SU1344367A1 - Method of anesthesiologic aid in small surgical interventian - Google Patents

Abstract

FIELD: anesthesiology. The purpose of the invention is to achieve and maintain general analgesia while reducing carpal tone. After administering atropine, dropletridol and fentanyl to the patient, calypsol is administered immediately before the operation and local anesthesia is administered to novocaine. no. If necessary, calypsol is reintroduced every 30-35 minutes of operation. The threshold in stagnation increases by 76-34%. 3 tab. 4 Sld 05

Description

The invention relates to medicine and can be used in anesthesiology and resuscitation.

The purpose of the invention is to achieve and maintain general analgesia with reduced muscle tone.

The method is carried out as follows.

Atropine (O, 3-0; 4 mg), droperidol (5-7.5 mg), fentanyl (0.05-0.1 mg) were administered intravenously to the patient in the operating room when the surgeon was ready for surgery in calydsol at a dose of 0.5-0.6 mg / kg body weight, local infiltrative anesthesia is performed by Novocain according to A.V. Vishnevsky. 1-2 minutes after the administration of calypsol, general analgesia develops, a significant decrease in a number of cases and the total absence of tactile sensation, adinas, a decrease in tone. Tension of muscles (out of volitional effort), calm, drowsiness, indifference to the surrounding. This condition of the patient is optimal for surgery: the skin incision and the subsequent stages of the operation for 30–35 minutes are not accompanied by pain, side effects and complications inherent in the anesthesia according to the prototype method. With surgeries of more than 30-35 minutes, calypsol is reintroduced in an initial dose (about 5-0.6 mg / kg) every 30,735 minutes of surgery.

In patients with normal blood pressure, asteuria, women, debilitated patients, 40 (1 h 40 min) 30 min after perbolnyh weighing less than 70 kg, minimum doses of drugs are administered. In physically strong patients, patients with elevated blood pressure, weighing more than 70 kg, maximum doses of drugs are administered.

Example 1. Sick 49 years. Diagnosis: recurrent umbilical grska. Surgery - hernia repair. Concomitant disease - ischemic heart disease: HELL 135/90 mm Hg, pulse 84 beats per minute, weight 68 kg. Anesthesia, mg: atropine 0.3; droperidol 5; fentanyl 0.05; calypsol 34 (0.5 mg / kg) intravenously, local anesthesia with novocaine according to A.V. Vishnevsky. After I min (simultaneously with the local anesthesia of the operative floor), effective pain relief, general analgesia, adines, and a decrease in the subcutaneous administration occurred and 35 minutes after the second administration, calipsol was administered at a dose of 0.6 mg / kg (35 48 mg) jg twice intravenously. Anesthesia course without complications. Transferred to the ward in a satisfactory condition, conscious, calm, oriented correctly.

50 The proposed method leads to. the development of general analgesia, as evidenced by the following phenomena: the absence of pain during manipulations in the scar tissue, when

gg is not possible to perform effective infiltrative anesthesia; clinical data on the operation anesthesia (in 18 patients with recurrent hernia and in 31 patients with revision

five

self (out of zero effort), sedation, drowsiness, lack of pain response and other unpleasant sensations on the skin incision and subsequent surgical manipulations (including in the Scar tissue). 30 minutes after the first administration, calypsol was reintroduced in a dose of

0.5 mg / kg (34 mg) intravenously due to a moderate reaction to manipulation in the surgical wound. Duration of operation 1 h 01 min. Anesthesia course without complications. Transferred to the ward in a satisfactory condition, conscious, calm, oriented correctly.

And pm. E 2. Patient 43 years. Diagnobs: acute appendicitis. Operation appendectomy. Concomitant disease - hypertensive disease I-II stage. HELL 165/90 mm Hg., Pulse 74 beats per minute, weight 80 kg. Anesthesia, mg: atropine 0.4; droperidol

5 7.5; Fentanyl 0.1; calypsol 48

(0.6 mg / kg body weight) intravenously, local anesthesia with novocaine according to A.V. Vishnevsky. After 2 minutes (simultaneously with local anesthesia of the operative floor), effective anesthesia, general analgesia, adinae, toning, tension relief (out of willed effort), sedation, drowsiness, lack of pain on the incision occurred.

skin and subsequent surgical manipulations, including with traction of the intestine and revision of the abdominal cavity. Due to the duration of the operation

0

after 35 minutes after the second injection, calipsol was administered at a dose of 0.6 mg / kg (48 mg) jg twice intravenously, when the patient reacted to the manipulation of the wound. Anesthesia course without complications. Transferred to the ward in a satisfactory condition, conscious, calm, oriented correctly.

50 The proposed method leads to. the development of general analgesia, as evidenced by the following phenomena: the absence of pain during manipulations in the scar tissue, when

gg is not possible to perform effective infiltrative anesthesia; clinical data on the operation anesthesia (in 18 patients with recurrent hernia and in 31 patients with revision

abdominal cavity); data from the study of pain sensitivity (Table 1), indicating a significant increase in pain sensitivity thresholds; the absence of pain in the early postoperative period (data in Table. 1); adinemi, pronounced decrease in tone, tension of the muscles (data from the study of the spontaneous myogram are shown in Table 2), which are of a central character. 10, the central character of these phenomena and the absence of a curare-like effect during anesthesia according to the proposed method are evidenced by the data of the study of the electrostimulation myogram with a fingernail brush (Table 3), the data given in Table. 2, which indicate an increase to the initial level of the amplitude of the spontaneous myogram with the patient's volitional force, the results of studies of the acid-base state and blood gas composition (41-7.38, pCOj 38–40 mm Hg, pOj 69-75 mmHg at, 05), external respiration (10.2-13.3 l / min at, 05). The absence of curare-like effect is also indicated by the following clinical data:

blow or suck in the abdomen during surgery.

time

Studies of the pain threshold, amplitude of the photoplethysmogram, reaction to pain in the area of operation, subjective sensations of signs of discomfort during the anesthesia stages show that effective pain relief occurs within 1-2 minutes after administration of calypsral, 30-35 minutes later, C-initial signs of insufficient pain relief, after 35 minutes, there are clear signs of inadequate

new anesthesia. Therefore, calypsol should be administered 1-2 minutes before the skin incision and repeated administration in the initial dose in 30-35 minutes during the operation.

The study of the parameters of pain sensitivity (Table 2) testifies to the super-total analgesic effect of the known drugs used in the new combination according to the proposed method. According to the proposed method, the tactile threshold exceeds the sum of effects achieved by individual preparations by 297-114%, the pain threshold - by 148-56%, the fatigue threshold - by 76-34%.

The proposed method allows on average to halve the consumption of novocaine (from 300-350 ml of a 0.25% solution by the prototype method to 150-170 ml according to the proposed method) in connection with effective pain relief at the painful stages of the operation, the absence of the need to reintroduce novocaine at a number of stages of the operation and reduce the possible current & nical action of novocaine.

Claims (1)

Invention Formula The method of anesthesia with minor surgical interventions, including intravenous premedication, 4 preparations for neuroleptalusalgia and local anesthesia of the surgical field, characterized in that, in order to achieve and maintain general analgesia while reducing muscle tone, an additional 1-2 minutes before Calipsol in a dose of 0.5-0.6 mg / kg is administered at the beginning of the operation, with repeated administration every 30-35 minutes until the end of surgery. Indicators of pain sensitivity at research stages Table 1 The amplitude of the cnotrraKRoft Miiorpa fMU (show off the accuracy of the finger) during the research stages (as a percentage of the initial value) The amplitude of the electrostimulation myogram (elevation of the fifth finger of the hand) at the stages of anesthesia examination by the proposed method (as a percentage of the initial value) Mtm,% 100 ± 5.6 9817,499 ± 6.9 ,, 05 VNIIPI Order 4871/6 Circulation 594 Subscription Random polygons pr-tie, Uzhgorod, st. Project, 4 Taslia Table 3 99t6, 199 ± 5.4 98t7.8 0 ,,, 05 0.05