Combined anesthesia types and components. Modern combined intubation anesthesia

COMBINED ANESTHESIA is a broad concept, implying the sequential or simultaneous use of various anesthetics, as well as their combination with other prep / mi: analgesics, tranquilizers, muscle relaxants, which provide or enhance the individual components of anesthesia.

Distinguish: 1) COMBINED INHALATION ANESTHESIS; 2) COMBINED NON-INHALATION ANESTHESIS; 3) COMBINED INHALATION + NON-INHALATION ANESTHESIS

; 4) COMBINED ANESTHESIA WITH LOCAL ANESTHESIA; 5) COMBINED ANESTHESIA WITH LOCAL ANESTHESIA

MUSCLE RELAXANTS e. Prep, which relax the striated muscles. There are central and peripheral relaxants. Relaxants of central action include tranquilizers, but their muscle relaxants effect is associated not with peripheral curariform action, but with the effect on the central nervous system. Muscle relaxants of peripheral action, due to the peculiarities of their influence on the process of synaptic transmission, are subdivided into 2 groups.

1. Non-depolarizing muscle relaxants. Relative to trarium, pavulon, arduan, norkuron, nimbex. They paralyze neuromuscular transmission due to the fact that they reduce the sensitivity of the H-cholinergic receptors of the synaptic region to acetylcholine and thereby exclude the possibility of end plate depolarization and muscle fiber excitation. Compounds of this group are true curariform substances. Pharmacological antagonists of these compounds are AChE substances (proserin, galantamine): by inhibiting the activity of cholinesterase, they lead to the accumulation of acetylcholine in the area of ​​synapses, which, with an increase in concentration, weakens the interaction of curariform substances with H-cholinergic receptors and restores neuromuscular transmission.

2.Depolarizing muscle relaxants cause muscle relaxation, exerting a cholinomimetic effect, accompanied by persistent depolarization, which also disrupts the conduction of excitation from the nerve to the muscle. Preparations of this group are rapidly hydrolyzed by cholinesterase; AChE preparations enhance their effect (succinylcholine, ditylin, listenone).

Depending on the duration of the induced neuromuscular block, muscle relaxants are divided into 3 groups: A) causing a rapidly developing neuromuscular blockade (within 1 minute), but with a short period of action (up to 15 minutes) succinylcholine.

C) causing a rapidly developing neuromuscular blockade with an average duration of action (15-30 min) norkuron, trarium, nimbex.

C) causing neuromuscular blockade with a long period of action (30-150 minutes) arduan, pavulon.

Muscle relaxants should be used only when the patient's consciousness is turned off !!!

Neuroleptanalgesia is a method of general non-inhalation anesthesia, with which the main pharmacies of the preparation I / I are a powerful neuroleptic (droperidol) and a strong central analgesic (fentanyl, morphine, promedol).

Ataralgesia — the combined use of an ataractic (diazepam) and a strong narcotic analgesic (promedol, fentanyl).

Central analgesia is a method of general anesthesia, in which all components of anesthesia are caused by large doses of central analgesics (morphine, fentanyl, promedol, dipidolor).

COMBINED ANESTHESIA - anesthesia, when the patient's consciousness during the operation is turned off by a general anesthetic, and relaxation in the operation area, peripheral analgesia and autonomic nerve blockade are provided by one of the types of local anesthesia.

Peripheral analgesia and autonomic nerve blockade are provided by one of the types of local anesthesia. Indications for endotracheal anesthesia:

1) surgical interventions on the organs of the chest; 2) surgical interventions on the organs of the upper half of the abdominal cavity; 3) neurosurgical operations and plastic surgery in the oral cavity; 4) surgical interventions in physiologically uncomfortable positions (on the abdomen, side), sharply disrupting pulmonary ventilation ;

5) emergency surgical interventions on the abdominal organs in newborns. 6) long-term surgical interventions (more than 40 minutes);

7) short-term interventions on the face and neck, which threaten to disrupt the free patency of the airways; 8) emergency surgical interventions (prevention of stomach contents from entering the respiratory tract).

Endotracheal anesthesia implies the mandatory use of muscle relaxants. The advantages of combined anesthesia with muscle relaxants:

a) Optimal conditions are created for: mechanical ventilation, which is especially important in operations accompanied by impaired external respiration (on the chest organs);

6) The toxic effect of narcotic substances on the body is reduced by reducing their total dose. At the same time, muscle relaxation is achieved by using muscle relaxants; c) Free airway patency is ensured regardless of the patient's position, the risk of asphyxia due to retraction of the tongue root, aspiration of vomit, blood is eliminated; conditions are created for active constant aspiration of the contents of the trachea; d) The conditions for gas exchange are improved by reducing the "dead space"; e) The introduction of a gas-narcotic mixture under pressure ensures optimal saturation of the body with oxygen.

Anesthesia. General concepts. Intravenous anesthesia. Combined general anesthesia.

General anesthesia, or anesthesia, - a condition characterized by a temporary shutdown of consciousness, pain sensitivity, reflexes and relaxation of skeletal muscles, caused by the effect of drugs on the central nervous system.

Inhalation and non-inhalation anesthesia are isolated depending on the route of administration of narcotic substances into the body.

Theories of anesthesia. Currently, there is no theory of anesthesia that clearly defines the mechanism of the narcotic action of anesthetics. In chronological order, the main theories can be presented as follows:

1. Coagulation theory of Claude Bernard (1875).

2. Lipoid theory of Meyer and Overton (1899 - 1901).

3. The theory of "strangulation of the nerve cells of Verworn" (1912).

4. The adsorption theory (boundary stress) was proposed by Traube (1904 - 1913) and supported by Warburg (1914 - 1918).

5. Pauling's theory of aqueous microcrystals (1961).

In recent years, the membrane theory of the mechanism of action of general anesthetics at the subcellular molecular level has become widespread. She explains the development of anesthesia by the influence of anesthetics on the mechanisms of polarization and depolarization of cell membranes.

Narcotic drugs cause characteristic changes in all organs and systems. During the period of saturation of the body with a narcotic drug, a certain pattern (staging) is noted in the change in consciousness, respiration, and blood circulation. In this regard, there are certain stages that characterize the depth of anesthesia. The stages are especially distinct with ether anesthesia. In 1920, Gwedel divided anesthesia into four stages. This classification is still the main one.

There are 4 stages: I - analgesia, II - agitation, III - surgical stage, divided into 4 levels, and IV - awakening.

Analgesia stage ( I ). The patient is conscious, but inhibited, dozing, answers questions in monosyllables. There is no superficial pain sensitivity, but tactile and heat sensitivity is preserved. During this period, it is possible to perform short-term interventions (opening phlegmons, abscesses, diagnostic studies). The stage is short-term, it lasts 3-4 minutes.

Excitation stage ( II ). At this stage, inhibition of the centers of the cerebral cortex occurs, while the subcortical centers are in a state of excitement: there is no consciousness, motor and speech excitement is expressed. Patients scream, trying to get up from the operating table. The skin is hyperemic, the pulse is frequent, the blood pressure is increased. The pupil is wide, but reacts to light, lacrimation is noted. Often there is a cough, increased bronchial secretion, vomiting is possible. Surgical manipulations against the background of arousal cannot be performed. During this period, it is necessary to continue saturating the body with a narcotic drug to deepen the anesthesia. The duration of the stage depends on the patient's condition, the experience of the anesthesiologist. Arousal usually lasts 7-15 minutes.

Surgical stage ( III ). With the onset of this stage of anesthesia, the patient calms down, breathing becomes even, the pulse rate and blood pressure approach the initial level. During this period, it is possible to carry out surgical interventions. Depending on the depth of anesthesia, there are 4 levels of the III stage of anesthesia.

First level( III ,1): the patient is calm, breathing is even, blood pressure and pulse reach their original magnitude. The pupil begins to narrow, the reaction to light is preserved. There is a smooth movement of the eyeballs, their eccentric arrangement. The corneal and pharyngeal-laryngeal reflexes are preserved. Muscle tone is preserved, therefore, it is difficult to carry out abdominal operations.

Second level (III, 2): the movement of the eyeballs stops, they are located in a central position. Pupils begin to dilate gradually, the pupil's response to light weakens. The corneal and pharyngeal-laryngeal reflexes weaken and disappear by the end of the second level. Breathing is calm, even. Blood pressure and pulse are normal. A decrease in muscle tone begins, which makes it possible to carry out abdominal operations. Usually anesthesia is performed at level III, 1 - III, 2.

Third level (III, 3) is the level of deep anesthesia. The pupils are dilated, react only to a strong light stimulus, the corneal reflex is absent. During this period, complete relaxation of skeletal muscles, including intercostal muscles, occurs. Breathing becomes shallow, diaphragmatic. As a result of relaxation of the muscles of the lower jaw, the latter can sag, in such cases, the root of the tongue sinks and closes the entrance to the larynx, which leads to respiratory arrest. To prevent this complication, it is necessary to bring the lower jaw forward and maintain it in this position. Pulse at this level is speeded up, small filling. Blood pressure decreases. It is necessary to know that carrying out anesthesia at this level is dangerous for the patient's life.

The fourth level ( III ,4): maximum expansion of the pupil without its reaction to light, the cornea is dull, dry. Breathing is shallow, carried out due to the movements of the diaphragm due to the onset of paralysis of the intercostal muscles. Pulse is threadlike, fast, blood pressure is low or not detected at all. Deepening the anesthesia to the fourth level is dangerous for the patient's life, as breathing and blood circulation may stop.

Agonal stage ( IV ): is a consequence of excessive deepening of anesthesia and can lead to irreversible changes in the cells of the central nervous system, if its duration exceeds 3-5 minutes. The pupils are extremely dilated, without reaction to light. The corneal reflex is absent, the cornea is dry and dull. Pulmonary ventilation is sharply reduced, breathing is shallow, diaphragmatic. The skeletal muscles are paralyzed. Blood pressure drops sharply. The pulse is fast and weak, often not defined at all.

Removal from anesthesia, which Zhorov I.S. defines as the stage of awakening, begins from the moment the anesthetic is stopped. The concentration of the anesthetic in the blood decreases, the patient goes through in the reverse order, all stages of anesthesia and awakening occurs.

Preparing the patient for anesthesia.

The anesthesiologist is directly involved in preparing the patient for anesthesia and surgery. The patient is examined before the operation, while not only paying attention to the underlying disease for which the operation is to be performed, but also finding out in detail the presence of concomitant diseases. If the patient is operated on as planned. then, if necessary, treat concomitant diseases, sanitize the oral cavity. The doctor finds out and evaluates the mental state of the patient, finds out allergic anamnesis, specifies whether the patient has undergone surgery and anesthesia in the past. Draws attention to the shape of the face, chest, neck structure, the severity of subcutaneous adipose tissue. All this is necessary in order to choose the right method of pain relief and a narcotic drug.

An important rule of preparing the patient for anesthesia is the cleansing of the gastrointestinal tract (gastric lavage cleansing enemas).

To suppress the psychoemotional reaction and suppress the function of the vagus nerve, before the operation, the patient is given special drug preparation - premed uk ation ... The purpose of premedication is to relieve mental stress, sedate, prevent unwanted neurovegetative reactions, reduce salivation, bronchial secretion, and enhance the anesthetic and analgesic properties of drugs. This is achieved by using a complex of pharmacological preparations. In particular, tranquilizers, barbiturates, antipsychotics, etc. are effective for mental sedation. Strengthening the activity of the vagus nerves, as well as reducing the secretion of the mucous membranes of the tracheobronchial tree and salivary glands, can be obtained with the help of atropine, metacin or scopolamine. Antihistamines are widely used, which have an additional sedative effect.

Premedication usually consists of two stages. In the evening, on the eve of the operation, hypnotics are prescribed inside in combination with tranquilizers and antihistamines. For especially excitable patients, these drugs are repeated 2 hours before the operation. In addition, anticholinergics and analgesics are usually administered to all patients 30-40 minutes before the operation. If cholinergic drugs are not included in the anesthesia plan, then the appointment of atropine before surgery can be neglected, however, the anesthesiologist should always be able to administer it during anesthesia. It must be remembered that if it is planned to use cholinergic drugs (succinylcholine, fluorothane) during anesthesia or instrumental irritation of the respiratory tract (tracheal intubation, bronchoscopy), then there is a risk of bradycardia with possible subsequent hypotension and the development of more serious cardiac arrhythmias. In this case, the premedication of anticholinergic drugs (atropine, metacin, glycopyrrolate, hyoscine) for the blockade of vagal reflexes is mandatory.

Usually, premedication for planned operations is administered intramuscularly, orally or rectally. The intravenous route of administration is inappropriate, because at the same time, the duration of action of the drugs is shorter, and the side effects are more pronounced. Only with urgent surgical interventions and special indications, they are administered intravenously.

M - anticholinergics.

Atropine. For premedication, atropine is administered intramuscularly or intravenously at a dose of 0.01 mg / kg. The anticholinergic properties of atropine can effectively block vagal reflexes and reduce the secretion of the bronchial tree.

Chapter 28

Combined anesthesia can be performed both with a hardware-mask and endotracheal method.

Indications for endotracheal anesthesia:

1) surgical interventions on the organs of the chest;

2) surgical interventions on the organs of the upper half of the abdominal cavity;

3) neurosurgical operations and plastic surgery in the oral cavity;

4) surgical interventions in physiologically uncomfortable positions (on the stomach, side, etc.), sharply disrupting pulmonary ventilation;

5) emergency surgical interventions on the abdominal organs in newborns.

6) long-term surgical interventions (more than 40 minutes);

7) short-term interventions on the face and neck, which pose a threat to the violation of the free patency of the airways;

8) emergency surgery (prevention of stomach contents entering the respiratory tract).

Conducting endotracheal anesthesia implies the mandatory use of muscle relaxants.

The basic principles of the use of muscle relaxants in anesthesiology are as follows.

1. Muscle relaxants in children should be used only against the background of depression of the central nervous system, that is, with the mind off.

2. The use of muscle relaxants necessitates mechanical ventilation, even when relaxants are administered in doses that do not cause noticeable suppression of spontaneous breathing. In fact, alveolar hypoventilation develops. Maintaining external respiration should continue until spontaneous respiration is fully restored.

3. Muscle relaxants provide completely only one component of anesthesia - muscle relaxation and partially the second - hyporeflexia. All other components - switching off consciousness, maintaining adequate gas exchange, blood circulation, metabolic processes - require the use of the entire arsenal of means and methods of modern anesthesia. This is all the more necessary because muscle relaxants, as it were, "mask" the disadvantages of anesthesia.

The advantages of combined anesthesia with muscle relaxants:

a) Optimal conditions are created for: mechanical ventilation, which is especially important in operations accompanied by impaired external respiration (on the chest organs);

6) Reduces the toxic effect of drugs on the body by reducing their total dose. In this case, muscle relaxation is achieved by using muscle relaxants;

c) Provides free airway patency, regardless of the position of the patient, eliminates the risk of asphyxia due to retraction of the root of the tongue, aspiration of vomit, blood, etc .; conditions are created for active constant aspiration of the contents of the trachea;

d) The conditions for gas exchange are improved by reducing the "dead space";

e) The introduction of a gas-narcotic mixture under pressure ensures optimal saturation of the body with oxygen.

28.1. Anesthesia technique with depolarizing muscle relaxants.

Currently, depolarizing muscle relaxants in children are used for the following indications: 1) for intubation of the trachea (bronchi); 2) during broncho- and esophagoscopic studies under anesthesia; 3) with anesthesia lasting less than 30 minutes, when it is required to turn off spontaneous breathing.

The premedication must include atropine, the rest of the components - according to indications. Introductory anesthesia is performed with any anesthetics, and their choice depends on the initial state of the child. Immediately after loss of consciousness, depolarizing muscle relaxants are injected intravenously at a dose of 1-2 mg / kg. After the introduction of depolarizing muscle relaxants, muscle fnbrillations occur - chaotic contractions of skeletal muscles. At this time, due to the suppression of spontaneous breathing, the concentration of inhalation anesthetics is reduced to the minimum figures (and nitrous oxide is turned off completely) and auxiliary ventilation of the lungs is started. At the onset of apnea, inhalation anesthetics are switched off from the breathing mixture and mechanical ventilation is performed with oxygen through the mask of the anesthesia apparatus in the mode of moderate hyperventilation. Tracheal intubation should be performed only after the complete cessation of fibrillations, since against their background it can be unsuccessful or traumatic.

After tracheal intubation, the child is transferred to mechanical ventilation with a gas-narcotic mixture. Relaxation is supported by fractional administration of a muscle relaxant every 5-7 minutes. In most children, after each injection of the drug, moderate bradycardia develops with a duration of 15-60 seconds. A decrease in blood pressure is sometimes observed. The duration of apnea can not always serve as a criterion for the duration of the action of the relaxant, since apnea can persist due to hyperventilation, and muscle tone is restored. Therefore, in the absence of objective methods for controlling artificial myoplegia, depolarizing relaxants should be administered when muscle tone appears. With long-term surgical interventions, the intervals between the injections of relaxants increase.

Depolarizing muscle relaxants are combined with almost all anesthetics. With fluorothane anesthesia, it is advisable to reduce the total dose of relaxants, and gradually increase the intervals between injections. This is due to the fact that fluorothane itself inhibits spontaneous respiration and prolongs apnea.

28.2. Anesthesia technique with non-depolarizing muscle relaxants.

Non-depolarizing muscle relaxants are used for surgical interventions lasting more than 40-60 minutes. The duration of action of a single dose is 30-40 minutes. Given the cumulative effect (the exception is atracurium hydrochloride), each subsequent dose of non-depolarizing muscle relaxants is reduced by 1/3. Clinical indications for re-administration of non-depolarizing muscle relaxants are:

1. An increase in resistance to inspiration, determined by compression of the bag or by the pressure gauge of the anesthesia machine.

2. The appearance of tension in the muscles of the abdominal wall.

3. Convulsive movements of the diaphragm, characteristic of hiccups.

4. Restoration of neuromuscular conduction up to 50% of the original value.

28.3. Anesthesia with depolarizing and non-depolarizing relaxants.

Atropine should be a mandatory component of sedation. Introductory anesthesia is carried out with any inhalation and non-inhalation anesthetics. After loss of consciousness, depolarizing muscle relaxants are administered. To prevent the development of muscle fibrillation, children can be pre-administered with small doses of non-depolarizing relaxants (1 / 10-1 / 5 of the main dose). When apnea occurs, a short-term hyperventilation with oxygen is performed. Against the background of relaxation (after the disappearance of fibrillations), the trachea is intubated and switched to mechanical ventilation with a gas-narcotic mixture. The depth of anesthesia should correspond to the stage of anesthesia III 1, providing a complete shutdown of consciousness and good analgesia. Immediately after tracheal intubation, a non-depolarizing relaxant is injected intravenously, and further maintenance of relaxation is carried out by its fractional administration. At the end of the operation, the dose of relaxants should be calculated so that spontaneous breathing is restored, if possible. After non-depolarizing relaxants, depolarizing ones can also be used. In this case, the action of the first clinically should be complete, as evidenced by the appearance of deep spontaneous breathing and muscle tension. But in such cases, the anesthesiologist must take into account that the effect of relaxants can be perverted (myoplegia is insufficient or, conversely, excessive).

Monitoring the child's condition when using muscle relaxants.

Visual assessment of the clinical course of combined anesthesia with muscle relaxants is rather difficult, it is based on determining the depth of anesthesia and the degree of relaxation. Currently, under conditions of combined anesthesia, two stages of anesthesia are practically distinguished - superficial and deep.

With superficial anesthesia, the pupil's reaction to light and lacrimation persists. After the cessation of the action of muscle relaxants, the clinical picture approaches that of a single-component anesthesia, i.e. you can identify a characteristic staging, pupillary reflexes appear, a reaction to pain irritation, etc. The appearance of increased sweating, tachycardia, increased blood pressure, excessive lacrimation, motor reactions in response to painful stimuli indicate an insufficient depth of anesthesia.

Deep anesthesia is characterized by a lack of reaction of the pupils to light and pupillary reflexes, depression of blood circulation and the activity of the autonomic nervous system. Of great importance in assessing the depth of anesthesia is the determination of the concentration of anesthetics in the inhaled mixture and such an objective method as electroencephalography.

In addition to determining the depth of anesthesia, it is necessary to assess the effectiveness of the action of muscle relaxants, i.e. the degree of myoplegia. However, the assessment of the relaxation of skeletal muscles is associated with certain difficulties, which are due to the fact that muscle relaxants are always used in combination with anesthetics, which are capable of themselves in varying degrees of myoplegic effect and mask the true effect of muscle relaxants.

Determination of the degree of myoplegia is possible in several ways.

1. Palpation and visual determination of relaxation. This is one of the most common methods. In this way, myoplegia is most often assessed by the surgeon, who reports on the condition of the muscle tone of the anterior abdominal wall. Visual and palpation methods determine the degree of restoration of muscle tone also after surgery.

2. By the presence of spontaneous breathing. This method is questionable and cannot be recommended for assessing the effectiveness of muscle relaxants.

3. Determination of the concentration of muscle relaxants in the blood. There are biological, chemical, spectrographic and polarographic methods for the determination of relaxants in the blood, but they are rather laborious and are not used by anesthesiologists in everyday practice.

4. Electrophysiological methods for assessing the action of muscle relaxants. Muscle relaxants relax the muscles by acting on the neuromuscular synapse. Therefore, using electrophysiological methods, obtaining the most accurate information about the functional state and conductivity of the neuromuscular synapse, it is possible to judge with great certainty the effectiveness of the action of muscle relaxants.

Termination of anesthesia and recovery from it are the most crucial periods of combined anesthesia with muscle relaxants. One should strive to ensure that awakening occurs soon after the end of the operation, and a sufficient analgesic effect persists after full awakening in the immediate postoperative period. It is necessary for the child to regain consciousness, adequate breathing and protective reflexes while still on the operating table.

The way out of anesthesia, during which muscle relaxants were used, is characterized by some peculiarities. The criteria for assessing the adequacy of spontaneous breathing are the absence of a clinical picture of respiratory failure and a normal blood gas composition. Despite the dose reduction and the timely administration of relaxants, the recovery of spontaneous breathing in children after surgery is often slowed down. This is one of the most common side effects of muscle relaxants.

There are many reasons for the delayed recovery of spontaneous breathing after surgery, and relaxants do not always play the leading role. The most common reasons are.

1. Conducting mechanical ventilation in the hyperventilation mode, leading to hypocapnia; with a significant decrease in PaCO 2, the activity of the respiratory center is not restored for a long time.

2. Violations of CBS. This factor is especially important when using depolarizing muscle relaxants. Violations of CBS during anesthesia are usually in the nature of metabolic acidosis. Depolarizing relaxants are less intensively hydrolyzed in an acidic environment; as a result, their duration is lengthened. The excretory function of the kidneys in conditions of metabolic acidosis is also reduced. This is an additional factor; causing a slowdown in the recovery of spontaneous breathing after surgery.

3. The effect of anesthetics or other drugs on neuromuscular conduction. To a greater extent, this applies to inhalation and non-inhalation anesthetics, which are combined with muscle relaxants. The neuromuscular blockade also deepens against the background of the action of drugs such as broad-spectrum antibiotics, analgesics, and local anesthetics.

4. Overdose or excessive accumulation of muscle relaxants in the body. This type of breathing disorder is less common, but it must be remembered. With an overdose of muscle relaxants, there is a complete absence of muscle tone, spontaneous breathing and complete or partial blockade of the neuromuscular synapse.

Decurarization.

Cholinesterase inhibitors - proserin (neostigmine, prostigmine) - have received practical application as antidotes for non-depolarizing relaxants. Proserin weakens the effect of muscle relaxants due to the inhibition of cholinesterase, which makes it possible to accumulate acetylcholine and displace relaxants from receptors. The use of antidotes for muscle relaxants in children is indicated if by the time of the end of the operation there is respiratory depression and a decrease in the muscle tone of the muscles. Self-raising of the head and a rather distinct clenching of the fingers into a fist indicate that the child has sufficient muscle tone. Neserin can be used as an antidote in those cases when, after repeated injections of depolarizing muscle relaxants, a change in the nature of the block has occurred. Clinically, this is manifested in a long (20-40 min), gradual restoration of spontaneous breathing.

Decurarization is advisable to carry out in the presence of attempts at spontaneous breathing. Initially, atropine is administered intravenously at a dose of 0.01 mg / kg. The preliminary administration of atropine is mandatory to remove the vagotonic effect of proserin. After 2-2.5 minutes. intravenous proserin is injected at a dose of 0.03-0.05 mg / kg slowly over 20-30 seconds. If, once administered, the dose did not give the desired effect, then , Obviously, the lack of spontaneous ventilation is not due to the continuing action of muscle relaxants, but other reasons.

The use of antidotes does not relieve the anesthesiologist from the need to closely monitor the child and, most importantly, his breathing. This is explained by the fact that after 30-40 minutes, when the effect of proserin ends, and the concentration of relaxants in the blood is still high enough, muscle relaxation can again occur - recurarization.

Word " anesthesia Comes from the Greek avaiagnoia, which means numbness or paralysis of sensitivity. Anesthesia is understood as the absence of all types of sensitivity: tactile, pain and temperature. The concept of "analgesia" means the loss of only pain sensitivity.

The purpose of the anesthetic aid- to ensure the painless performance of interventions with violation of the integrity of body tissues (both classic open surgical operations and minimally invasive), as well as invasive diagnostic studies and increasingly widespread interventions related to the field of so-called interventional medicine (therapeutic effect under control visualization research methods).

the main goal anesthetic benefits- anesthesia - can be achieved in two ways - with the help of classical anesthesia and regional anesthesia. General anesthesia is synonymous with anesthesia. It differs from regional anesthesia, among other things, in that it involves turning off the patient's consciousness.

Anesthesia implies anesthesia the whole body and is always carried out with the mind turned off or at least depressed. The sometimes used expression "full anesthesia" is a pleonasm and should not be used, in any case, by specialists.

To conduct a general pain relief at the disposal of anesthesiologists are inhalation (enter the bloodstream through the lungs) and intravenous anesthetics. The point of application of these funds is the central nervous system (CNS), i.e. brain and spinal cord. Theoretically, it is necessary to distinguish inhalation, intravenous and balanced anesthesia, which is understood as anesthesia achieved by the combined use of inhalation and intravenous anesthetics.

Since the general anesthetics, as a rule, depress respiration, then artificial lung ventilation devices (IVL) are needed to maintain it.
When conducting a regional anesthesia are limited to anesthetizing a specific part of the body ("local" anesthesia). Distinguish between central regional (spinal, epidural and caudal, or sacral) and peripheral (brachial plexus block, blockade of individual nerves) anesthesia. For regional anesthesia, special drugs called local anesthetics are used.

They are not introduced systemically, and in the area of ​​nerve conductors to block excitability and conduction of nerve impulses. At the same time, the patient's consciousness and breathing are preserved.

Combined anesthesia

In some cases and with certain surgical interventions you can combine general anesthesia and regional anesthesia (combined anesthesia). This method of anesthesia is especially useful in cases where a regional anesthesia catheter as part of perioperative analgesia must be used for "selective" analgesia in the postoperative period.

Combined anesthesia should not be confused with combined anesthesia, which means the combined use of centrally acting drugs belonging to different pharmacological groups, such as:
- Intravenous anesthetics for induction of anesthesia and inhalation anesthetics for maintaining anesthesia;
- Intravenous hypnotics to maintain sleep, opiates to maintain analgesia, and muscle relaxants to relax skeletal muscles.