General anesthesiology and reanimation

1. General anesthesiology and reanimation m.d. Shydlovscky. A.V.

3. Terminology • Anesthesiology( from an– absence, еstesia –feeling, logos – science) – it is science about anaesthetizing at surgical interferences. • Basic task of anesthesiology– to protect an organism from an operating trauma. In course of time, to the extent of accumulation of knowledges and application, value of word ” anesthesiology“, domains broadened considerably. • For today it is science about a management vital functions not only in connection with an operation but also at the critical conditions of dear origin.

4. Terminology • Reanimation (re – again,animatio – revive) – process of treatment of the terminal states, revival of organism, complex of medical measures, directed on proceeding in going out, or just faded vitally important functions of organism. • Reanimatology (Reanimation + logos – science) – science about the revival of organism. • Intensive care– a process of patients treatment is in critical conditions, complex therapy at grave and threatenings life conditions. It is directed on a correction or substitution vitally of important functions of organism.

5. Terminology • Critical condition–cases, when present violations vitally of important functions of organism do not can spontaneously be corrective by self-regulation and need partial, or complete substitution. • Terminal condition(pre-agony, agony, clinical death) – on a limit (terminus) between life and death which represents the making progress fading vitally of important functions of organism up to their loss.

6. Terminology • Intensive supervision– looking and care of the patients with potential possibility of critical conditions development . • A supervision is conducted: • by an invasion (with intruding for example in the bloodflow system, sechevidil'nu system etc.) and • by not invasion methods with the use of the special hardwares with continuous or at stated intervals registration indexes.

7. Anesthesiology • Concrete tasks (components) of the anaesthetic providing of operative interferences it is possible to formulate like: -exception of consciousness– braking of psychical perception (anesthesia, sleep); -anaesthetizing– blockade of pain impulses (analgesia); - neyro-vegetative blockade; - loss of motive functions; - maintenance of adequate interchange of gases; - maintenance of normal exchange of matters; • To attain these tasks it is practically impossible the method of monoanesthesia. Therefore basic principle of modern anesthesia is it combined, that the use is for achievement of adequate anesthesia of different facilities (preparations) and methods (manipulations).

8. Facilities and methods of anesthesiology • Toponarcosis 1. Medicinal : - terminal; - infiltrative - explorer: barrel, plexus, paravertebral; - regional: epidural, spinal. 2. Unmedicinal: - akupunktur; - electro- andpharmacoakupunktur; - by cold.

9. Facilities and methods of anesthesiology • General anaesthesia 1. Medicinal: Monoanesthesia Combined - inhalation- two and more inhalation anesthetics - mask - two and more notinhalation anesthetics - intratracheal- inhalation andnotinhalation anesthetics -endobronkhial- anesthetics + neyrotropic facilities - not inhalation (analgeticsi,ataraktics,myorelaxants) - intravenous - neyrotrophic facilities without anesthetics - peroral - rectal - intramuscle - hypodermic - intrabone - intracavital 2. Notmedicinal - electro-anesthesia - hypno-narkosis

10. Types of local anesthesia (Infiltration, plexus)

11. Variety of local anesthetic (blockade humerus plexus)

12. Types of local anesthesia (spinal anesthesia)

13. Facilities and methods of anesthesiology Such classification of anaesthetizing types are used in clinical practice: Toponarcosis: General anesthesia: - regional Inhalation: - explorer - masc - epydural - endotrakheal - subdural Intravenous: - caudal - with artifitual breathing - without artifitual breathing Combined - with artifitual breathing - without artifitual breathing

14. Stages and levels of anesthesia

15. Arsenal of anesthetics • Inhalation anesthetics: - Gaseous (protoxide to nitrogen, ksenon); - Liquid volatile (Ftorotan, and his derivatives) • Not inhalation anesthetics : - barbiturates, ketamine, propofol - For premedication apply benzodiazepini - For anaesthetizing apply neyroleptics (droperidol, haloperidol), narcotic analgetics (Morphinum, phentanyl, meperidin) - For weakening of strated muscles muscles at implementation of trachea intubation and creation of optimum terms for implementation of operation apply muscle relaxants (ditilin, arduan) Antagonists of narcotic analgetics (Naloxonum, nalorfin)

16. Methods of trachea intubation • Orotracheal • Nasotracheal • With the help of bronchoscope

17. Stages of trachea intubation

18. Stages of trachea intubation

19. Complication of anesthesia • Local: - uneffective anaesthetizing; - an anaphylactic reaction is on anesthetics; - disorders of breathing, circulation of blood • General (can arise up on the different stages of the anaesthetic providing: premedication, primary anesthesia, maintenance of anesthesia, in a postoperative period) Reason of complications can be : - specific action of anesthetics, - violation of anesthesia conduct technology, - features of patient and diseases, - character of operative interference.

20. Most characteristic and frequent complications of anesthesia • Breathing organs: accumulation of sputum, laryngo- bronkhospazm, falling back of jaws, aspiration, at vomit and regurgitation (syndrome of Mendelssohn), disorders of the breathing adjusting • Cardiac system: changes of cardiac rhythm, arteriotony, fibrilyaciya myocardium, embolisms and thromboses (reasons are disorders of interchange of gases) • Nervous system:slow awakening, cramps, psychical violations (excitation, amnesia), peripheral neuritises, paresises, paralyses. • Gastroenteric tract: vomit and aspiration of vomit masses in respiratory tracts (syndrome of Mendelssohn)

21. Local anesthesia • Preparations : - novocaine (0,25 – 2 % solution) - sovcaine (0,5 – 1 % solution) - dicaine (0,25 – 2 % solution) - trimecaine (0,25 – 2 % solution) - lidocaine (0,5 – 2 % solution)

22. Varieties of toponarcosis

23. Varieties of toponarcosis

24. Varieties of toponarcosis(spinal anesthesia)

25. Varieties of toponarcosis(Areas of leadthrough of toponarcosis: elbow, humeral interlacement, finger, middle nerve)

26. Varieties of toponarcosis(Vagosympathic blockade, lumbar)

27. Reanimation • Phases of organism dying process • Preagony. Characterized the progressive fading of consciousness. Changes of hemodynamics: takhikardia, low pulse, mionectic BP, low microcirculation, breathing is superficial, often pathological. • Terminal pause. More frequent takes place at bloodloss. Transitional state between preagony and by agony. State of unconsciousness. Single respiratory motions appear at the accumulation of PsO2. • Agony.Characteristic is strengthening of cardiac activity and breathing as a result of proceeding in oxygenation. Breathing for as fish. Then cardiac activity goes out acutely. • Clinical death. Stop of breathing and circulation of blood. Basic exchange processes are stored and in anaerobic terms acutelyslow. Lasts 3 – 5 minutes. This phase is characteristic that there is possibility to pick up thread all vitally important functions at acute clinical death, including to the brain.

28. Reanimation • Social death(spiritual, theology, civil) .Characterized by the loss of function of cortex at the maintainance of vegetative functions. Develops in that case, when a reanimation begins lately and conducted uneffective. Duration of it from hours to a few months and depends on weight of damages which develop in the period of clinical death, qualities of intensive therapy and examination in a ppostreanimation period. • Death of cerebrum. Characterized by the loss of function of all cerebrum at artificial maintenance of breathing and circulation of blood. • Biological death (real). Characteristic irreversible biophysiology violations of all functions and systems of organism. Turbid, drying out cornea, of a corpse spots, wide pupils.

29. Diagnostics of clinical death • Basic signs: - absence of pulsation is on carotids - absence of breathing - wide pupils, irresponsive on light (through 40 – 60 secs. after the stop of circulation of blood). • Additional signs: - pallor or cyanosys of skin covers with a transition in earthily - grey color - absence of independent motions and arephlexy. After establishment of diagnosis of clinical death it is necessary to begin the leadthrough of reanimation

30. Algorithm of reanimation measures First stage of reanimation • Providing of overhead respiratory tracts communicating • Artificial ventilation of lights • Massage of heart Second stage of reanimation Begins from the moment of arrival of first-aid. A purpose of this stage is proceeding in independent circulation of blood. • Providing of the vehicle breathing (intubation of trachea) • Continuation of the closed massage of heart Third stage of reanimation - of long duration continuation of life. Treatment of postreanimation illness. • Purpose: proceeding in higher cerebral functions

31. Benedicite!