MindMap Gallery Medical intravenous anesthesia Tintin brother out-of-print secrets

Medical intravenous anesthesia Tintin brother out-of-print secrets

This is a mind map about the out-of-print secrets of Tintin. Intravenous general anesthesia: a method of injecting drugs through the vein and acting on the central nervous system through blood circulation to produce general anesthesia. Mainly used for induction of general anesthesia, maintenance of compound anesthesia and total intravenous anesthesia and sedation of ICU patients.

Edited at 2024-03-14 09:42:50

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Medical intravenous anesthesia Tintin brother out-of-print secrets

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Outline

intravenous anesthesia

Overview

definition

Intravenous general anesthesia: A method in which drugs are injected into a vein and act on the central nervous system through blood circulation to produce general anesthesia. host It is used for the induction of general anesthesia, the maintenance of combined anesthesia and total intravenous anesthesia, and the sedation of ICU patients.

advantage

Fast onset of action and strong potency

Good patient compliance

Administration of anesthesia is relatively simple

Complete range of drugs

No pollution and relatively safe

The effects of anesthesia can be reversed.

shortcoming

Poor controllability

Complex administration is necessary, and drug interactions are complex

Significantly inhibits respiratory circulation

Classification

Classification according to clinical application

Intravenous induction anesthesia: Intravenous anesthetics are injected intravenously to make the patient go from awake to unconscious, and to reach a certain depth of anesthesia, for tracheal intubation, etc. Lay the foundation for operation and maintenance of anesthesia.

Intravenous maintenance anesthesia: Continue intravenous administration after induction of anesthesia to maintain anesthesia at an appropriate depth until the end of surgery.

Classification according to method of medication

Single injection method: suitable for anesthesia induction and short-term surgery, but the dosage is difficult to accurately control

Fractional injection method: Inject a larger dose first, and then add additional doses in installments as needed. It is suitable for short or long surgeries where the depth of anesthesia is easy to fluctuate.

Continuous drip method: A method of maintaining stable blood concentration of intravenous anesthetics with a short action time. Widely used and easy to maintain stable

Monitored Anesthesia Management MAC

concept

Special medical services provided by anesthesiologists to patients undergoing diagnostic and therapeutic procedures. Including preoperative visit, intraoperative anesthesia treatment, and postoperative follow-up. Sedation, analgesia and other drugs are often required, but the use of muscle relaxants is not included. However, it is different from conscious sedation. The distinguishing feature of the latter is that the patient is always conscious and able to communicate with others.

content

①Monitor important vital signs. ② Diagnosis and treatment of clinical problems in MAC ③ Give sedation, analgesics, anesthetics and other medications according to the situation during the operation. ④ Other required medical services.

Propofol

The most widely used intravenous anesthetic in clinical practice, it has a rapid onset of action and a short duration of action. No obvious analgesic effect. The structure is similar to VE, inhibits the generation of oxygen free radicals and antagonizes their oxidation. Reduce cerebral blood flow, reduce cerebral metabolic rate, and reduce intracranial pressure. Dose-dependent circulatory and respiratory depression. Injection pain: pre-inject lidocaine. Epileptiform tics: diazepam, physostigmine. allergic reaction.

Contraindications

Allergic severe circulatory insufficiency Pregnant and lactating women Hyperlipidemia patients psychosis or epilepsy Children under 3 years old

Ketamine

① Non-barbiturate intravenous general anesthetic, the aqueous solution is stable and acidic. ② It is the only clinical intravenous anesthetic drug that can produce strong analgesia.

Indications ① Pediatric anesthesia. ② In combination with muscle relaxant intubation, it is suitable for patients with congenital heart disease with right-to-left shunt. ③ Patients with bronchial asthma. ④ Various minor surgeries, surface surgeries and diagnostic examinations.

Contraindications ① Those with severe hypertension and a history of cerebrovascular accidents. ② Increased intracranial pressure, intracranial tumors, and intracranial aneurysms. ③ If the intraocular pressure is increased or the eyeball is open and damaged, the eyeball needs to be immobilized during surgery. ④ Patients with hyperthyroidism and pheochromocytoma. ⑤ Insufficient cardiac function, cardiomyopathy,

complication ① Cyclic changes ② Increased intracranial pressure ③ Respiratory depression ④ Psychiatric symptoms ⑤ Temporary blindness ⑥ Increased secretions

etomidate

① Non-barbiturates ② A powerful, short-acting hypnotic drug that has mild circulatory inhibition and can dilate coronary arteries. ③ Commonly used for anesthesia induction ④ Inhibit adrenocortical function ⑤ Myotonia and clonus are present ⑥ Injection pain ⑦ Nausea and vomiting

Thiopental sodium

Barbiturates: inhibit polysynaptic transmission and the activity of the ascending reticular system in the central nervous system to produce a general anesthetic effect. ② Advantages: quick onset of effect, short maintenance time, easy operation and management. ③ Disadvantages: imperfect effect, incomplete awakening, suppression of respiratory circulation, increased respiratory secretions.

Indications ① Compound anesthesia: induction is smooth and fast, and is widely used for general anesthesia intubation. ② Used alone for minor surgeries and cardioversion. ③ Control spasms and convulsions: as a symptomatic treatment measure. ④ Cranial brain surgery: Intermittent medication in neurosurgery reduces intracranial pressure, reduces brain metabolism, and reduces

Dexmedetomidine

Application in intravenous anesthesia ① A highly selective α2-adrenergic receptor agonist with sedative, anxiolytic, hypnotic, analgesic, and antisympathetic effects. ② The clearance rate is related to height and is not affected by age, weight, and renal function. ③ The main effect on breathing is the reduction of tidal volume, and the respiratory frequency has little effect. ④ Slow down the heart rate, reduce systemic vascular resistance, and have a certain protective effect on ischemic myocardium. ⑤ It should not be used alone for anesthesia induction and maintenance, but as an auxiliary drug for anesthesia, it can reduce the dosage of sedatives, hypnotics, and opioids. ⑥ Use with caution in patients with heart block or severe cardiac dysfunction.

sodium oxybate

① Long-acting intravenous general anesthetic, which has a slow onset of action, reaches its peak in 20 to 30 minutes, and lasts for 60 to 90 minutes. Its metabolites are carbon dioxide and water. No toxic side effects. ② The effect is similar to physiological sleep without obvious respiratory depression. ③ Causes parasympathetic nerve excitement, slows down the heart rate, and can stimulate the circulation at the same time. ④ It can be used safely by patients with poor physical condition and shock, and there is no limit on the total amount.

Indications: children and patients undergoing long-term surgery

Contraindications: Outpatient minor surgery, patients with severe hypertension, hypokalemia, heart block, bradycardia, epilepsy, and asthma (5) Complications ① Upper respiratory tract obstruction ② Increased secretions ③ Extrapyramidal symptoms: Reticular activating system is relatively enhanced ④ Wake-up delay ⑤ Hypokalemia ⑥ Nausea and vomiting

midazolam

① Water-soluble benzodiazepines are less irritating. ② It has a short action time, slight effects on respiratory circulation, and is used for induction and maintenance. ③ Compound anesthesia induction with propofol, analgesics, and muscle relaxants to prevent intraoperative awareness, regional anesthesia, sedation, and anterograde amnesia. ④ People with high sensitivity, angle-closure glaucoma, and severe pain are contraindicated. ⑤ It is forbidden to use for cesarean section.

Fentanyl

Overview ① Fentanyl is a phenylpiperidine derivative, a synthetic opioid agonist, with a powerful analgesic effect that is 75 to 125 times that of morphine. ② There is respiratory depression. ③ The circulation impact is slight. ④ No histamine release and blood vessel dilation effect.

2) Indications ① Anesthesia induction: intubation dose 6μg/kg ② Maintenance of general anesthesia: additional 0.05-0.1 mg every 30-60 minutes during surgery ③ Large-dose fentanyl compound anesthesia: the main anesthesia method for cardiac and major vascular surgery, 50 to 100 μg/kg ④ MAC: Outpatient surgeries with minimal surgical stimulation and short duration, such as induced abortion, abscess incision and drainage, etc.

3) Things to note ① Circulatory system: Increase vagus nerve excitability ② Respiratory system: choking, respiratory depression, respiratory amnesia ③ Muscle rigidity ④ Nausea, vomiting, skin itching

sufentanil ① The strongest analgesic effect, 5 to 10 times that of fentanyl ② Short elimination time and long analgesic effect, 2 times that of fentanyl ③ Side effects are relatively mild

remifentanil ① The analgesic efficacy is equivalent to that of fentanyl. ② Ultra-short-acting, elimination half-life of 9 minutes. ③ The chemical structure contains ester bonds and is rapidly hydrolyzed by non-specific esterases in blood and tissues. ④ Advantages: Accurately adjust the dosage, easy to reverse; mild side effects; not dependent on liver and kidney function; no accumulation after repeated use; can be used for TCI. ⑤ Disadvantages: Early postoperative pain, respiratory depression, nausea and vomiting, muscle stiffness, etc.

target controlled infusion system

Concept: Based on pharmacokinetics and pharmacodynamics, a plasma or effect chamber drug concentration is artificially set, and the computer-controlled infusion system continuously changes the drug administration rate to quickly reach and maintain a stable plasma or effect chamber drug concentration. , a drug delivery mode that can adjust the depth of anesthesia, sedation and analgesia according to clinical needs.

content

① Pharmacokinetics: Proven correct drug models and pharmacokinetic parameters ② Control unit: rules that control the drug infusion rate (software and microprocessor) ③ Connection system: used to connect equipment to control units and infusion pumps ④ User interface

Classification

① Open-loop system: Set the corresponding concentration and continue infusion. ② Closed-loop system: Feedback the TCI system to adjust the infusion parameters based on the patient’s monitoring indicators (BIS, HRV, circulation indicators, etc.)

Characteristics of controlled infusion using plasma concentration as target concentration

The plasma concentration rises rapidly to the set value. Effect chamber concentrations rise relatively slowly. The desired effect creates hysteresis. Inducing and maintaining plateau. I recovered well after the operation. It is suitable for elderly, frail and patients with poor cardiac function.

Characteristics of concentration-controlled infusion using the effect chamber as the target concentration

① The concentration in the effect chamber quickly reaches the set value. ② Plasma concentration produces significant overshoot. ③ Rapidly produce the expected central effect. ④ Short induction time and strong predictability. ⑤ Excessive plasma concentration may inhibit respiratory circulation. ⑥ Suitable for young, strong patients with good cardiac function.