous oxide or "laughing gas". Wells had a tooth removed, but he felt no pain. Wells was inspired by a successful experience and began to promote a new method. However, a repeated public demonstration of the action chemical anesthetic ended in failure. Wells failed to win the laurels of the discoverer of anesthesia.

The invention of ether anesthesia

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

In medical circles, they picked up the idea ether anesthesia. Operations with its use were made by doctors in France, Great Britain, Germany.

Who invented anesthesia in Russia? First Russian doctor who ventured to test 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 discoverer of anesthesia in Russia.

The contribution of N. I. Pirogov to the world anesthesiology and traumatology

Other Russian doctors followed in the footsteps of Inozemtsev, 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 injured limbs with the help of plaster cast. The physician tested his method on wounded soldiers during Crimean War. However, Pirogov cannot be considered the discoverer this method. Gypsum as a fixing material was used long before him (Arab doctors, the Dutch Hendrichs and Mathyssen, the Frenchman Lafargue, the Russians Gibental and Basov). Pirogov only improved plaster fixation, made 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, the Scottish obstetrician D. Simpson, actively introduced anesthesia for women in labor to facilitate 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 anesthesia. He quickly plunged a person into sleep, had a deeper effect. He did not need additional equipment, it was enough to inhale the vapors with gauze soaked in chloroform.

Cocaine - local anesthetic of South American Indians

Ancestors local anesthesia considered to be South American Indians. They have been practicing cocaine as an anesthetic since ancient times. This plant alkaloid was extracted from the leaves of the local shrub Erythroxylon coca.

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

Koller's research in local anesthesia

The need to provide anesthesia in a limited area was especially acute for dentists. Extraction of teeth and other interventions in dental tissues caused unbearable pain in patients. Who Invented Local Anesthesia? In the 19th century, in parallel with experiments on general anesthesia searches were made effective method for limited (local) anesthesia. In 1894, a hollow needle was invented. To stop toothache, dentists used morphine and cocaine.

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

The history of the development of endotrachial anesthesia

In modern anesthesiology, endotracheal anesthesia, also called intubation or combined anesthesia, is most often practiced. This is the safest type of anesthesia for a person. Its use allows you to control the patient's condition, to carry out 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 person and thereby saved his life.

André Vesalius, a professor of medicine from Padua, conducted experiments on animals in the 16th century 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 XIX century, the German surgeon Trendelenburg made a breathing tube equipped with a cuff.

The use of muscle relaxants in intubation anesthesia

The mass use of intubation anesthesia began in 1942, when Canadians Harold Griffith and Enid Johnson used muscle relaxants during surgery - drugs that relax muscles. They injected the patient with the alkaloid tubocurarine (intokostrin), obtained from the well-known poison of the South American curare Indians. The innovation facilitated the implementation of intubation measures 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 applied, the latest medical developments are being 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 "stupefying" properties of diethyl ether vapors 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, the dentist Morton, with the participation of the chemist Jackson in Boston, successfully demonstrated ether anesthesia. This date is considered the birthday of anesthesiology.

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

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

To understand the genesis of the symptoms that develop during ether anesthesia, it must be remembered that various functions and reflexes are carried out by various structures and systems of the brain. The anesthesia clinic, 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 one explain that different parts of the brain are not simultaneously subjected to inhibition caused by an anesthetic?

Numerous studies conducted by the schools of Jackson and I.P. Pavlov have shown that phylogenetically young CNS structures are less resistant to the action of any stimuli, including anesthetics, than older ones. Thus, the inhibition of brain structures during anesthesia occurs, as it were, 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 are faster and differentiate (that is, with a large set of reflexes) respond to any stimulation. As an example, we can compare the innumerable set of functions of the cerebral cortex and a small arsenal of centers medulla oblongata. At the same time, the most refined functions of the cortex, such as the 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 35ºС. Under the influence of light and air, it decomposes with the formation of toxic products, therefore it is stored in a dark sealed container. He and his vapors are highly flammable and explosive. The ether has a high narcotic activity and a large latitude therapeutic action. Under the influence of ether, the secretion of the salivary and bronchial glands increases, the tone of the muscles of the bronchi decreases, irritation of the membranes of the respiratory tract occurs, accompanied by cough, laryngospasm, 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 propagation of inhibition through the structures of the brain. At present, Guedel's classification of phases, developed by him in 1920-1937, is generally recognized. He was the first to propose a graphical representation of the phase of the course of anesthesia.

First phase - analgesia (I)- characterized by only partial inhibition of the cerebral cortex, leading to loss of pain sensitivity and retrograde amnesia. The complete absence of neurovegetative blockade and reliable ways to stabilize 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 dislocation, opening of a superficial abscess, etc.).

The phase of analgesia 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, actively react to light. Respiration and pulse are quickened, blood pressure is slightly increased. Tactile, temperature sensitivity and reflexes are preserved, pain sensitivity gradually fades away. In the usual course of anesthesia, its duration is 3-8 minutes, after which there is a loss of consciousness and the second phase of anesthesia begins.

The second phase - excitation(II)- characterized by progressive inhibition of the cerebral cortex, which is manifested by a lack of consciousness and motor-speech excitation due to the absence of an inhibitory effect of the cortex on the subcortical centers. Surgical manipulations are impossible due to motor-speech excitation.

Skin sharply hyperemic, the eyelids are closed, the pupils are dilated, the reaction to light is preserved, lacrimation, involuntary swimming movements of the eyeballs are noted. Muscles, especially chewing, sharply tense (trismus). Cough and gag reflexes are enhanced. The pulse is speeded up, arrhythmias are possible, blood pressure is increased. Possible involuntary urination and vomiting. The concentration of ether in the gas mixture in 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 proceeds longer and more actively in physically strong individuals and alcoholics (persons sensitized to neurotropic poisons).

Third phase - surgical- is 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 vapors. With its onset, the concentration of the anesthetic in the gas mixture is reduced to 4-8% by volume, and later - to maintain anesthesia - up to 2-4% by volume.

1st level - 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 the subcortical structures (globe pallidum, caudate body, etc.) and complete inhibition of the cortex, as a result of which motor-speech excitation ends.

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

At the same time, the persistence of the corneal and pharyngeal reflexes (see below) indicates that the brainstem has not yet been affected by the inhibition process; no neurovegetative blockade. These data make it possible to characterize level III 1 as superficial anesthesia, the depth of which (in the absence of potentiators, 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 lies in the fact 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 familiarize yourself 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 throughout almost the entire trunk. Sensitive nuclei lie in the anterior part of the bridge and the 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 CHMN). 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 the inhibition has reached the brainstem, 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" zones and organs become possible.

Breathing is even, slow. Pulse and blood pressure - at the initial level. Mucous membranes are moist. The skin is pink. The eyeballs are fixed. Pupils of normal width, 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 reduce 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.

3rd level - 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 the impulses go to the superior quadrigemina, where they switch to the paired small-cell parasympathetic nucleus of Yakubovich, which gives rise to the n.oculomatorius fibers, which contract the circular muscle of the iris. Inhibition of the pupillary reflex indicates a further spread of inhibition down the brainstem. 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 covered a large part of the brain stem. Experimentally and clinically (with stem strokes) it has been established that the blockade of the trunk at the level of the bridge leads to respiratory and circulatory arrest. Signs of inhibition of the centers of the medulla oblongata at this level are already quite obvious. Tachycardia and a tendency to hypotension indicate an increasing deficit of BCC due to vasoplegia. Breathing becomes more and more superficial, is preserved mainly due to diaphragmatic breathing. The function of external respiration level III 3 is decompensated, which requires auxiliary ventilation. At this level, the laryngeal reflex is completely inhibited, which makes intubation possible without the use of muscle relaxants.

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

4th level - diaphragmatic breathing - III 4 - characterized by extreme inhibition of all vital functions, complete areflexia, requiring an immediate cessation of the supply of anesthetic, mechanical ventilation with oxygen, the use of vasopressors and compensation for the BCC deficiency. Should not be allowed in anesthesiology practice.

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

Fourth phase - awakenings (IV) characterized by the reverse development of the described symptoms within 5-30 minutes, depending on the achieved depth of anesthesia. The stage of excitation is short-term 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. In the II and II phases, the development of laryngeal and bronchospasm is possible under the influence of irritating ether vapors. Less commonly observed reflex apnea of ​​the same origin. Described isolated cases vagal cardiac arrest under the influence of ether vapors ( nervus vagus innervates part of the epiglottis). Asphyxia may develop as a result of vomiting and aspiration of gastric contents (reflex, in phases I and II) or passive regurgitation of gastric contents and retraction of the root of the tongue at level III 3-4.

ANESTHESIA MASK- an independent device or part of the apparatus that is applied to the patient's face for inhalation anesthesia and (or) artificial ventilation of the lungs. Masks are divided into two main groups: non-hermetic (open) - for anesthesia by the drip method 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 patient's lungs and 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 anesthetic-breathing masks was carried out much earlier than the discovery of inhalation anesthesia and is associated with the discovery of oxygen and its inhalation - Chaussier masks (1780), Menzies (1790), Girtanner (1795). Directly for anesthesia, masks appear only in the middle of the 19th century - the mouth mask was proposed by W. Morton in 1846, facial masks - by N. I. Pirogov, J. Snow and S. Gibson in 1847. 1862 K. Shimmelbusch offered a simple wire mask, a cut frame before an anesthesia is covered with 4-6 layers of a gauze (fig. 1, 1). Similar in design to Esmarch's masks (Fig. 1, 2) and Vancouver's. The masks of Schimmelbusch, Esmarch and the like are non-hermetic masks. So called. asphyxiating masks (for example, the Ombredand-Sadovenko mask) have only historical significance. Leaky masks due to simplicity and general availability in the past were widely used in anesthesiology, practice, while diethyl ether, chloroform were mainly used, less often halothane, trichlorethylene and chloro-ethyl. Special attention when using these masks, they pay attention to protecting the skin of the face, conjunctiva and cornea of ​​the patient's eyes from irritant volatile anesthetics. For protection, they lubricate the skin of the face with petroleum jelly, cover the eyes and face around the mouth and nose with a towel, evenly drip anesthetic over the entire surface of the mask, etc. However, due to the shortcomings of this technique (less accurate than in cases of using anesthesia machines and evaporators with dosage anesthetic), the impossibility of carrying out mechanical ventilation under these conditions, as well as the pronounced pollution of the operating room atmosphere with vapors of volatile anesthetics, leaky masks are practically not used. However, their use may be the only possible method holding general anesthesia in difficult conditions. In modern anesthesiology, practice use tight masks.

The main requirements for modern masks: the minimum volume of the so-called. potential harmful space (volume of the dome of the mask after pressing it to the patient's face; Fig. 2); tightness due to the snug fit of the mask to the patient's face; the absence of toxic impurities in the material from which the mask is made; simple sterilization. The dome of masks is most often made of giga. antistatic rubber or various kinds 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, between which there is air (Fig. 3). In the center of the dome of the mask there is a fitting for attaching it to the adapter of the anesthesia machine. For general anesthesia in ophthalmology, a mask is proposed, the connector (fitting) is directed towards the patient's chin (Fig. 4). Nasal masks (Fig. 5) are most commonly used in dentistry; they allow enough freedom to manipulate in oral cavity patient. An example of an oral mask is Andreev's flat mask (Fig. 6) with a parietal direction of the applied fixation force, in contrast to the nature of the fixation of conventional sealed masks. fixation mandible carried out with the help of additional straps. Unobstructed airway patency is ensured by using a special oropharyngeal duct, which is inserted after the mask is fixed on the face (after induction anesthesia against the background of total muscle relaxation). The advantages of such masks are the reduction of potential harmful space and the possibility of hermetically fixing the mask to the patient's face.

To prevent infection of patients, either the use of disposable masks or careful disinfection and sterilization is recommended. The mask is usually mechanically cleaned and washed with water and soap, followed by sterilization (disinfection) and secure storage to eliminate or reduce the likelihood of recontamination of the mask. It is possible to use both physical (thermal exposure, 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 solution of furatsilina, 0.05% aqueous solution of diocide; vapors of formaldehyde, ethylene oxide, etc. The use of phenol derivatives for the purpose of disinfection is considered dangerous, since phenol can penetrate rubber and cause chem. facial burn.

Save masks to plastic bags, glass desiccators, etc.

Bibliography Andreev G. N. Modern features solving the main problems of the mask method of inhalation anesthesia and artificial lung ventilation, Anest. and resuscitation, No. 1, p. 3, 1977, bibliogr.; Vartazaryan DV Sterilization and disinfection of anesthesia and 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.

With this substance, a new era in operational medicine began. It was ether anesthesia (aether pro narcosi) that allowed scientists to perform the first operations using general anesthesia. Having begun its life journey in the middle of the nineteenth century, stabilized ether for anesthesia is still used in anesthesiology.

Despite the variety of drugs for anesthesia, 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 the ether yet long time. This is important reasons: wide therapeutic range and ease of anesthesia with ether. In the modern anesthetic manual, the drug is not used for monocomponent anesthesia, but is successfully used in combination with other drugs.

• A wide therapeutic range that allows you to easily adjust the depth of narcotic sleep, as well as reducing the risk of overdose.
• It is a muscle relaxant, so the ether is convenient for most operations.
• Does not enhance the effect of adrenaline on myocytes.
• It is possible to use both mask and intubation method.
• Allows simultaneous inhalation of the patient with a high concentration of oxygen.

Ethereum Disadvantages

• It takes a long time for narcotic 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, 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 completion of the substance, at which time respiratory depression, increased secretion of saliva and gastric juice, which often leads to vomiting with the development of aspiration (reflux of stomach contents into lung tree).
• Impairs insulin sensitivity to glucose, thus may raise blood sugar levels.

How ether is used by modern anesthesiologists

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

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 clear liquid that evaporates easily, creating high concentration narcotic fumes. Vapors are flammable and explosive, especially when joint application with oxygen.

Indications and contraindications for the use of ether

As part of combined general anesthesia, stabilized ether for anesthesia 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 an electric tool (due to the risk of explosion). Explosiveness is one of the factors limiting the use of ether for monocomponent anesthesia.

With caution, use ether for anesthesia stabilized 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).

Ether 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; it is not desirable in patients with diabetes and metabolic disorders.

Conclusion

Medicines for general pain, like other medicines, undergo extensive research (clinical trials) before being approved for use in humans. 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 narcotic drugs is a necessary measure. With the right and skillful combination of different anesthetics, specialists perform anesthesia as safely and comfortably as possible for the patient. Brief Introduction narcotic drugs does not lead to development drug addiction and irreversible side effects.