Types of general anesthesia in modern medicine. Local anesthesia Varieties of local anesthesia

Local anesthesia (from the Greek "an" - denial, "aesthesis - sensation) leads to the suppression of peripheral mechanisms for the perception of pain and other stimuli by the terminal apparatus of the nervous system or their conductors.

In surgery, several types of local anesthesia are used.

Infiltration anesthesia. With this type of anesthesia, peripheral nerve endings that perceive pain and other stimuli are turned off. This is done by impregnating the tissues in the area of the operation with an anesthetic solution (0.25% solution of novocaine), which, coming into direct contact with the nerve endings, causes a break in the conduction of nerve impulses (Fig. 1). Infiltration (impregnation) of tissues with a solution of novocaine is carried out in layers. First, through a thin needle, an anesthetic solution is injected into the thickness of the skin, creating a so-called “lemon peel” at the site of the future incision. Then the needle is advanced into the subcutaneous tissue, injecting a solution of novocaine into this layer, and behind it into deeper tissues. An incision of the skin and subcutaneous tissue can be made immediately after infiltration with an anesthetic solution of only these layers, and then injected under the aponeurosis, etc. In this case, the surgeon alternately uses a syringe and a scalpel.

Rice. 1. Local anesthesia.
A - infiltration of the skin with novocaine; B - layered tissue infiltration; B - anesthesia from two injections according to the principle of a rhombus; G-anaesthesia of the limb according to the type of cross section.

Conductor(regional or regional) anesthesia leads to a violation of the conduction of pain sensations by blocking the nerve trunks that innervate this area. To do this, a 1-2% novocaine solution is injected either into the nerve, or, much better, into the perineural tissue in order to avoid complications associated with nerve dissection.

case anesthesia, developed by A. V. Vishnevsky (1928), was a further development of infiltration anesthesia. Under pressure, a large amount of a weak solution of novocaine (0.25%) is injected, which, according to the principle of "tight infiltrate", spreads ("creeps") between the fascia, anesthetizing the nerve elements in the interfascial spaces. This achieves, in addition, the "hydraulic preparation" of tissues, which makes it easier for the surgeon to isolate organs and separate pathological adhesions. With this method, tissue infiltration always precedes their dissection.

Intravenous anesthesia, proposed by Beer (1908), is based on the introduction of an anesthetic solution into a vein. Novocaine quickly diffuses from the venous bed into the tissues and blocks the nerve elements located in them. An elastic bandage is applied to the limb proximal to the operation site, squeezing the veins. By puncture, 100-250 ml of a 0.5% solution of novocaine is injected into a superficial vein, and then 50-100 ml of saline, which contributes to better diffusion of novocaine. Pain relief occurs after 20-30 minutes and stops with the removal of the bandage.

Intraosseous anesthesia is based on the same principle, but at the same time, novocaine solution is injected into the cancellous bone. A sharply beveled needle with a mandrel is passed through the cortical layer of the bone by 0.5-1.5 cm into the spongy substance. Removing the mandrin, 25-120 ml of a 0.5% solution of novocaine is injected. On the arm, a puncture is made into the head of the I and II metacarpal bones, into the distal epiphysis of the radius, the olecranon, and the epicondyles of the shoulder; on the leg - in the head of the I metatarsal bone, in the outer surface of the calcaneus, the outer malleolus, the internal condyles of the tibia and the condyles of the thigh.

Spinal anesthesia, proposed by Quincke (1891), is the introduction into the subarachnoid space of an anesthetic that blocks the conduction of the nerve roots of the spinal cord. The puncture of the subarachnoid space is carried out with a thin and long needle with a mandrel, usually in the interval between the spinous processes of the III and IV lumbar vertebrae. When the needle is advanced through the tissues at a depth of 4-6 cm, a characteristic crunch is felt (puncture of the dura mater). After passing the needle for another 2 mm, the mandrin is removed and 2 ml of a 5% solution of novocaine is injected. Anesthesia of the lower extremities occurs in 5-10 minutes.

On an outpatient basis, local infiltration is used anesthesia novocaine solution. For minor interventions, it is convenient to use ampouled novocaine solutions, since it can be stored for a long time, is sterile and is always ready for use. For more extensive interventions, carrying out novocaine blockades, a 0.25-0.5% solution of novocaine prepared and sterilized in vials is used. For this purpose, a saline solution is prepared according to the prescription of A. V. Vishnevsky.

Then, for sterilization, this solution is boiled and 2.5 g of novocaine powder is added to the boiling liquid (to obtain a 0.5% solution), with which boiling is continued for another 1 minute. Longer boiling leads to the destruction of novocaine and a decrease in the analgesic effect of the solution. To narrow the vessels and slow down the absorption of novocaine introduced into the tissues, add 1 ml of a 0.1% solution of adrenaline. According to a simplified method, novocaine is prepared in an isotonic (0.9%) solution of sodium chloride.

The highest single dose of novocaine in terms of dry preparation is 0.75 g (150 ml of a 0.5% solution). In a 0.25% solution, a much larger amount of novocaine can be used, since the drug is absorbed more slowly, and when the tissues are cut, part of the solution is poured out. It is permissible to inject up to 1.5 liters of a 0.25% solution of novocaine. In outpatient practice, it is advisable to prepare a solution of novocaine in hermetically sealed vials of 30-50 ml. Each vial is used once. The novocaine remaining in the open vial is considered unsuitable for further use, since its sterility is inevitably violated. For small volume anesthetized areas, it is convenient to use a novocaine solution in 5 ml ampoules.

For local infiltration anesthesia, syringes with a capacity of 5-10 ml are used. We must strive to produce as few skin punctures as possible in the interests of maintaining sterility. The needle is gradually advanced deep into the tissues, preceded by the introduction of novocaine solution. First, the skin is infiltrated through a thin needle with a solution of novocaine (intradermal administration) until a "lemon peel" is formed. Then, through a thick needle, subcutaneous fatty tissue is impregnated with a solution, and, if necessary, deeper tissues. It is important to anesthetize, first of all, the skin, which is highly sensitive. Intradermal infiltration with a solution of novocaine is carried out along the entire length of the upcoming incision.

The puncture of the skin with a needle in a new place should be carried out along the edge of the formed "lemon crust" so that subsequent injections are painless. During the operation, sometimes it is necessary to additionally inject a solution of novocaine into the surrounding tissues. When injecting near blood vessels, the syringe plunger should be slightly pulled back periodically to check whether the end of the needle has entered the lumen of the vessel. If this happens, then the needle is removed from the vessel and again advanced into the tissue, changing direction somewhat. Anesthesia usually occurs within 5 minutes. However, before making an incision, the degree of anesthesia should be checked with a needle prick.

Contraindications to local novocaine anesthesia practically none, except in cases of hypersensitivity to novocaine in some patients. Complications are mainly associated with an overdose of the drug or its introduction into the vascular bed. Such a complication is manifested by a drop in blood pressure, increased heart rate, cold sweat, anxiety of the patient.

Conduction anesthesia in minor surgery is used mainly for operations on the fingers of the hand (opening panaritium, surgical treatment of wounds, amputation or disarticulation of the phalanx). Interventions on the distal and middle phalanges are usually performed using conduction anesthesia according to Lukashevich, which allows not only to provide good anesthesia, but also temporary bleeding of the surgical site, which greatly facilitates the implementation of the intervention itself.

A circular tourniquet is applied to the base of the finger from a sterile thin rubber tube or gauze band, which also prevents the rapid absorption of the injected novocaine. The essence of anesthesia lies in novocaine blockade along both digital nerves passing along the lateral surfaces. A short thin needle is injected with a short thin needle at the border of the dorsal and lateral surfaces of the proximal or middle phalanx and 3 ml of 1% novocaine solution is injected, gradually moving the needle in the palmar direction and towards the bone. Similarly, novocaine (3 ml of a 1% solution) is injected on the other side of the finger.

When the pathological process is localized on the proximal phalanx or the entire finger is affected, conduction anesthesia is used at the level of the distal epiphyses of the metacarpal bones according to Oberst or at the level of the diaphysis of the metacarpal bones according to Usoltseva. The very same technique for performing anesthesia in both cases is almost identical. At the level of the middle of the diaphysis of the metacarpal bone or distally, novocaine is injected intradermally with a thin needle over the interosseous space. Then, a novocaine solution is injected subcutaneously through this area with a thicker needle, gradually moving the needle deep into the palmar surface. In total, 15-20 ml of a 1% solution of novocaine is injected.

The needle is withdrawn to the level of subcutaneous fatty tissue and is passed horizontally through it to the second interosseous space, performing infiltration anesthesia. After that, a needle puncture on the second side of the metacarpal bone becomes painless. 15 ml of 1% solution of novocaine is also brought to the second nerve. Several fingers can be anesthetized in the same way. Anesthesia occurs in 4-5 minutes and lasts for about an hour. A contraindication to conduction anesthesia is individual intolerance to novocaine. A complication is possible - damage to the vessel on the back of the hand by the needle; sometimes there are temporary dizziness and nausea from the action of novocaine.

Intraosseous anesthesia provides a relatively long-term anesthesia of the entire segment of the limb - the entire hand or foot. However, it is rarely used in outpatient practice. The novocaine solution injected intraosseously spreads through the cancellous bone, enters the venous vessels distal to the applied tourniquet, and from the venous network diffuses into the tissues, impregnates them and causes anesthesia of the entire area of the limb distal to the tourniquet. The introduction of a solution of novocaine intraosseously is carried out only through healthy tissues with strict observance of asepsis. To perform anesthesia, a thick, short needle with a relatively blunt cut and a well-fitting mandrel and a 10 ml syringe with a well-lapped plunger are required.

For anesthesia of the hand, novocaine solution is usually injected into the epiphysis of the radius, during operations on the foot - into the calcaneus. Before anesthesia, the limbs are elevated to ensure venous outflow and a circular rubber tourniquet is applied proximal to the injection site, compressing both venous and arterial vessels until the pulse disappears on the arteries distal to the tourniquet. A thin needle produces anesthesia of the skin and periosteum over the site of the upcoming bone puncture. A needle with a mandrel is passed through the anesthetized area of the skin and then the needle is advanced with rotational movements through the cortex of the bone to a depth of 1-1.5 cm until a "failure" is felt into a more pliable spongy substance.

The mandrin is removed and novocaine solution is injected through the needle. The first portions of the solution cause pain, so it is advisable to first introduce 3 5 ml of 2% novocaine solution, wait 2-3 minutes, and then add 0.5% novocaine solution in an amount of 40-50 ml for the foot. Anesthesia occurs after 5-10 minutes and is maintained until the tourniquet is tightened. The rapid entry into the general circulation of novocaine after removing the tourniquet can cause dizziness, a drop in blood pressure. In this regard, 1 ml of a 5% solution of ephedrine is preliminarily injected intravenously or 1 ml of a 10% solution of caffeine is injected subcutaneously in advance (before the start of surgery).

I. INTRODUCTION

Local anesthesia is one of the safest methods of anesthesia. With the development and widespread introduction of general anesthesia into clinical practice, its role has somewhat decreased. However, it is widely used in outpatient surgery. It occupies a worthy place in endoscopic examinations.

Local anesthesia, especially such types as spinal, epidural anesthesia, anesthesia of the brachial plexus, has firmly established itself among the main methods of modern anesthesia. If in the 50-70s of the last century, with the development and widespread introduction of general anesthesia into clinical practice, the role of local anesthesia decreased, then the last decade was marked by an unprecedented interest in it both in our country and around the world. This is explained by the development of new surgical technologies - reconstructive operations on the limbs and prosthetics of large joints, endoscopic operations in urology and gynecology, and new approaches to postoperative, obstetric, chronic pain, incl. in cancer patients. In all these areas of medicine, local anesthesia is the most effective and physiological, corresponding to modern concepts of proactive analgesia. At the same time, its progress is also associated with the emergence of new effective local anesthetics (bupivacaine, ropivacaine, etc.), disposable special low-traumatic needles for spinal anesthesia, thermoplastic epidural catheters and bacterial filters, which increased the reliability and safety of local anesthesia. , allowed to use it in children's practice and day surgery.

Local anesthesia by the method of creeping infiltration and novocaine blockades have a long and well-deserved tradition in domestic surgery thanks to the work of Academician A.V. Vishnevsky. In Yaroslavl, well-known surgeons Professor G.A. Dudkevich, A.K. Shipov. Distinguished by safety, relative simplicity and efficiency, these types occupy a worthy place in outpatient surgery, endoscopic examinations, in the diagnosis and treatment of surgical diseases and injuries. As a component of general anesthesia, local anesthesia is successfully used to block reflexogenic and shockogenic zones in the surgical area, reducing the body's need for general anesthetics and increasing the patient's protection from surgical trauma. This is especially important with modern approaches to surgery in oncology, with multiple injuries, when surgery is performed simultaneously on several organs.

In this regard, mastering the technique of local anesthesia, determining indications and contraindications for local anesthesia for the diagnosis and treatment of various diseases is currently relevant.

2. LESSON OBJECTIVE

To acquaint students with a modern view of local anesthesia, with its role and significance in practical surgery; to study the methods of local anesthesia, indications and contraindications for its implementation; to acquaint students with the main types of novocaine blockades.

3. SELF TRAINING

A. PURPOSE

AFTER LEARNING THE TOPIC THE STUDENT SHOULD KNOW

The role and importance of local anesthesia in surgical practice.
Types of local anesthetics.
Methods of surface anesthesia and indications for its use.
Infiltration anesthesia, preparations, features of the method and the role of domestic scientists in their development.
Conduction anesthesia, its features.
Spinal, epidural anesthesia, its technique.
The concept of novocaine blockades, types of novocaine blockades, indications for their use.
Mistakes, dangers and complications arising from the use of local anesthesia

AFTER STUDYING THE TOPIC, THE STUDENT SHOULD BE ABLE TO

Collect instruments for local infiltration anesthesia.

Lay the patient down for spinal and epidural anesthesia,

Lay the patient down for cervical vagosympathetic blockade according to A.V. Vishnevsky. Find the projection of the needle prick for the blockade.

Lay the patient down for lumbar novocaine blockade according to A.V. Vishnevsky. Find the projection of the needle prick for the blockade.

B. LITERATURE

L.V. Vishnevsky. Local anesthesia by the method of creeping infiltrate. Medgiz. 1942.

V.K. Gostishchev. General surgery. Moscow. Medicine 2001.

G.A.Dudkevich. Local anesthesia and novocaine blockade. Yaroslavl. 1986.

A.K. Shipov. Blockade of nerve nodes and plexuses. Yaroslavl, -; 1962.

Guide to anesthesiology. Edited by A.A. Bunatyan. M., "Medicine", 1996.

J. Morgan, M. Mikhail. Clinical anesthesiology, parts 1,2. M-SPb. 1999-2000 "

regional anesthesia. Return to the future. Collection of materials. Ed. A.M. Ovechkin. M. 2001

B. BLOCK OF INFORMATION

Humanity has long sought to alleviate suffering by all means. The ancient Egyptians, Chinese, Romans, Greeks used mandrake alcohol tincture, poppy decoction, and opium for pain relief. In Egypt, even before our era, crocodile fat mixed with the powder of its skin was used for local anesthesia, Memphis stone powder mixed with vinegar was applied to the skin. In Greece, a bitter root was used, a tourniquet was applied to compress tissues.

In the 16th century, Ambroise Pare received a decrease in pain sensitivity by compressing the nerves. Bartholinius in Italy and the Napoleonic surgeon Larrey used the cold to reduce soreness during surgery. In the Middle Ages, "sleepy sponges" were used, impregnated with Indian hemp, henbane, hemlock, mand-ragora.

Local anesthesia during surgical interventions received its "development after the work of our domestic scientist V.K. Anrep (1880). He studied the pharmacological properties of cocaine in experimental animals, pointed out its ability to cause anesthesia and recommended the use of cocaine in operations on people. Provodnikova anesthesia for operations on the finger was used by Lukashevich and Oberet (1886).A.V. Orlov used a 0.25-0.5% solution of cocaine for local infiltration anesthesia (1887). cocaine to infiltrate tissues during surgery.Brown (1887) suggested adding adrenaline to a solution of cocaine under local anesthesia to reduce bleeding from a wound and make it difficult for cocaine to be absorbed into the blood.Beer used spinal anesthesia in 1898. Eichhorn's discovery in 1905 of novocaine was met with great positively.

In the twenties, a significant contribution to the development and implementation of the method of spinal anesthesia in surgery was made by the largest domestic surgeon S.S. Yudin, successfully using it in surgical interventions that were difficult for that time.

A.V. Vishnevsky (1923-1928) developed a simple, affordable method of local anesthesia based on the principle of creeping infiltrate. The method was used with equal success in large and small operations for pure and purulent diseases. After the publication of his works, local anesthesia began to be used in almost all surgical interventions, both in our country and abroad.

A.V. Vishnevsky showed that hydraulic preparation of tissues allows better orientation in the vessels and nerves, better understanding of the anatomical relationships of tissues in the area of the surgical field. Layer-by-layer impregnation of tissues with novocaine solution takes time and waiting until anesthesia occurs. A solution of novocaine is injected slowly, when the tissues are cut, a significant part of the solution is removed with napkins and tampons. Practice has shown that with correctly performed anesthesia, the waiting time is the most minimal, more often, immediately after anesthesia, the operation is started.

In parallel with the development of methods of local anesthesia, there was an intensive study of the physiology and pathology of pain, the mechanisms of the formation of pain syndrome. At present, the important role of pain impulses from the surgical wound, which, having arisen during the operation, leaves a trace in the form of long-term excitation of neurons of the posterior horns of the spinal cord, which is the basis for maintaining postoperative pain and the occurrence of chronic pain, has been established. It has been shown that the performance of operations of increased traumatism under general anesthesia, the use of strong narcotic analgesics after them (morphine, dilidolor) does not eliminate this impulsation. It, like a kind of "bombardment", attacks the spinal cord, disabling the physiological mechanisms of the body's own pain (antinociceptive) defenses. The use of local anesthesia under these conditions before surgery, and its maintenance in the postoperative period, makes it possible to reliably block this impulse, while maintaining the mechanisms of antinocicepsia. An illustration of these ideas is the operation of amputation of a limb with an inevitable injury to the nerve nerve trunks during neurotomy. Performing it under anesthesia without local anesthesia of the nerve trunks increases the frequency of occurrence of such a serious and difficult-to-treat complication as phantom pain after surgery. Back in 1942, the outstanding domestic neurosurgeon N.N. Burdenko in his monograph "Amputation as a neurosurgical operation" pointed out the importance and necessity of blocking the nerve trunks with local anesthetics before their intersection. Lacking modern for us ideas about the pathophysiology of postoperative pain, he, thanks to his clinical experience and intuition, approached the correct solution of a complex problem.

With a new approach to surgical pain, the concept of proactive analgesia has been formed. It provides for the creation of a full-fledged analgesia before the onset of the action of a painful stimulus. The stronger the pain effect, the more important is the blocking of pain impulses by local anesthetics before it reaches the neurons of the spinal cord. Narcotic analgesics administered intravenously block pain impulses mainly at the supraspinal level and cannot be considered as the only and reliable means of protecting the operated patient from pain.

PREPARATIONS FOR LOCAL ANESTHESIA

Anesthetics or local anesthetics include novocaine, trimecaine, lidocaine, mercocaine, swarms of willow caine, pyromecaine, etc. Anesthetics differ from other painkillers in that they act mainly on the peripheral receptor apparatus: spinal nerve roots, sensory nerve fibers and finishing them. Turning off the sensitivity under the action of anesthetics occurs in a known sequence. First, pain sensitivity disappears, then olfactory, gustatory, temperature and tactile.

Methods of administration of anesthetic substances: dermal, subcutaneous, regional, infiltration, epidural, epidural, spinal, conduction,

ganglionic, endoneural, paraneural. paravertebral, parasacral, transsacral, intra-arterial, intravenous and intraosseous. The most common method of administering an anesthetic is infiltration. Local anesthesia is used not only during operations, but also in the form of novocaine blockades.

NOVOCAINE ( novocainum)

p-Diethylaminoethyl ester of para-aminobenzoic acid hydrochloride.

Colorless crystals or odorless white crystalline powder. Let's very easily dissolve in water (1:1), we will easily dissolve in alcohol (1:8).

Novocaine is a local anesthetic drug. In terms of its ability to cause surface anesthesia, it is less active than cocaine, but much less toxic, has a greater breadth of therapeutic action and does not cause the phenomena of drug addiction characteristic of cocaine. In addition to the local anesthetic effect, novocaine, when absorbed and directly injected into the blood, has a general effect on opi-anism: it reduces the formation of acetylcholine and lowers the excitability of peripheral cholinergic systems, has a blocking effect on the autonomic ganglia, reduces spasms of smooth muscles, lowers the excitability of the heart muscle and the excitability of the motor areas of the cerebral cortex. In the body, novocaine is relatively quickly hydrolyzed, forming para-aminobenzoic acid and diethylaminoethanol.

Novocaine is widely used for local anesthesia, mainly for infiltration and spinal anesthesia. For infiltration anesthesia, 0.25-0.5% solutions are used; for anesthesia according to the method of A.V. Vishnevsky, a 0.125-0.25% solution is used; for conduction anesthesia - 1-2% solutions; for epidural anesthesia - 2% solution (20-25 ml), for spinal anesthesia - 5% solution (2-Zml).

When using novocaine solutions for local anesthesia, their concentration and amount depend on the nature of the surgical intervention, the method of application, the condition and age of the patient. It must be taken into account that with the same total dose of the drug, the toxicity is higher, the more concentrated the solution is. To reduce absorption into the blood and prolong the action of novocaine, a 0.1% solution of adrenaline hydrochloride according to I calla per 25 ml of novocaine solution is usually added to it.

LIDOCAINE ( Lidocainum)-

a-Diethiamino-2,6-i methyl acetanilide hydrochloride.

White crystalline powder, easily soluble in water and alcohol. amide type anesthetic,

Unlike novocaine, it is not an ester, it is metabolized more slowly in the body and has a longer effect. Trimeca-in belongs to the same group of local anesthetics. Lidocaine is a strong local anesthetic that causes all types of local anesthesia: terminal, infiltration, conduction. Compared to novocaine, it acts faster, stronger and longer. The relative toxicity of lido canna depends on the concentration of the solution. In fry concentrations (0.1%), its toxicity does not differ from the toxicity of novocaine, but with an increase in concentration to I -2%, toxicity increases by 40-50%.

TRIMECAIN ( Trimecainiim)

a-Diethiamino-2,4,6-trimethylacetanilide hydrochloride.

White or white with a slight yellow tint crystalline powder, which is easily soluble in water and alcohol.

In terms of chemical structure and pharmacological properties, tri-mecaine is close to lidocaine. It is an active local anesthetic, causes rapidly onset, deep and prolonged infiltration, conduction, epidural, spinal anesthesia; in higher concentrations (2-5%) causes superficial anesthesia. Trimecaine has a stronger and longer-lasting effect than novocaine. It is relatively less toxic, does not irritate.

PYROMECAINE ( pyromecainum)

2,4,6 - Trimethanilide - 1 - butyl - pyrrole idinecarboxylic -2 - "acid hydrochloride.

White or white with a slight creamy tint crystalline powder. Easily soluble in water and alcohol.

This drug is used in ophthalmology as a 0.5-2% solution, as well as in the study of the bronchi.

MARKAIN (BUPIVAKAIN)

A modern local anesthetic of the amide type, which contributed to the widespread use of local anesthesia. It is characterized by a slow onset of action compared to lidocaine, but a prolonged analgesic effect (up to 4 hours). It is used for all types of local anesthesia, most often for conduction, spinal and prolonged epidural anesthesia, incl. for postoperative pain relief. In eye surgery, it is used for retrobulbar anesthesia and anesthesia of the pterygopalatine ganglion. Causes predominantly blockade of sensory nerve fibers rather than motor ones. With accidental intravenous administration, it has a cardiotoxic effect, which is manifested by a slowdown in conduction and a decrease in myocardial contractility. Available in ampoules with 0.25%, 0.5% and 0.75% solutions.

ROPIVACAIN (naropnn)

A new local anesthetic homologue of bupivacaine. It retains its positive properties, but its cardiotoxicity is more pronounced. It is mainly used for conduction, epidural, epidural-sacral anesthesia. So, anesthesia of the brachial plexus with a 0.75% solution of ropivacaine occurs after 10-25 minutes and lasts more than 6 hours. For epidural anesthesia, 0.5-1.0% solution is used.

LOCAL ANESTHESIA BY THE METHOD OF CREEPING INFILTRATION ACCORDING TO A.V. VISHNEVSKY

The skin, subcutaneous tissue, and then deeper tissues are infiltrated with a novocaine solution. With infiltration anesthesia, tissues are stratified (hydraulic preparation). Creeping infiltrate consistently spreads, capturing all tissues, penetrates to the nerve endings and trunks.

For infiltration anesthesia, A.V. Vishnevsky proposed the following solution:

Novocaine - 2.5

Sodium chloride - 5.0

Potassium chloride - 0.075

Calcium chloride - 0.125

Adrenaline - 1:1000.0-X drops

Distilled water - 1000.0

The novocaine solution exhibits an analgesic effect, sodium chloride maintains isoionic, calcium has a stimulating effect on the body, reduces tissue swelling, potassium improves the functioning of the heart muscle, increases the permeability of the sheaths of nerve fibers, and therefore the novocaine solution penetrates better.

The simplicity of the method of anesthesia, the safety and non-toxicity of the drug contributed to the widespread introduction of this type of anesthesia. In addition, novocaine solution contributes to the normalization of metabolism and improves nervous trophism.

The advantage of the infiltrative anesthesia method is as follows: harmless to the body, simple technique and technique, most patients with various diseases can be operated on, hydraulic preparation of tissues is provided, which contributes to more careful handling during surgery, novocaine solution improves tissue trophism, the percentage of postoperative complications.

Anesthesia technique

Under sterile conditions, a syringe needle is injected, a 0.25% solution of novocaine is injected, the skin is tightly infiltrated until it turns white (a sign of capillary compression) and until “goose skin” (“lemon peel”) is formed. A second injection is made along the edge of this infiltrate, and so the infiltration continues throughout the site of the proposed operation. Then a tight infiltration of the subcutaneous tissue and deeper tissues is carried out. During the operation, the infiltration of tissues with a solution of novocaine continues as the tissues are cut.

The course of local anesthesia

The first period is the production of anesthesia.

The second period is waiting for 5-10 minutes.

The third period is complete anesthesia, lasting 1-2 hours (subject to re-infiltration as the tissues separate).

The fourth period is the restoration of sensitivity.

With local anesthesia, pain sensitivity is turned off, muscles relax at the injection site of novocaine. Local anesthesia is an anti-shock measure.

All complications associated with infiltration anesthesia can be divided into three degrees.

First degree: pale skin, cold sweat, dizziness, general weakness, dilated pupils, increased heart rate, nausea, weakened breathing.

Second degree: motor agitation, fear, hallucinations, convulsions, delirium, vomiting, increased heart rate, drop in blood pressure and weakening of breathing.

Third degree: frequent pulse of weak filling, arrhythmia, intermittent breathing, dilated pupils, loss of consciousness, convulsions.

Prevention of complications consists in applying a tourniquet to the anesthetized limb in order to reduce the absorption of novocaine solution. When excited, sedatives are prescribed. In severe cases, carry out artificial respiration, artificial ventilation of the lungs; with a deterioration in cardiac activity, caffeine, water-soluble cardiac glycosides can be administered.

TYPES OF ANESTHESIA

The isolation method of anesthesia according to R.R. Vreden is achieved by introducing an anesthetic solution along the incision line and somewhat wider.

Circle Anesthesia: An anesthetic is injected in a diamond shape surrounding the intended incision site. The method was developed by Hackenbruch in 1900.

Case anesthesia according to A.V. Vishnevsky is carried out by introducing a solution of novocaine under the skin, subcutaneous tissue and sequentially into muscle cases. With case anesthesia, less novocaine is consumed than with cross-sectional anesthesia, which significantly reduces intoxication.

Presacral anesthesia according to A.V. Vishnevsky, the skin and subcutaneous tissue are anesthetized in the middle between the coccyx and the buttocks and behind. Having felt the anterior surface of the sacrum with the end of the needle, 150-200 ml of novocaine solution is injected like a tight infiltrate, which "moisturizes" all the roots emerging from the holes in the sacrum.

Conduction (regional) anesthesia is carried out by bringing the anesthetic substance to the sensitive nerve perineurally, endoneurally or near the nerve. The most commonly used method is the perineural method. The nerve is surrounded by membranes, and weak solutions of novocaine do not have enough effect on it. Therefore, I-2% solutions of novocaine are often used in an amount of 20-30 ml.

Intercostal anesthesia is performed at a point located in the middle of the distance from the spinous processes of the thoracic vertebrae to the inner edge of the scapula. Starting from the first rib, a needle prick is made and a 0.25-0.5% novocaine solution is injected into the skin. Consistently this technique is repeated in each intercostal space. Intercostal anesthesia is used for fractured ribs and other severe chest injuries.

Spinal anesthesia (spinal, subarachnodal) is currently one of the main methods of anesthesia and is widely used in both traditional and endoscopic operations on the lower extremities, their joints and blood vessels, the pelvis, perineum, colon, in urology, gynecology in operative obstetrics. From the standpoint of proactive analgesia, it is advisable to combine it with general anesthesia against the background of mechanical ventilation during extensive and traumatic operations. For the first time, spinal anesthesia was performed by Beer in 1898, introducing cocaine into the subanachnoid space using the needle he proposed for this.

The mechanism of spinal anesthesia is based on segmental blockade of the posterior (sensory) and anterior (motor) roots of the spinal cord when a local anesthetic enters the cerebrospinal fluid, mixes with it, and lavages the roots. The blockade of the posterior roots causes complete analgesia, turning off temperature, tactile and proprioceptive sensitivity.

Since the anterior roots contain both motor fibers to skeletal muscles and sympathetic preganglionic fibers that maintain vascular tone, their blockade causes muscle relaxation and vasodilation. In cases of initial hypovolemia, the latter may be accompanied by a dangerous decrease in blood pressure, which requires intravenous administration of plasma substitutes and vasoconstrictors.

For spinal anesthesia, brands are used and, as an exception, novocaine. The time of its onset and duration depend on the type of local anesthetic. So, 5 ml of a 2% solution of novocaine cause anesthesia after 5 minutes lasting no more than 45 minutes, the same amount of lidocaine - a little more than 1 hour, with the introduction of 5 ml of a 0.5% solution of marcaine, anesthesia occurs after 10 minutes and lasts about 3 hours.

Perform spinal anesthesia in the position of the patient sitting or lying on his side. His head and back should be bent. The nurse must fix the position of the patient. At the level of the scallop line is the spinous process of the 1st lumbar vertebra. An injection is made after novocaine anesthesia under its spinous process, sometimes higher. The needle is placed between the spinous processes somewhat obliquely, taking into account the inclination of the spinous processes. Advance the needle slowly. With a puncture in the interspinal ligament, resistance is determined. Less resistance is determined by puncture of the dura mater. Mandrin should be removed after puncture of the interspinous ligament. A puncture of the dura mater feels like a puncture of parchment paper. When a liquid appears, it is necessary to stop the advancement of the needle, attach a syringe with an anesthetic solution to it. Pump the cerebrospinal fluid into a syringe, then slowly inject the entire contents into the spinal canal. After that, the needle is removed, the injection area is treated, the patient is placed with his head up to prevent the anesthetic from flowing into the higher parts of the spinal cord. The standards of modern spinal anesthesia provide for the use of special disposable extra thin needles (outer diameter of about 0.5 mm) - This causes less trauma to the dura mater, contributes to the rapid tightening of the post-puncture hole, preventing the outflow of cerebrospinal fluid into the epidural space and the appearance of headaches in patients.

Among other complications of spinal anesthesia, a significant spread of anesthesia upwards with a drop in blood pressure and respiratory disorders, urination disorders, and pain at the puncture site are possible.

Epidural anesthesia

The introduction of a solution, a local anesthetic, into the space between the yellow ligaments. the periosteum of the vertebrae and the dura mater causes its slow subshell penetration to the roots of the spinal cord, which, exiting between the vertebrae, are surrounded in the form of clutches by this meninges. Therefore, the development of symptoms of segmental root blockade with epidural anesthesia will be the same as with spinal anesthesia, but longer and requires a larger amount of anesthetic administered. So, with the epidural injection of 20 ml of a 2% lidocaine solution, the full onset of anesthesia is observed no earlier than after 20 minutes, with its duration being about one and a half to two hours. The required duration of anesthesia (up to several days) can be achieved by administering maintenance doses of the anesthetic through a catheter placed in the epidural space. Puncture and catheterization of the epidural space can be performed at different levels of the thoracic and lumbar spine, depending on the area of operation. For anesthesia, a 2% solution of lidocaine, a 0.5-0.75% solution of marcaine or naropin are used, trimecaine is used much less frequently. In order to avoid infection of the catheter during repeated administration of anesthetics, they are injected through a bacterial filter connected to the catheter.

This technique of prolonged epidural anesthesia has found wide application in various surgical interventions on the organs of the thoracic (including the heart) and abdominal cavity, pelvic organs, urinary organs, large vessels, both for operations and after them for the purpose of full anesthesia without narcotic analgesics, early restoration of intestinal motility, activation of the patient. It quite fully reflects the requirements for proactive analgesia, can be combined with both general and spinal anesthesia, carried out without switching off the patient's consciousness during surgery, and with it turned off, with spontaneous breathing and mechanical ventilation.

Out of connection with the operation, prolonged epidural anesthesia (blockade) is effective for chest injuries with multiple rib fractures, severe pancreatitis, peritonitis with severe intestinal paresis. In these conditions, it provides, in contrast to narcotic analgesics, not only complete pain relief without respiratory depression and coughing of the left reflex, but also blockade of sympathetic fibers, resulting in the elimination of vascular spasm, improvement of microcirculation, which leads to the restoration of impaired organ function . In addition, prolonged epidural anesthesia is used for labor pain relief, in the treatment of chronic pain in cancer and other diseases.

For epidural anesthesia, special Tuohy-type needles, labeled catheters, syringes, bacterial needles in sterile disposable packages are used. Like spinal anesthesia, it is performed under strict aseptic conditions. The position of the patient is sitting or lying down. After anesthesia of the skin, the needle is inserted between the spinous processes of the vertebrae to a depth of a fixed position, excluding its displacement from the center to the side. This position indicates the proximity of the needle to the yellow ligaments. A mandrel is removed from it, a sealed syringe with air is attached, which is constantly pressed while carefully moving the needle along with the syringe forward, feeling the air resistance to the piston. As soon as the needle passes through the entire thickness of the elastic yellow ligament and enters the epidural space, there is a loss of this resistance, a peculiar feeling of needle failure. This space is only 2-5 mm wide, partially filled with loose fatty tissue and veins that form plexuses. If the needle accidentally slips a little higher and damages the dura mater, then both the outflow of cerebrospinal fluid from the needle when the syringe is disconnected from it, and the entry of the anesthetic injected into the epidural space into the cerebrospinal fluid are possible, which is manifested by signs of spinal anesthesia. Therefore, to check the route of entry of the injected anesthetic through the needle, if no cerebrospinal fluid is released from it, a test dose of the anesthetic is injected, for example, 5 ml of a 2% lidocaine solution, and its effect is observed for 5 minutes. If there are no signs of the onset of spinal anesthesia, a catheter is passed through the needle, the needle is removed and the anesthetic is injected fractionally (5 ml each) to the calculated dose and the clinical effect of anesthesia.

Contraindications are the same as for spinal anesthesia.

Epidural-sacral anesthesia is caused by the introduction of an anesthetic solution through the sacral opening into the sacral canal. The anesthetic solution washes the sacral roots located in loose fiber. During epidural anesthesia, the position of the patient is knee-elbow. The hiatus sacra!is is felt for, a needle is inserted into this place, having previously anesthetized the skin and subcutaneous tissue. The needle is set at an angle of 20°, that is, in the projection of the passage of the sacral canal. Once in the hole, the needle is advanced 5 cm and 20 ml of a 2% solution of novocaine is injected.

NOVOCAINE BLOCKS

A.V. Vishnevsky considers novocaine blockade as the sum of the effects of a weak stimulus - novocaine solution on the peripheral and central nervous system. At the site of the infusion of novocaine solution, inhibition occurs, blocking of nerve structures and slight irritation of the entire central nervous system, which affects the improvement of trophic function, especially in the focus of the pathological process. The use of blockades with a weak solution (0.25%) of novocaine in inflammatory diseases turned out to be very useful. In the phase of tissue edema after blockade, the inflammatory process may undergo a reverse development. In those observations where necrosis and suppuration have already developed, the infiltration of tissues around the purulent focus decreases, and the purulent focus is delimited earlier. Novocaine blockades are used for diagnostic and therapeutic purposes, as well as for the prevention of suppuration.

DELAYING RECOVERY

Cervical vagosympathetic blockade according to A.V. Vishnevsky

Cervical vago-sympathetic blockade by the closed method according to A.V. Vishnevsky is used for pleuropulmonary shock, severe injuries of the chest and its organs, during operations on the abdominal organs and in the postoperative period.

The blockade is performed on the operating table. The patient is placed on his back, turning his head in the opposite direction. A roller is placed under the shoulder blades, the hand on the side of the blockade is pulled down. The surgeon places the index finger of the left hand at the edge of the sternocleidomastoid muscle and displaces it and the organs of the neck inwards. The injection is made above the intersection of the muscle with the external jugular vein. First, a 0.25% solution of novocaine is injected into the skin with a thin needle, then a long needle is inserted through the resulting infiltrate, directed inwards and upwards, to the front surface of the spine. The needle is advanced inside, the posterior leaf of the vagina of the sternocleidomastoid muscle is pierced and 30-50 ml of a 0.25% solution of novocaine is injected in small portions of 2-3 ml, the syringe is often removed from the needle in order to avoid injury to large vessels. Lumbar (perinephric) novocannov blockade according to A.V. Vishnevsky

The blockade is carried out in the tissue surrounding the kidney by introducing novocaine in order to turn off a large number of nerve nodes, trunks and nerve endings and improve the regulatory function of the nervous system in the blockade zone.

The patient is laid on his side, with a roller placed under the lower back. A thin needle infiltrates the angle between the long muscles of the back and the 12th rib. Through the resulting infiltrate, a long needle is injected perpendicularly, with a prerequisite in front of the solution jet, a needle is inserted into the tissues, the posterior leaf of the renal fascia is pierced. The jet of novocaine starts to go very easily, and after the control removal of the syringe, the liquid does not flow back through the needle. This is an indicator of the correct insertion of the needle into the parsfrium. Introduced from 60 to 120 ml of 0.25% novocaine solution.

Among the complications that can occur during a parasphral blockade, it should be noted that the solution enters the kidney (in this case, the piston goes tight and blood enters through the needle); getting into a blood vessel (blood in a syringe); getting into the large intestine (intestinal soda, gases come from the needle).

Paraperitoneal neocann blockade according to G.A. Dudkevich

All organs of the abdominal cavity are associated with certain segments of the spinal cord. After the blockade of 8-9-10-11 thoracic nodes, pain stops or sharply decreases in acute cholecystitis and pancreatitis. The injected novocaine solution into the preperitoneal tissue washes the nerve endings of the 6-7-8-9-10-11 intercostal nerves. The blockade is successfully used in acute pancreatitis, acute cholecystitis, stomach ulcers, and cholelithiasis.

The blockade is performed at a point that is 3-5 cm below the xiphoid process of the sternum in the midline. After the introduction of novocaine into the subcutaneous tissue, the aponeurosis is punctured along the white line of the abdomen. under which 120 ml of a 0.25% solution of novocaine is injected. Case novokannovy blockade of the limb The position of the patient - on the back. With a thin needle, an injection of the skin on the anterior surface of the thigh. The skin is infiltrated with novocaine solution. At the site of anesthesia, the skin is pierced and the needle is passed to the bone and 60 ml of a 0.25% solution of novocaine is slowly injected. The same is repeated on the back of the thigh. A solution of novocaine slowly penetrates all the branches of the fascial sheets, blocking the nerve pathways. In the same way, a case blockade of the shoulder is carried out. On the lower leg and forearm, novocaine is injected under the fascia. Up to 200 ml of a 0.25% solution of novocaine goes to the thigh, up to 150 ml to the lower leg and shoulder. Short Novocaine Nerve Blockade

A short novocaine block is the most common way to treat boils, carbuncles, mastitis and other purulent diseases. Near the focus of inflammation, an injection is made with a thin needle and a novocaine solution is injected into the skin. A thin needle changes to a longer one and 60-120 ml of a 0.25% solution of novocaine is injected under the inflamed focus. After the blockade, pain and swelling decrease. If there is no suppuration, then the inflammation can regress. Often, penicillin or another antibiotic is administered along with novocaine. This treatment is indicated for purulent diseases of low prevalence (furuncle, carbuncle, hydradenitis, lymphadenitis, lymphangitis).

In addition to the listed novocaine blockades, there are: blockade of the sciatic nerve according to Voyno-Yasenetsky, subpectoral blockade according to L.V. Maraev, blockade of the cardio-aortic reflexogenic zones according to A.K. Shilov and G.A. Dudkevich; blockade of the stellate and upper thoracic paravertebral sympathetic nodes according to A.K. Shipov and others.

D. STUDY QUESTIONS

The concept of local anesthesia, its role and significance in surgical practice
Types of local anesthetics, their pharmacodynamics and far makoka netika

3. Name the drugs that prolong the action of novocaine.

4. The role of domestic scientists in the development of local anesthesia methods.

5. Anesthesia by lubrication, irrigation. Indications, contraindications, technique.

6. Local infiltration anesthesia. Indications, contraindications, technique.

Conduction anesthesia. Indications, contraindications, technique of execution. The drugs used for its implementation.
Spinal and perndural anesthesia. Indications, contraindications, technique. Drugs used for their implementation.

9. The concept of novocaine blockades, types of novocaine blocks.

10. Technique for performing cervical vago-sympathetic novocaine blockade. Indications and contraindications for its use.

11. Technique for performing lumbar novocaine blockade. Indications and contraindications for its implementation.

What is conduction anesthesia according to Lukashevich-Oberst?
Technique for performing intercostal novocaine blockade.
Indications and contraindications for its use.
Mistakes, dangers and complications arising from local anesthesia.

E. SITUATIONAL TASKS

1. The patient has subcutaneous panaritium 111 fingers of the left hand. Your choice of local anesthesia. The technique of its implementation.

2. The patient has fractured ribs, cyanosis, pain, shortness of breath, rapid pulse. What type of novocaine blockade can be applied.

Z. The patient is to undergo a herniotomy. What type of local anesthesia can be applied. The technique of its implementation.

E. RESPONSE BENCHMARKS

1. The patient needs to perform conduction anesthesia of the finger with a 2% solution of novocaine according to the Lukashevich-Oberst method. (see text)

2. In case of multiple fracture of the ribs and the presence of a pleuro-pulm clinic of disgraced shock, it is necessary to perform a cervical, vago-sympathetic blockade according to the method of A.V. Vishnevsky (see text).

3. During the operation of hernia repair under local anesthesia, local infiltration anesthesia is performed with a 0.25% solution of novocaine according to the method of tight creeping infiltrate according to A.V. Vishnevsky, (see text).

4. TEST CONTROL OF PREPARATION FOR THE LESSON

Indicate the correct answers to the questions

1. Local anesthetics include:

a) Nitrous oxide

b) Fluorotan

c) Hexenal

d) Novocaine

e) Barbamnl

2. What concentration of novocaine is used for infiltration anesthesia?

d) 2.0%
e) 5.0%

3. What solution is used to prepare novocaine?

a) Glucose solution 5%.

b) Calcium chloride solution 10%.

c) Electrolyte solution.

d) distilled water.

4. Neck vago-sympathetic blockade is indicated for:

a) Traumatic shock.

b) Pleuro-pulmonary shock.

c) Tumors of the mediastinum.

d) Bronchial asthma.

5. For lumbar blockade use:

a) Novocaine 0.25%

b) Lidocanno t 3%

c) Trimecaine 2%

6. To prolong the action of novocaine use: a) Atropine.

b) Papaverine.

c) adrenaline.

d) morphine.

Any person who had to lie on the operating table asked himself the question: “Under what kind of anesthesia to do the operation?”. There are many options for anesthesia in modern anesthesiology, and each method has its own characteristics, consequences, positive and negative sides. Any operation under anesthesia is a risk for the doctor and for the patient, so it is necessary to carefully approach the choice of analgesia.

In the medical sense, anesthesia is the introduction of the human body into a temporary state, characterized by a blackout of consciousness, lack of sensitivity to pain, a decrease in all reflexes and relaxation of all skeletal muscle groups.

Currently, anesthesia is divided into types, depending on how the analgesic narcotic substance is administered.

Allocate:

Local anesthesia. This group includes the following types of anesthesia: infiltration, conduction, spinal, epidural, intraosseous, and the last four types are classified as local regional methods of anesthesia.
Inhalation general anesthesia.
Non-inhalation general anesthesia.
Combined anesthesia.

Local anesthesia: types and methods of drug administration

The concept of "local anesthesia" includes a temporary reversible elimination of the sensitivity of nerve endings to painful stimuli in the desired part of the human body. This type of anesthesia has a lot of advantages: no preparation for pain relief, no need to monitor the patient after the drug is discontinued, there are practically no negative consequences, the possibility of performing an operation on an outpatient basis, the list of contraindications is much shorter than other methods of pain relief.

Regional anesthesia

This type of anesthesia is done when there is a need to remove sensitivity from a certain topographic zone, and general anesthesia is inappropriate or contraindicated. In this case, the drug is administered in close proximity to the nerve trunk or plexus, which is responsible for the sensitivity of the desired area. Consciousness and respiratory function of the patient are preserved.

This group includes the following types:

Epidural anesthesia

Anesthesia occurs due to the blockade of the spinal roots, while the drug is injected under the periosteum, over the hard shell of the spinal cord. Negative consequences do not develop in the case of a correctly performed analgesia technique.

Spinal anesthesia

The difference from epidural anesthesia lies in the injection site of the drug - the narcotic substance is injected into the subarachnoid space of the spinal cord, under the hard shell. There is a complete loss of not only the pain sensitivity of the lower body, but also a complete relaxation of the muscles - the patient cannot move the lower limbs. Possible negative consequences with the wrong technique.

Inhalation types of anesthesia

This group includes mask and endotracheal types of anesthesia. Anesthesia and loss of consciousness is achieved by introducing volatile narcotic substances into the respiratory tract - ether, halothane, nitrous oxide.

When conducting inhalation anesthesia, 4 main stages are distinguished:

General anesthesia - the patient is still conscious, but there is no pain sensitivity. Reflexes are inhibited, the patient answers questions inhibited. At this stage, it is possible to carry out quick interventions, such as opening phlegmon and abscesses, and doing various diagnostic procedures. The duration of the stage is 3-5 minutes.
Excitation - the processes of the cerebral cortex are inhibited, and the subcortical ones are excited. Despite the lack of consciousness, the patient is in an agitated state, may attempt to stand up. At this stage, intervention is prohibited, it is necessary to continue to administer drugs to enhance the depth of sleep.
Surgical stage - the patient is calm, unconscious, breathing and heart rate are within normal limits. All necessary surgical interventions are done precisely at this phase of anesthesia. This stage is dangerous by stopping breathing and palpitations, in the cerebral cortex, with a long stay in deep anesthesia, irreversible consequences develop, so it is necessary to closely monitor the patient's vital signs.
Awakening - when the administration of the drug is stopped, its concentration in the blood decreases, and the patient wakes up, while going through all the stages in the reverse order.

Mask general anesthesia

This type of general anesthesia is used in surgery for short surgical interventions or when introduced into a deeper sleep. The patient is tilted back and the mask is put on so that it covers the nose and mouth, and asked to take a few deep breaths. A person under the influence of drugs quickly falls asleep. To stop anesthesia, the medication is stopped. Negative consequences in the form of poor health disappear in a short time.

Endotracheal general anesthesia

With the endotracheal method, the narcotic substance enters the body using a special tube that is inserted into the trachea. This type of anesthesia is used more often than others, as it provides free airway patency, and also provides access to the neck, face, head. The use of this method in surgery provides the possibility of long-term surgical interventions without negative consequences.

Fluorothane general anesthesia

Fluorotan is a strong narcotic that allows you to quickly bring the patient to the desired depth of anesthesia. When using this method, there is a rapid onset of sleep, there is no stage of excitation, it is easy to adjust the depth of sleep and remove the patient from the state of anesthesia. However, despite the large number of advantages, in modern practice this type of general inhalation anesthesia is being done less and less, it has faded into the background due to one serious side effect - halothane negatively affects hemodynamics, reducing the contractility of the heart muscle and dilating blood vessels. Due to this effect, a sharp drop in blood pressure is possible in patients. Also, ftorotane has a harmful effect on the liver.

Raush anesthesia

This is one of the varieties of inhalation anesthesia, which is currently not used in the practice of an anesthesiologist. This method involved the use of a mask through which chloroethyl vapor was supplied, or simply a liquid containing ether was poured onto gauze and brought to the patient's nose. The duration of such anesthesia did not exceed 5 minutes, the person woke up quickly, and after waking up he experienced severe malaise, so the use of this type of general anesthesia in surgery was inappropriate.

Non-inhalation (intravenous) anesthesia

Intravenous general anesthesia has several advantages over inhalation methods. With this type of general anesthesia, the patient “turns off” faster and there is no stage of excitation. However, when using this method alone, the anesthetic effect is very short-lived, so intravenous anesthesia is most often done by inhalation. The patient is intubated only after the start of the non-inhalation method. The drugs of choice for intravenous anesthesia are drugs from the group of barbiturates - hexenal and thiopental sodium.

Local anesthesia (the popular name is also found - local anesthesia) - anesthesia of a certain area of \u200b\u200bthe body by a violation of the conduction of the nerves that innervate this area. An analgesic effect is achieved by injecting drugs called local anesthetics into the tissues.

It is worth noting that the term "local anesthesia" is a popular name, but from the point of view of medicine it is not correct and carries any semantic load, since anesthesia is caused by inhibition of the central nervous system and immersion of a person in an unconscious state.

Anesthesia with local anesthetics is characterized by a relatively low risk of undesirable consequences, the same safety and possibility of use for both adults and children, a relatively weak effect on the fetus, which makes it possible to use it during pregnancy.

Local anesthesia has a very wide application and is effectively used in almost all areas of medicine. The method is most commonly used in dentistry and surgery, including for simple abdominal operations.

Types of local anesthesia

"Local anesthesia" along with the vast scope of applications also provides an abundance of its types, which determine its popularity.

Application anesthesia

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