MindMap Gallery anaesthetization
This is a mind map about anesthesia. It is generally believed that anesthesia is a reversible functional suppression of the central nervous system and/or peripheral nervous system produced by drugs or other methods. This suppression is mainly characterized by the loss of sensation, especially pain.
Edited at 2022-08-05 19:23:54El cáncer de pulmón es un tumor maligno que se origina en la mucosa bronquial o las glándulas de los pulmones. Es uno de los tumores malignos con mayor morbilidad y mortalidad y mayor amenaza para la salud y la vida humana.
La diabetes es una enfermedad crónica con hiperglucemia como signo principal. Es causada principalmente por una disminución en la secreción de insulina causada por una disfunción de las células de los islotes pancreáticos, o porque el cuerpo es insensible a la acción de la insulina (es decir, resistencia a la insulina), o ambas cosas. la glucosa en la sangre es ineficaz para ser utilizada y almacenada.
El sistema digestivo es uno de los nueve sistemas principales del cuerpo humano y es el principal responsable de la ingesta, digestión, absorción y excreción de los alimentos. Consta de dos partes principales: el tracto digestivo y las glándulas digestivas.
El cáncer de pulmón es un tumor maligno que se origina en la mucosa bronquial o las glándulas de los pulmones. Es uno de los tumores malignos con mayor morbilidad y mortalidad y mayor amenaza para la salud y la vida humana.
La diabetes es una enfermedad crónica con hiperglucemia como signo principal. Es causada principalmente por una disminución en la secreción de insulina causada por una disfunción de las células de los islotes pancreáticos, o porque el cuerpo es insensible a la acción de la insulina (es decir, resistencia a la insulina), o ambas cosas. la glucosa en la sangre es ineficaz para ser utilizada y almacenada.
El sistema digestivo es uno de los nueve sistemas principales del cuerpo humano y es el principal responsable de la ingesta, digestión, absorción y excreción de los alimentos. Consta de dos partes principales: el tracto digestivo y las glándulas digestivas.
anaesthetization
Preparation before anesthesia
Anesthesia rating (not important)
Level 1 is really normal, level 2 compensates to normal and has no performance, level 3 has performance and can cope with normal life, level 4 is enough to choke, with the risk of death at any time, level 5 will die within 24 hours.
Preparation before anesthesia
Body
Corrected Hb ≥ 80 (comparison: indication for blood transfusion is Hb less than 70), albumin Alb ≥ 30g/l (normal 35, compared with blood transfusion: <35 for plasma transfusion, <30 for human albumin transfusion)
Blood pressure is less than 180/100mmhg (compared to: 160/100mmhg during perioperative period); to prevent intraoperative hypotension, avoid using central antihypertensive drugs (otherwise refractory hypotension may occur)
Diabetes is controlled to <8.3, and urine ketone bodies are negative (compared to perioperative period: 5.6-11.2)
Discontinuation of medication
Digitalis
Disable on the day of surgery (combined with heart failure, atrial fibrillation and dilated cardiomyopathy)
Supplement: Do not stop hormones, antidepressants, anti-asthma drugs, and antihypertensive drugs until they are used up on the same day.
Antihypertensive drugs (beta blockers, Betaloc)
Stop taking the medicine on the same day. Stopping the medicine too early may cause rebound hypertension.
quit smoking
2 weeks (Check X-ray, blood gas, and lung function if combined with respiratory disease)
aspirin
1 week
Afraid of blood clotting
combined with pulmonary infection
Antibiotics for 3-5 days
gastrointestinal tract
No drinking for 2 hours, 4-6 hours for children, 6-8 hours for adults
Comparison: perioperative period: no drinking for 4 hours, fasting for 8-12 hours
What should I do if I’ve already eaten?
Awake endotracheal intubation or sellik maneuver intubation
Gastrointestinal preparation to prevent aspiration
Premedication
Sedative (valium-diazepam), hypnotic (phenobarbital-sedative and anticonvulsant), analgesic (opioids: morphine, pethidine, pethidine), anticholinergic (scopolamine-inhibits glandular smooth muscle and vagus; compare with anisodamine is digestion)
anaesthetization
local anesthesia
local anesthetic
Classification
Lipids
Procaine, Decaine
Extrahepatic plasma cholinesterase (ester-to-ester)
Amides
lidocaine, bupivacaine, ropivacaine
Intrahepatic Microsomal Enzyme Metabolism (Lidocaine: Lidocaine)
Mechanism
Block Na channels
performance
The lower the dissociation constant (pka), the higher the lipid solubility (potency), the higher the protein binding rate, the better
toxicity
toxic reactions
The most common is a toxic reaction caused by exceeding the maximum amount of local anesthetic.
extreme amount
Procaine
1000mg(Masturbation-1)
Tetracaine
40mg superficial anesthesia, 80mg nerve block
lidocaine
100mg superficial anesthesia, 400mg nerve block (Dolly the sheep is going to die (1, 4) is going to die)
hypersensitivity reaction
Small dose, not an allergic reaction (this is an interference item)
detail
Procaine
The least toxic, most susceptible to allergies, and the least fat-soluble (least effective)
lidocaine
Fastest onset of effect
Di, tetracaine
Strong mucosal penetration (burrowing into the ground) - so it is used for topical anesthesia, low pka (strong kart pk), so diffusion is poor and onset of effect is slow
Bupivacaine (bupivacaine)
Bubi is like a children's cartoon, used for secretory analgesia and on-demand self-controlled analgesia after surgery.
Ropivacaine
The latest amide, replacing bupivacaine because it is less cardiotoxic than bupivacaine
Type of anesthesia
Local anesthesia
Classification
topical anesthesia
Urinary catheter inserted into urethra
local infiltration
area block
nerve block
Brachial plexus block (C5678T1 anterior branch)
interscalene path
Indications
Shoulders
complication
Phrenic nerve, recurrent laryngeal nerve, cervical sympathetic nerve palsy
Epidural or total spinal anesthesia
Toxic reactions of local anesthetics
supraclavicular path
Indications
brachial plexus trunk
complication
Phrenic nerve, recurrent laryngeal nerve, cervical sympathetic nerve palsy
pneumothorax
Toxic reactions of local anesthetics
axillary path
Indications
Forearm and inner hand (interference: lateral forearm cutaneous nerve and its musculocutaneous nerve)
complication
Toxic reactions of local anesthetics
nerve block
Local anesthetic: epinephrine
1: 200,000, 100ml local anesthetic with 0.5mg epinephrine
Epinephrine: used to delay absorption, reduce toxicity, and vasoconstriction
Fingers without adrenaline
To prevent ischemic gangrene
spinal anesthesia
Classification
Spinal numbness
Puncture site L3-4, suitable for short-term, lower body perineal
Anesthetic is injected into the subarachnoid space (cerebrospinal fluid) to directly suppress
One injection, small dose with fine needle
Liquid diffusion
Dosage of medicinal solution (most important), body position (where to go), injection speed, puncture gap, specific gravity of medicinal solution (where to go)
Cut-off anesthesia, numbness
special type
sellar area anesthesia
Postoperative complications
Cauda equina syndrome (not important)
Hypotension headache after cerebrospinal fluid loss
Treat headache: lie down with pillow removed
Treatment: fluid rehydration (crystal glue)
Interfering items: hypertonic sugar water or mannitol
Contraindications
shock
Absolutely contraindicated due to sympathetic suppression-lowering of blood pressure after spinal anesthesia
high intracranial pressure
Because it can cause foramen magnum hernia
Epidural anesthesia
The puncture site can be anywhere, suitable for long distances
The anesthetic is injected into the epidural space (no cerebrospinal fluid is withdrawn, which is equivalent to injecting it on a solid body), which indirectly suppresses
Continuous administration, thick needle and large dose
Liquid diffusion
Gap (the most important), volume of drug solution, catheter placement direction, injection method (wide at one time, small at multiple times)
Segmental anesthesia, where is the anesthesia?
special type
sacral anesthesia
Injection from sacral hiatus
Postoperative complications
Presacral artery syndrome (unimportant)
Sensory dissociation, movement disorders
total spinal anesthesia
Accidentally enter the subarachnoid space
Treatment: Immediate ventilator support, circulatory support (fluid replacement, vasopressors: dopamine, epinephrine, norepinephrine) are required
Contraindications
coagulation disorder
Aspirin not stopped for 1 week
Summary: During epidural anesthesia
concentration
depth
volume
anesthesia plane
dose
Onset and duration, and provide depth of block
effect
Nervous system is the function
Block sequence: hot numbing and pressure
Sympathetic (heat)-superficial sensory nerves (numb)-motor nerves (shen)-proprioceptive (deep) sensation (pressure)
Side effects outside the nervous system
inhibition
breathe
If total spinal anesthesia is used, use a ventilator
cycle
Anesthetics can negatively affect cardiac muscle strength and peripheral blood vessel dilation.
Rehydration Ephedrine (stimulates α and β receptors)
negative heart rate
Atropine, isoproterenol
Urology
Urinary retention in the bladder, indwelling catheterization
excited
Digestive excitement (vagal excitation, sympathetic depression)
No food or water before surgery, gastric tube left in place
Supplementary (not important)
Recovery Time
Local anesthesia: after surgery; spinal anesthesia: 8-12h; general anesthesia: recovery of consciousness; gastrointestinal tract: 2-3 days after exhaustion
Anesthesia
process
induce
Mask inhalation Intravenous administration (propofol, etomidate, midazolam)
After loss of consciousness, administer muscle relaxants and then intubate
maintain
vein
Sedation-analgesia-muscle relaxation
sedatives
sleep hypnosis
Flumazenil antagonized
analgesics
opioid receptors
Naloxone antagonist (can treat alcoholism)
Muscle relaxants
Only relaxes skeletal muscles, no sedation or analgesia
Neostigmine antagonistic
inhalation
N2O O2 Halothane/Fluorether
Replenish
During inhalation anesthesia, CO2 accumulation manifests
CO2 stimulates breathing, and accumulation symptoms: HIGH, high blood pressure, fast breathing, fast pulse, telangiectasia, nail bed flushing
CO2 is expelled too quickly: LOW, low blood pressure, apnea
drug
sedatives
Propofol
Quick induction, quick recovery, fat emulsion
etomidate
No effect on circulation (taking off clothes - pounding heartbeat), used for coronary heart disease
midazolam
Anterograde amnesia
Ketamine (K powder)
Confusion, loss of consciousness, preservation of spontaneous breathing, basic anesthesia for children
Thiopental sodium
Bronchospasm
Supplement: Interference items: antihistamines (this is for hepatic encephalopathy, use antihistamines for hypnosis)
analgesics
Opioids: remifentanil
Muscle relaxants
Only relaxes skeletal muscles, no sedation or analgesia
Depolarizing muscle relaxants
Occupying the pit and pooping all the time, my muscles twitched and then my muscles relaxed.
Succinylcholine (obsolete)
antagonistic
neostigmine
non-depolarizing muscle relaxants
Don’t poop when occupying a hole, don’t tremble before muscle relaxation
medicine
atracurium
hoffman pathway metabolism
Vecuronium bromide
No histamine release, used in coronary heart disease
Rocuronium
Fastest onset of effect
antagonistic
neostigmine
Contraindications
myasthenia gravis
inhalation anesthetic
N2O
Sedation and analgesia
Adverse reactions
Intestinal root obstruction and bullous pneumothorax are contraindicated: because it will increase the pressure in the closed chamber
Halothane, fluoroether
Isoflurane
Strong anesthetic effect and odor
Enflurane
Eye surgery, epilepsy
Sevoflurane (most commonly used)
The most effective anesthesia
Desflurane
Heart surgery, minimal impact on circulation
Influencing factors
The higher the oil/gas ratio, the lower the MAC (minimum alveolar effective concentration), the lower the blood/gas distribution coefficient (the stronger the controllability and the faster recovery), the better it is to use.
General anesthetics for coronary heart disease
The only wisdom is my heart
Vecuronium bromide, etomidate, desflurane, remifentanil
cardiopulmonary cerebral resuscitation
What is saved is the heart, what is protected is the brain
Supplement: Sudden loss of consciousness is required to diagnose cardiac arrest.
three steps
Basic life support (primary resuscitation) (CAB)
The most important thing is to determine the patient's consciousness and aortic pulse (carotid artery pulse is a sign of successful resuscitation)
C (circulation chest compression)
Compression amplitude 5-6cm, compression relaxation time = 1:1, compression frequency 100-120 times/min, chest compression: artificial respiration = 30:2
A (airway open airway)
The most commonly used method of pressing the forehead and raising the chin
B (breathe artificial respiration)
CE hair or mouth to mouth
Advanced life support (advanced resuscitation)
defibrillation
The most common ventricular fibrillation (asynchronous electrical cardioversion)
For comparison, asynchronous ventricular fibrillation without R wave is used, synchronization is used for ventricular tachycardia with R wave, amiodarone is used for normal blood pressure, and electrical cardioversion is used for abnormal blood pressure.
vein
Adrenaline
respiratory tract
Tracheal intubation (depth 4-5cm (notation: dead cover))
ECG and PETCO2 (end-tidal CO2, rising indicates recovery)
Reflects cardiac output and lung tissue perfusion (not important) to determine whether resuscitation is successful
ICU maintenance after successful resuscitation
breathe
Ventilator
cycle
Rehydration Vasoactive Drugs
brain resuscitation
Hypothermia, reduction of intracranial pressure, systemic support (infection item: respiratory and circulatory support, because respiratory circulation and cerebral resuscitation are parallel and not subordinate)
Replenish
Ventilator
100% no spontaneous breathing
Complete Mandatory VentilationVC
Spontaneous breathing may occur during intermittent periods
Synchronized intermittent mandatory ventilation
100% breathing spontaneously
Full support for ventilated PSV
ARDS patients
Small tidal volume, optimal PEEP
Five principles of cancer pain and three-stage analgesia
Oral administration
Give medication on time
Interfering items: On-demand administration (patient-controlled analgesia after surgery)
Step-by-step dosing
Mild
Nonsteroidal: ibuprofen
Moderate
Weak Opiate: Codeine
Severe
Strong Opiate: Fentanyl
personalized medicine
Start with a low dose