Is it always intubated under anesthesia? Endotracheal (inhalation) anesthesia - "Endotracheal anesthesia
Today, you will not surprise anyone with such a method of treatment as surgery. But even a few centuries ago, the operation was equated with death: most patients died from sepsis or. For a long time the introduction of a person into surgical sleep remained the most difficult task of medicine. With the study of chemistry, the process went faster. Improved mixtures and preparations for anesthesia were created, which, moreover, are now carried out in different ways. One of them is endotracheal anesthesia. What it is? How is it used and when is it needed? We will answer these and many other questions in the article.
From the history of endotracheal anesthesia
For the first time this type of anesthesia was tried in the XIV-XV centuries, when the doctor Paracelsus from Switzerland inserted a tube into the trachea of \u200b\u200ba person, thereby saving his life. Three centuries later, in this way, people were saved from lack of air. In 1942, an anesthesiologist from Canada first used muscle relaxants - substances that reduce the tone of skeletal muscles to the point of complete immobilization. Thanks to this discovery, anesthesia has become safer and more perfect, allowing specialists to fully control the course of surgical sleep during the operation.
In the middle of the 20th century, endotracheal anesthesia began to develop rapidly, which was also facilitated by Soviet doctors. Today it is the most common method used in most operations.
Endotracheal anesthesia: what is it?
Pain relief is used to protect the body from the enormous stress of surgery. It can be local, regional, or general. The latter type is called anesthesia. It is characterized by a complete "shutdown" of the patient's consciousness with the onset of surgical sleep. In modern anesthesiology, intravenous, mask or combined anesthesia is used. The latter combines two methods: substances enter both the bloodstream and the respiratory tract. This type is called endotracheal anesthesia.
Experts rightfully consider it the safest and effective method pain relief: it allows you to fully control the patient's condition, achieve deep surgical sleep and relaxation of skeletal muscles, as well as avoid unpleasant complications such as aspiration and respiratory failure.
Indications
Endotracheal anesthesia protects the patient from painful shock and respiratory failure, which makes it possible to use it during operations and resuscitation. Indications for combined anesthesia may include:
- operations on the mediastinum, pharynx, inner ear, oral cavity and head;
- interventions in which it is necessary to use muscle relaxants;
- failures in the nervous system;
- full stomach syndrome;
- risk of airway obstruction.
Endotracheal general anesthesia is more often used for long-term operations, the duration of which is more than 30 minutes. It can be used at any age under different conditions of the patient, since it does not burden the heart and is much less toxic to other methods of pain relief.
Contraindications
Planned surgery (for example, surgery to remove a mediastinal tumor) is accompanied by a thorough examination of the patient's condition. The doctor has the necessary time to familiarize himself with the patient's medical record, having time to calculate the possible risks and identify contraindications to one or another method of anesthesia. Combined anesthesia is not recommended for the following conditions:
- infectious diseases;
- pathology of the liver, kidneys;
- suspicion of myocardial infarction;
- respiratory tract pathology;
- physiological features of the structure of the pharynx;
- severe endocrine disorders.
The use of endotracheal anesthesia is especially dangerous for upper respiratory tract infections, since the risk of lung infection is high.
Stages of combined anesthesia
So, endotracheal anesthesia. What is this for a doctor? The anesthesiologist performs three sequential steps: induction of surgical sleep, maintenance of a stable state, and awakening. The first stage is to provide a light induction of anesthesia. The patient receives drugs intravenously or inhales a mixture of gases. When the muscles are completely relaxed, the anesthesiologist inserts an endotracheal tube into the lumen of the trachea. It provides ventilation of the lungs with oxygen and inhalation of gaseous anesthetics.
After the surgeons have finished their work, there comes a crucial moment for the anesthesiologist - the withdrawal of the patient from anesthesia. The dosage of drugs is gradually reduced. After the restoration of spontaneous breathing, extubation is performed - removal of the endotracheal tube from the trachea. The patient is transported to the ward, monitoring vital signs and the postoperative recovery process.
Introductory anesthesia
Light initial anesthesia is necessary for painless and safe intubation, without which endotracheal anesthesia is impossible. To achieve this state, inhalation or intravenous pain relievers are used. In the first case, the patient breathes through the mask with vapors of Etran, Foran, Ftorotan or other similar mixtures of anesthetics. Sometimes nitrous oxide with oxygen is sufficient.
The drugs administered intravenously are usually barbiturates and antipsychotics (droperidol, fentanyl). They are used in the form of a solution (no more than 1%). The dose of the drug is selected by the anesthesiologist individually for each patient.
After light anesthesia has worked, tracheal intubation is performed. For this, muscle relaxants are used to relax the muscles of the neck. The tube is inserted using a laryngoscope, after which the patient is transferred to artificial lung ventilation. The stage of deep anesthesia begins.
Droperidol: instruction
Droperidol is a neuroleptic often used for endotracheal anesthesia. In terms of chemical structure, this substance is a tertiary amine. Has a sedative effect within 3 minutes after administration. Blocks dopamine receptors, which causes neurovegetative inhibition. In addition, it has antiemetic and hypothermic effects. It has little effect on breathing.
It is prescribed for premedication, induction anesthesia, myocardial infarction, shock condition, severe angina pectoris, pulmonary edema and hypertensive crisis. Recommended as a drug that eliminates nausea and vomiting. It has low toxicity, which makes it suitable for use in pediatric surgery and obstetrics.
The technique of using neuroleptics for induction anesthesia
There are several options for performing neuroleptanalgesia. Introductory anesthesia is usually carried out according to the following scheme: droperidol, the instructions of which were discussed above, in the amount of 2-5 ml with 6-14 ml of fentanyl is intravenously administered to the patient. At the same time, a mask is served with a mixture and oxygen in a ratio of 2: 1 or 3: 1. After suppression of consciousness, muscle relaxants are injected and intubation is started.
Droperidol has a neuroleptic effect for 4-5 hours, so it is administered at the beginning of the anesthesia. Calculate it taking into account body weight: 0.25-0.5 mg / kg. Re-introduction the drug is necessary only for long-term operations.
Fentanyl in the amount of 0.1 mg is injected every 20 minutes and its supply is stopped 30-40 minutes before the end of the surgical intervention. The initial dose is 5-7 mcg / kg.
Intubation
After suppression of consciousness, oxygen is carried out using an anesthetic mask. Then the doctor performs intubation through the mouth (less often through the nose). The head is thrown back, the mouth is opened. A laryngoscope with a straight blade is introduced along the midline between the palate and the tongue, pressing the latter up. Moving the instrument further, the apex of the epiglottis is raised. The glottis is shown, into which it is injected. It should go into the trachea by about 2-3 cm. After successful intubation, the tube is fixed and the patient is connected to a ventilator.
Less commonly, a curved-blade laryngoscope is used. It is inserted between the base of the epiglottis and the root of the tongue, pressing the latter upward from itself. If it is impossible to insert the tube through the mouth, use the lower nasal passage. For example, an operation is performed to remove the cyst of the oral cavity.
Maintenance and recovery from anesthesia
After intubation and connection of the patient to the main period begins. Surgeons are actively working, the anesthesiologist closely monitors life support indicators. Every 15 minutes, the heart rate, blood pressure are checked, with the help of monitors, the patient's cardiac activity is monitored.
General anesthesia is maintained with additional doses of antipsychotics, muscle relaxants, or inhalation of anesthetic mixtures. The operation under combined anesthesia allows the anesthesiologist to adapt to the body's needs for pain relief, providing an optimal level of safety.
After the end of the surgical manipulations, the last stage begins - the exit from the narcotic sleep. Until this moment, the dosage of drugs is gradually reduced. To restore breathing, atropine and proserin are administered with an interval of 5 minutes. After making sure that the patient is able to breathe on his own, extubation is performed. For this, the area of \u200b\u200bthe tracheobronchial tree is cleaned. After removing the tube, a similar procedure is performed with the oral cavity.
Postoperative observation
After leaving the operating room, the patient is placed in the intensive care unit, where his condition is carefully monitored. After general anesthesia, unpleasant sensations develop, less often complications. Usually postoperative patients complain of:
- pain;
- a feeling of discomfort in the throat;
- nausea;
- weakness and muscle fatigue;
- drowsiness;
- confusion of consciousness;
- chills;
- thirst and lack of appetite.
These symptoms usually resolve within the first 2 to 48 hours after surgery. To eliminate pain, analgesics are prescribed.
So let's recap. Endotracheal anesthesia - what is it? This is a method of introducing a person into a surgical sleep, which allows performing complex operations, controlling the activity respiratory system... Combined anesthesia is less toxic, and the depth of anesthesia is easy to control during the entire period of the intervention. Endotracheal anesthesia primarily refers to intubation followed by connection of the patient to a ventilator. In this case, both inhalation and drug anesthetics are used, which are usually combined.
The essence of anesthesia used by the endotracheal method is that the substance itself, which has a narcotic effect, is injected into the patient's body through a special tube, which is previously placed in the trachea. This method has many advantages.
Let's list the main ones:
- ensuring free passage of the respiratory tract;
- the possibility of using this method for various surgical interventions: on the head, on the face, on the neck, etc.;
- aspiration of blood and vomit is completely excluded;
- the amount of drugs used is significantly reduced;
- it is possible to improve gas exchange, taking into account the reduction of the so-called. "Dead" territory (space).
Endotracheal anesthesia indications for the use of such anesthesia are possible in cases where a major surgical intervention is necessary. In this case, multicomponent anesthesia is used, in which strong muscle relaxants are present (this type of anesthesia is also called combined). Due to the fact that some types of narcotic substances used in rather small doses together give a much lighter toxic effect on the body, the patient's postoperative condition will be significantly improved. The use of modern combined anesthesia allows doctors to fulfill such goals as:
- carry out anelgesia;
- turn off consciousness;
- put the patient into a state of relaxation.
Achievement of the first two points is possible with the help of used drugs (one or more) by inhalation or non-inhalation.
The use of anesthesia is permissible at the very first level of the stage of surgical intervention.
The third point (relaxation of the body) can be achieved by introducing relaxants into the body, which have an effect on the patient's muscles.
The stages of endotracheal anesthesia are carried out in three stages
The 1st stage is called "introduction"
This stage is carried out with the help of the introduction of any narcotic substance that provokes the appearance of deep anesthetic sleep, which proceeds without the stage of voluntary awakening. Achieving such a goal is possible with the use of:
- barbiturates;
- sombrevin, in combination with fentanyl;
- sombrevina, in combination with promedol;
- thiopental sodium.
All of the above drugs are used in the form of a solution (no more than 1%) and are administered intravenously (the dose of such an administration should be at least 500 mg, but no more than 1000 mg). In parallel, against the background of anesthetic sleep, doctors perform tracheal intubation.
2nd stage is called "maintenance"
In order to maintain the general anesthetic state, it is possible to use any anesthetic agent that creates an effect that protects the body from surgical trauma. Such funds are called:
- fluorothane;
- oxygen with nitrous oxide;
- cyclopropane.
You can also arrange for neuroleptanalgesia.
Doctors provide maintenance of anesthesia at the first and second levels of the surgical stage of the operation. And in order to eliminate muscle tension, muscle relaxants are introduced, which cause myoplegia in all muscle groups - both skeletal and respiratory. That is why, the main condition for the use of modern combined methods that have an analgesic effect is that in parallel, mechanical ventilation (artificial ventilation of the lungs) is carried out, the implementation of which is a process of rhythmic pressing on the bellows or with the help of a special ventilator.
Recently, the use of neuroleptanalgesia is especially common. This method is characterized by the use of oxygen with nitrous oxide, fentanyl, muscle relaxants and droperidol. The state of anesthesia is maintained with the help of nitrous oxide together with oxygen (correlated as 2: 1), as well as fractional administration of droperidol and fentanyl (1-2 ml is administered every 15-20 minutes). In the event that the patient has a rapid pulse, fentanyl is administered, and if an increase in blood pressure is detected, droperidol is administered. The use of just this type of anesthesia in such proportions allows achieving the safest result for the patient.
3rd stage is called "hatching"
The closer the surgical intervention comes to an end, the less the doctor injects drugs and muscle relaxants, gradually reducing such an introduction to zero. Gradually, the patient regains consciousness, while restoring the ability to breathe independently, as well as restoring muscle tone. To assess the adequacy of breathing, indicators such as pH, Po2, Pco are used. After the main indicators of homeostasis are restored, the patient is extubated, and then transports him, in order to further monitor the condition, to the postoperative hospital ward.
An indispensable factor in a successful surgical intervention is control over the direct conduct of anesthesia.
At the time when anesthesia occurs, doctors constantly and systematically determine and then evaluate all the main hemodynamic parameters of the patient's body. This happens by measuring blood pressure and measuring the patient's pulse rate every 7-15 minutes. Those patients who have diseases of the cardiac and vascular system, as well as in the case of thoracic operations, are constantly monitored for the activity of the cardiac system.
It is possible to use electroencephalographic observation in order to determine the level of anesthesia.
In order to control the ventilation of the lungs and metabolic changes during the action of anesthesia, it is necessary to conduct research on pH, Po2, Pco2 by specialists, that is, the acid-base states of the body.
While modern endotracheal anesthesia acts on the patient, the nurse maintains the patient's anesthetic record, where homeostasis indicators must be recorded:
- respiration rate;
- ventilation parameters;
- heart rate;
- pressure level (both arterial and central venous) and other indicators.
Also, this map should reflect the passage of all stages of the passage of anesthesia and the surgical intervention itself. Nurse also notes all preparations and honey. funds that were used during anesthesia. The time of passage of each stage of the surgical intervention and the time of administration of medications must be indicated. At the end of the operation, determine all the drugs used in calculating the total amount spent, and make the appropriate notes on the card. If any complications occurred during anesthesia or surgery, information about them is also necessarily entered in the medical record. This card will then be included in the patient's medical history. It is due to such accurate reporting, as well as due to the amazing effectiveness of the treatment itself, that Israeli anesthesiologists are considered the best in the world, and the anesthesiological methods used are the most advanced. This is evidenced by international statistics.
However, after endotracheal anesthesia of sensation, a number of complications will also appear, the occurrence of which depends on the anatomical and physiological features of the structure of the body of a particular patient, such as:
- poor head extension;
- poor jaw removal;
- the presence of a short epiglottis.
Even in the most skillful hands, with all of the above features, it is difficult to see the glottis during intubation. It is from unsuccessful intubation that deaths still occur. If such a case occurs, the assistance of a physician with extensive experience is needed. In order to save a person, a tracheostomy or diffusion breathing is used: with the help of a simple needle, a puncture is made in the trachea, then the puncture site is connected to a tube that supplies oxygen. However, the use of such a method of artificially maintaining ventilation of the lungs is possible no longer than 30-40 minutes, because then carbon dioxide accumulates in doses that are lethal to humans.
Laryngospasm and bronchospasm are no less frequent complications.
The first condition occurs due to a very tight closure vocal cords, as a result of which it becomes impossible to insert the tube. This condition is removed with muscle relaxants, after the introduction of which the muscles relax and it is necessary to immediately transfer the patient to artificial ventilation of the lungs.
The second condition occurs when smooth muscle contraction occurs and the action of relaxants does not bring any results. In this case, the doctor uses bronchodilator agents.
* Price for endotracheal anesthesia is included in the cost of the operation
Some general information about the methods of anesthesia. Anesthesia can be local or general. Local anesthesia is used in small surgical interventions... For example, when removing papillomas, wen and moles, or when reinforcing the face. With local anesthesia, the patient is awake, but the operation area completely loses sensitivity.
General anesthesia is necessary for prolonged and complex operations... Under general anesthesia, the patient is immersed in a state of drug-induced sleep, and vital functions - breathing, cardiac activity - are controlled by an anesthesiologist. Anesthesia is always general anesthesia. The terms "local anesthesia" or "general anesthesia" are meaningless, although sometimes they can be found in publications and in everyday speech.
What is endotracheal anesthesia?
There are two types of general anesthesia - intravenous and inhalation anesthesia. In the first case, drugs that put a person to sleep are injected by the anesthesiologist intravenously. With inhalation anesthesia, drugs enter the body with inhaled air in gaseous form.
Inhalation anesthesia can be performed using a mask or intubation technique. The mask technique involves the supply of oxygen and drugs for anesthesia through a special mask and does not require the introduction of a breathing tube into the trachea. With the intubation technique, a tube is inserted into the trachea through which oxygen and substances for anesthesia are supplied, and carbon dioxide is removed.
Endotracheal anesthesia is a technique of inhalation anesthesia, a variant of general anesthesia in which, during the operation, drugs and external breathing is carried out through a special tube inserted into the upper respiratory tract, that is, into the trachea.
Combined endotracheal anesthesia is a separate method of general anesthesia in which drugs for anesthesia are administered both intravenously and through the respiratory tract. In other words, it is a combination of intravenous and inhalation anesthesia.
How is endotracheal anesthesia performed?
Preparation for surgery consists of several stages. The preparatory stage is premedication. Before the operation, the patient is given sedatives - tranquilizers, drugs with anxiolytic effect. Taking sleeping pills the evening before the operation is also part of the preparatory phase. Thanks to premedication, a person approaches surgery in a calm and balanced state.
Immediately before the operation, an induction anesthesia is performed - intravenous administration sedatives that allow you to fall asleep smoothly before intubation begins. The next step is muscle relaxation. When the patient falls asleep, he is injected with a small dose of muscle relaxants - drugs that help relax muscles. Thanks to muscle relaxants, the tone of the muscles of the larynx decreases and optimal conditions are created for the introduction of an endotracheal tube.
The fourth stage is the direct introduction of the endotracheal tube and its connection to the ventilator. At this stage, the patient is already asleep and dreams, and nothing bothers him.
Benefits of endotracheal anesthesia
Maximum safety and complete control over the depth of medication sleep are the main advantages of endotracheal anesthesia. The risk of "waking up during the operation" is excluded, as well as the slightest likelihood of disruption of the respiratory and cardiovascular systems. In other words, it is the safest and most reliable type of general anesthesia, during which the anesthesiologist has everything under control!
The benefits of endotracheal anesthesia are due to the continuous monitoring of respiratory function through intubation. The anesthesiologist constantly monitors adequate ventilation of the lungs, accurately doses the amount of oxygen entering the lungs, carefully controls the carbon dioxide content in the exhaled air.
From the point of view of safety, one more point is important - the risk of tongue sinking, which is present with intravenous and mask technique of anesthesia, is eliminated. In addition, the endotracheal tube completely isolates the airway from the esophagus, which eliminates the likelihood of saliva and stomach contents entering the pulmonary system.
Other features and advantages of endotracheal anesthesia are the possibility of active use of muscle relaxants, the possibility of long-term operations with artificial ventilation of the lungs, minimization of the risk postoperative complications from the respiratory and cardiovascular system.
Endotracheal anesthesia - indications
IN plastic surgery endotracheal anesthesia is used in many operations. Examples include rhinoplasty, augmentation mammoplasty, abdominoplasty, mastopexy, circular facelift, and SMAS platysmoplasty. Liposuction can also be performed using an intubation technique, although local anesthesia may be selected for low volume correction.
Endotracheal anesthesia is indicated for all long-term operations, accompanied by a violation of the integrity of deep tissues, not only the skin. This is how a general rule can be formulated. Minor surgical interventions are often performed under local anesthesia. Examples are otoplasty for lop-eared, bulhorn (a type of lip plastic) or lipoma removal.
After endotracheal anesthesia
The final stage of general anesthesia is the withdrawal of the patient from the state of drug-induced sleep. After endotracheal anesthesia, there is some confusion, which is explained by the residual effect of sedatives on the central nervous system. Potential headaches, mild dizziness and nausea are associated with this. However, the peculiarities of modern drugs for anesthesia are such that while the patient may be worried about their residual effect, he is in a state that resembles euphoria. And when the euphoria passes, the "echoes" of anesthesia also disappear.
A specific phenomenon after endotracheal anesthesia is a slight sore throat, perspiration, possibly a cough. These consequences are explained by the fact that the endotracheal tube irritates the mucous membrane of the larynx and trachea. As a rule, the discomfort disappears within 24 hours.
Complications of endotracheal anesthesia
Any surgical intervention is associated with the risk of postoperative complications. The purpose of using endotracheal anesthesia is to minimize this risk. Thanks to the intubation technique for administering drugs, the risk of aspiration of gastric contents into the lungs is reduced, the risk of infection of the respiratory tract, the risk of respiratory or cardiovascular failure is minimized.
Complications of endotracheal anesthesia, that is, complications caused by the introduction of an endotracheal tube, are extremely rare. These include injuries to the tongue or larynx, which occur during intubation "on the go" before urgent (urgent) operations. There are no complications of endotracheal anesthesia with elective surgical interventions, which include all plastic surgeries.
Endotracheal anesthesia - contraindications
Endotracheal anesthesia is widely used in all branches of surgery largely due to the fact that it has practically no contraindications. The intubation technique allows complete control of vital functions, with its help even 16-hour heart surgeries are performed.
In the context of plastic surgery, endotracheal anesthesia has no contraindications. Why? Because intubation cannot be used only under certain conditions in which any operation that is not associated with the elimination of an immediate threat to life is contraindicated. For example, endotracheal anesthesia is contraindicated in case of myocardial infarction or pneumonia, but it would never occur to anyone to do plastic surgery.
To learn more about the anesthetic techniques used in a particular plastic surgery, sign up for a free consultation with a surgeon at the Soho Clinic.
Endotracheal anesthesia - modern look pain relief, the effect of which is based on the supply of anesthetic through the trachea. Simply put, anesthesia is through the airways. This is a type of general anesthesia that most fully meets the requirements of modern multicomponent / combined anesthesia. Since it allows you to use different pharmacological substances, a purely selective (separate) type of action (for example, muscle relaxants and / or drugs and hypnotics), but at the same time complementing and reinforcing each other's actions.
Endotracheal anesthesia what is it
This is a sequential technique in which: the patient is immersed in medication sleep, reflexes are medically reduced and breathing and skeletal muscles are turned off with muscle relaxants, after which the anesthesiologist inserts into the larynx or a special airway or laryngeal mask or, as in the example below, a special endotracheal tube.
Endotracheal and intubation anesthesia with the development of science and high technology are no longer absolute synonyms. Since the supply of inhalation anesthetic into the trachea can be carried out not only through the endotracheal tube, but also through the supraglottic airway or laryngeal mask. Esmarch's gauze mask, perhaps, can be found either in the picture or in the museum.
And thanks to him, the possibilities of surgeons and surgery of those times increased significantly. Decreased mortality primarily from pain shock.
And the real flourishing of the era of endotracheal anesthesia came after 1942, with the revolutionary invention of muscle relaxants by G. Griffith and E. Johnson and the successful conduct of edotracheal anesthesia in Montreal.
Modern endotracheal anesthesia
Most fully meets the concept of adequate anesthesia. Somehow:
-psychic (emotional calmness of the patient)
- complete and perfect 100% pain relief
-blocking and inhibition of unnecessary pathological reactions of the body
- adequate gas exchange and basal metabolism and metabolic rate of the body
- adequate hemodynamics and ultimately oxygen transport: delivery, consumption, utilization.
Dear reader, it would be unforgivable not to mention the main components of modern general anesthesia, which are best represented by the example of multicomponent endotracheal anesthesia.
So:
- Inhibition of mental reactions and perception (sleep)
- Analgesia. Blockade of pain (afferent, from the surgical wound to the brain) impulses.
- Hyporeflexia and or / areflexia (blockade and inhibition of autonomic reactions: heart palpitations (tachycardia) or vice versa slow (bradycardia), increased salivation, or lacrimation (lacrimation).
- Miorelaxation-switching off of motor activity.
- Circulatory control
- Control of blood gas exchange through adequate monitoring of the functions of external respiration (airway patency).
The widespread popularity of endotracheal anesthesia is associated with the following.
- The use of muscle relaxants, with a guaranteed adequate function of gas exchange under conditions of surface anesthesia and complete immobilization, allows you to reduce the dose of general anesthetics and their toxic effects on the body.
- Ensuring the patency of the airways, regardless of the position of the patient on the operating table and the area of \u200b\u200boperation, reliable protection against possible ingestion of stomach contents, especially during emergency operations (Meldenson's Syndrome).
-Optimum conditions for artificial ventilation of the lungs, as well as for operations on one lung and or in conditions of artificial circulation.
Endotracheal anesthesia indications and contraindications, complications
- Contraindications to and intravenous anesthesia.
- The need for reliable respiratory protection.
Patients with a full stomach or at risk of regurgitation (movement of food opposite to physiological: from the stomach into the esophagus) and aspiration (ingestion of gastric contents into the respiratory tract: Mendelssohn's syndrome). - Forced position of the patient on the operating table, in which control and monitoring of airway patency is difficult: Trendelenburg, Overholt, etc.).
- For operations on the head, facial skull, neck. Operations on the pharynx, nasal cavities, in / lower jaw, inner ear, eye sockets, trachea, floor of the mouth, thyroid surgery.
- For surgical interventions on the mediastinum, heart, abdominal cavity (middle and upper floors, laparoscopic operations).
- Patients in critical conditions, when initially there are gross disorders of the functions of vernal breathing and gas exchange.
All kinds of shocks. - Surgical intervention lasting 15-20 minutes.
- Bleeding from the placenta puff in obstetrics. When you can't cheat.
There are no absolute contraindications. The laboratory proven intolerance to general anesthetics, namely, inhalation anesthetics, can be considered relative. In this case, the alternative is total intravenous anesthesia under mechanical ventilation. If there is no expressed need for respiratory protection, regional: spinal or.
Complications of endotracheal drugbehind
They can be extremely tragic. , both for the patient and for the anesthesiologist. Inadequate anesthesia of the patient leads to a reflex and hormonal explosion, in the flesh to cardiac arrest, but that's half the trouble. The whole technique of endotracheal anesthesia involves the installation of an endotracheal tube into the trachea, and this must be done in 30-40 seconds. Without damaging your teeth soft tissue, the vocal cords and the trachea itself.
Intubation of the trachea is a crucial and extremely risky moment: since the patient does not breathe, and in case of unsuccessful intubation of the trachea, a number of life-threatening situations may occur associated with ventilation of the airways:
-the patient can be ventilated (with an Ambu bag, ventilator), but cannot be intubated.
- the patient can be ventilated and can be intubated.
- the patient cannot be ventilated, cannot be intubated.
The last fatal complication is due to anatomical features:
-slaped chin, large and long tongue and high palate.
-short "Bullish" neck
- non-flexing cervical vertebrae,
- tight mobility of the lower jaw)
- loss of visualization of the glottis (entrance to the trachea), bleeding,
- pathological fluid from the trachea or gastric contents.
I will tell you about the ways and methods of solving these fatal complications in the posts on intubation.
And now the next group of complications
- cardiac arrest due to insufficient depth of anesthesia
- rupture of lung tissue and air entering the pleural cavity
(pneumothorax and mediastinal displacement) - laryngospasm and bronchial spasm (reflex compression of the vocal cords, trachea, and large bronchi
- damage to the vocal cords: sagging one or both, or avulsion
- inflammation of the garter space (especially in children)
- extraction of teeth, damage to the eyes, tissues of the lips and mucous membranes of the larynx and pear-shaped fossa
- mendelssohn's syndrome (ingestion of gastric contents into the tracheobronchial tree
Endotracheal anesthesia drugs
Inhalation anesthetics, depending on the dosage, cause inhibition of the expulsion of the left atrium, the contractile function of the right and left ventricles. Information on the effect on the effect on the incidence of ventricular / atrial arrhythmias varies. There is no 100% data on the dose dependence of drugs on the incidence of arrhythmias. However, they have been shown to have cardio protective effects on cardio vascular system with myocardial infarction and persistent ischemia of the heart muscle. In most cases, the muscles of the bronchi, mainly the distal (small) bronchi, are relaxed.
At the moment, the most popular inhalation anesthetics are represented by the family of halogen-containing agents: sevoflurane, isoflurane, desflurane, halothane. Also nitrous oxide (halothane, is still actively used in our clinic for children).
Advantages over intravenous anesthetics
Inhalation anesthetics can be measured with special vaporizers. Intravenous anesthetics can only be calculated in a syringe.
The distribution of inhalation anesthetics in the body is influenced by: drug concentration, fresh gas flow, alveolar ventilation and cardiac output. They are in liquid form.
A brief description of:
Sevoflurane -modern anesthetic of the third generation. The minimum alveolar concentration of MAC is 2.01. Minimal irritation of the mucous membrane of the respiratory tract, depression of the myocardium, tone of the peripheral vascular system (OPPS), increases cerebral blood flow. It can be used for prolonged sedation of the patient.
Isoflurane - a representative of the second generation of inhalation anesthetics. In terms of the strength of anesthesia, it is ahead of sevoflurane. Isoflurane more strongly inhibits respiration, often causes tachycardia, due to irritation of the upper respiratory tract (the smell is extremely disliked by children) .It causes a decrease in the tone of peripheral vessels. Poppy 1.15
So in what quantities should a drug for inhalation anesthesia be measured, given that it is a liquid in a vial, and when it gets into a specialized evaporator, it is supplied as a gas to the patient's lungs?
For thisin the 1960s, the term minimum alveolar concentration (MAC) was specifically introduced as a single unit of strength of action of inhalation anesthetics.
So MAC: determination of the minimum alveolar concentration of an inhalation anesthetic at atmospheric pressure, necessary to prevent a motor response in response to a painful stimulus in 50% of patients.
MAC of sevoflurane, isoflurane and desflurane depending on age. 
Desflurane -
as well as sevoflurane, a third-generation inhalation anesthetic. 6.0 vol% .
The anesthetic force is 4 times lower than the above described anesthetics. High pressure saturated steam requires a dedicated thermo-compensated vaporizer. (A separate vaporizer is used for each inhalation anesthetic)
There is a controversial opinion that awakening from desflurane is faster than from sevoran. Desflurane is not the best drug for induction of anesthesia, as it irritates the airways.
At the moment, in the light of the concept of modern multicomponent anesthesia, mono anesthesia (that is, anesthesia with one drug) is not applicable.
Endotracheal anesthesia is used with intravenous anesthetics, muscle relaxants, hypnotics, and opioid synthetic drugs. Often, the latter play the role of the basis of anesthesia, and inhalation anesthetics primarily play the role of a hypnotist (sleep) and, to a lesser extent, an anesthetic as such. This allows, due to the reinforcing action of each other, to reduce the dose of both inhalation and intravenous anesthetics. Consequently, to reduce the likelihood of a depressive or toxic effect on the body. In addition, often in very traumatic operations in conjunction with.
Well, now you know, at least in general terms, what endotracheal anesthesia is, the method of indications and complications.
General anesthesia can be given to a patient in two ways: by injecting the drug into a vein or by inhalation. The second option is also divided into two types: mask and intubation (endotracheal) anesthesia. You've probably seen how a translucent mask is applied to a person's nose and mouth before surgery in films and TV series about a hospital. But this method is not always possible, so patients are often intubated by placing a tube that delivers the drug directly into the trachea.
What you need to know about intubation anesthesia
Otherwise, this type of anesthesia is called endotracheal (literal translation "inside the trachea"). This name is explained by the technique of execution: a tube for supplying an anesthetic mixture is inserted directly into the trachea, which allows air to pass directly to the lungs.
It sounds scary and unusual for an ordinary person. But, in reality, thanks to intubation anesthesia, doctors have more opportunities for surgical intervention. The risks become several times less, because the patient is under the total control of special equipment. The anesthesiologist can see all the parameters of the patient's vital activity on the monitor, monitor his breathing and the state of being in a narcotic sleep.
Advantages and Disadvantages of Modern Endotracheal Anesthesia
To understand exactly that intubation anesthesia is a reliable method of introducing a patient into a narcotic sleep, let us consider its main advantages over mask sleep.
But there is nothing ideal, therefore, the method of carrying out endotracheal anesthesia has its drawbacks.
- Difficulty performing intubation (doctor must be an experienced professional).
- There is a risk of injury to the mucous membranes of the respiratory tract.
Contraindications to intubation anesthesia
Endotracheal anesthesia may not always be used. The following points are contraindications to it:
- features of the anatomical and physiological structure of the larynx (short epiglottis);
- acute pathologies of the kidneys and liver;
- recently suffered a heart attack;
- diseases of the bronchopulmonary system;
- the patient has acute respiratory diseases at the time of the operation.
If you make sure that there are no contraindications to endotracheal anesthesia, then the negative consequences will be minimized.
Stages of endotracheal anesthesia
Knowing the principle of performing anesthesia, it is not so scary to go for an operation. Therefore, many potential patients who will soon have general anesthesia by intubation decide to undergo a short educational program.
Introductory anesthesia
Today, combined anesthesia is most often used: first, the patient is put to sleep with drugs, while maintaining ventilation with a mask. This is necessary so that during the installation of the endotracheal tube, the person is already under anesthesia and cannot interfere with the actions of the doctor.
Tracheal intubation
If the patient is to undergo oral surgery, but intubation is performed through the nose. In all other cases - through the mouth.
The patient's head is tilted back a little. IN oral cavity a laryngoscope is inserted - a special tool that allows you to fix the mouth open and illuminate the cavity. When the glottis is clearly visible, an endotracheal tube is inserted into it, to which a ventilator (mechanical ventilation) is connected.
Basic anesthesia
As anesthetic substances for intubation anesthesia, various mixtures can be used, which necessarily include oxygen and fluorothane. The tube is designed so that the exhaled carbon dioxide does not mix with the main mixture. Additionally, the patient is given:
- muscle relaxants (to prevent reflex muscle reactions during surgery);
- antipsychotics (to suppress autonomic reactions);
- analgesics (to reduce pain sensitivity).
The patient's readiness for surgery is determined by clinical manifestations: dry skin of a natural color, absence of tachycardia, normal pulse, etc.
Removal from intubation anesthesia
It is produced by gradually reducing the dosage of the supplied anesthetic mixtures. This is what the anesthesiologist does. As soon as the doctor sees that the patient's breathing function is fully restored, and all indicators are normal, he removes the endotracheal tube. But for a few minutes before the patient is fully awakened, his respiratory activity is maintained with the help of a mask.
Endotracheal anesthesia for pregnant women
Regular anesthesia is never given to women in labor who are conscious. The exception is cases when during childbirth it turns out that a woman is unable to give birth on her own. When severe pain the mother is offered. And if a woman loses consciousness, an emergency intubation is performed with the aim of performing a caesarean section.
Possible complications after intubation anesthesia
Endotracheal anesthesia rarely causes negative consequences. If during the operation there were no extraordinary situations (deviation from the norm of the basic vital signs), then this will not affect the patient's health.
Some people who have undergone surgery under endotracheal anesthesia complain of a lump in the throat, damage to the mucous membrane, scratches on the tongue or lips. This happens, but it is quite natural when carrying out such manipulations. Such temporary consequences may be associated with insufficient experience of the doctor who performed the intubation.
Severely ill ( elderly age, complications associated with concomitant diseases) need careful care and observation in the post-anesthetic period. Doctors monitor the condition of such patients, making adjustments with medication if necessary.
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