La isigaba se-Caesarean nge-anesthesia jikelele Sekuyisu eliya ngokuya lingavamile, kodwa lihlala libalulekile ezimweni ezithile eziphuthumayo noma lapho ukulaliswa kwezinzwa kwesifunda kunqatshelwe. Abesifazane abaningi bezwa ngobungozi bayo ngaphandle kokuthi kube khona abachaza kahle ukuthi iyini, isetshenziswa nini, nokuthi inamuphi umthelela empilweni yabo neyengane yabo.
Ukuqonda ukuphepha kwe-anesthesia jikelele Ngesikhathi sokuhlinzwa, kusiza ukunciphisa ukwesaba, ukucacisa okulindelekile, futhi kuvumele ukubamba iqhaza okusebenzayo ekuthathweni kwezinqumo. Namuhla, sinobufakazi obanele besayensi mayelana nezinzuzo zayo, ububi, imiphumela kusana olusanda kuzalwa, izinkinga ezingase zibe khona lapho umama ekhulelwe—kuhlanganise nempilo yengqondo yangemva kokubeletha—kanye nendlela odokotela ababulala izinzwa abayisebenzisa ngayo ukuze banciphise izingozi.
Kunini lapho i-anesthesia ejwayelekile isetshenziswa endaweni yokuhlinzwa?
The main imihlahlandlela international Bavumelana: noma nini lapho kungenzeka, i-neuraxial anesthesia (umgogodla noma ukuqeda) uma kuqhathaniswa nenqubo evamile yokuhlinzwa. Isizathu esiyinhloko siwukunciphisa ingozi yezinkinga zokuphefumula, ukulangazelela okuqukethwe kwesisu, nezinkinga ekulawuleni indlela yomoya, ezivame kakhulu kwabesifazane abakhulelwe.
Noma kunjalo, phakathi kuka-0,5 no-1% wezingxenye zokuhlinzwa Zenziwa ngaphansi kwe-anesthesia jikelele. Iningi lalezi zinqubo lihambisana ukuhlinzwa okuphuthumayo noma okuphuthumayo, lapho kungekho khona isikhathi esanele sokwenza inqubo yesifunda ephephile noma iphikisana.
Izifundo zochungechunge olukhulu lweziguli Ucwaningo lubonisa ukuthi lapho ukulaliswa kwezinzwa okuvamile kuye kwadingeka ngesikhathi sokuhlinzwa, inkomba eyinhloko kube isidingo sokuyekisa ukukhulelwa ngokushesha ngenxa yengozi kamama noma yengane. Kulezi zimo, isivinini sibaluleke kakhulu: okubalulekile ukuletha umntwana nokuzinzisa umama, kunokuba ukwazi ukulungiselela ngokuthula i-anesthesia yomgogodla.
Phakathi kwezizathu ezivame kakhulu zokukhetha i-anesthesia jikelele Baqokomisa umbono wokuthi asikho isikhathi sokuvimba kwesifunda, ukuba khona kokuphikisana okusemthethweni kwe-neuraxial anesthesia (i-coagulopathies, ukopha okuphawulekayo, izifo endaweni yokubhoboza, izifo ezithile ze-neurological, njll.) futhi, ngokwezinga elincane, ukwenqaba okucacile kwesiguli ukwesaba ngesikhathi sokubeletha noma ukwehluleka kwe-anesthesia yesifunda eyaqalwa ngaphambilini.
Ngephesenti elincane kakhulu lamacala I-anesthesia ejwayelekile isetshenziswa ngemuva kokunganele noma ukwehluleka komgogodla noma i-epidural anesthesia. Uma ukuvinjelwa okwanele kungafinyelelwanga nge-anesthetic yendawo eyengeziwe noma ama-opioid futhi ukuhlinzwa kufanele kuqhubeke, inqubo iguqulwa ibe yisigaba sokuhlinzwa ngaphansi kwe-anesthesia evamile nge-endotracheal intubation ukuze kuqinisekiswe i-analgesia nokulawulwa kwendlela yokuphefumula.
Izinzuzo kanye nokubi kwe-anesthesia ejwayelekile esigabeni sokuhlinzwa
Ukubulala izinzwa okuvamile “akubi” ngokwencazeloKodwa-ke, kuyindlela enobuhle nobubi obuphawuleka kakhulu okufanele iqondwe. Uma ikhonjiswe kahle futhi yenziwa ngemithetho eqinile, ingaba ithuluzi elibalulekile lokusindisa izimpilo ekubelethweni.
Phakathi kwezinzuzo zayo eziyinhloko Kukhona isivinini indiza ebulala izinzwa emiswa ngayo, into ebalulekile ezimweni eziphuthumayo ezimbi. Ngaphezu kwalokho, inikeza a izinga lokuhluleka eliphansi Ngokuphathelene ne-analgesia ye-intraoperative, ivumela ukulawula okuphelele kokuphefumula ngokusebenzisa i-intubation kanye ne-ventilation mechanical, kusiza ukuphathwa kwe-hemodynamic ezimweni ezibucayi, futhi ivumela ukungenelela okuhlangene (isb., Isigaba sokuhlinzwa kanye nokunye ukuhlinzwa ngesikhathi esisodwa).
Enye inzuzo eyinhloko ukulawula ngokushesha kokuquleka Ezimweni ezifana ne-eclampsia, i-anesthesia ejwayelekile ivumela ukuzinza kwesimiso sezinzwa esimaphakathi, ukuvikelwa kwendlela yokuphefumula, kanye nesenzo esihlanganisiwe nethimba lokubelethisa kanye neqembu labagula kakhulu.
NgaphansiOkwesatshwa kakhulu ubunzima be-intubation: abesifazane abakhulelwe basengozini enkulu yokuphefumula kanzima ngenxa yezinguquko ze-anatomical (i-edema yezicubu, ukwanda kwesayizi yebele, intamo encane yeselula, inkomba ephezulu yomzimba) kanye nokunciphisa ukusebenza kwamaphaphu, okusheshisa ukuchithwa kwe-oxygen.
Kukhona futhi ingozi yokulangazelela okuqukethwe kwesisu Ngesikhathi sokungeniswa noma ukukhishwa, njengoba bonke abesifazane abakhulelwe babhekwa "njengesisu esigcwele" kusukela ku-trimester yesibili kuze kube okungenani amahora angu-24 ngemva kokubeletha. Ukuphumula okweqile kwesibeletho ngenxa yama-halogenated agents (ngokopha okwandayo), ukucindezeleka kokuphefumula noma kwemizwa kusana olusanda kuzalwa ngenxa yokudlula kwezidakamizwa ze-transplacental, kanye nokubambezeleka okungenzeka kokubeletha kungase kwenzeke. ukuthintana kwesikhumba kanye nokusungulwa kokuncelisa ibele.
Ukuqhathanisa nezinzwa zesifunda: ukufa, ukugula, kanye nengane
Izincwadi zamashumi eminyaka adlule Lokhu kuye kwashintsha kakhulu umbono wendabuko wokuthi ukulalisa izinzwa okuvamile kwezingxenye zokuhlinzwa "kuyingozi kakhulu" kune-anesthesia yesifunda. Ngenxa yokuthuthukiswa kwamasu, imithi, kanye nokuqapha, ukufa komama okuhlobene nokubulala izinzwa okuvamile kuye kwehliselwa kumazinga afana kakhulu nalawo okubulala izinzwa kwesifunda lapho izimo ziphathwa ngendlela efanele.
Ezinye izifundo zabantu Abonisa ukuthi ingozi yokufa komama ngenxa yezimbangela ezihlobene nokubulala izinzwa ezingxenyeni zokuhlinzwa lapho kuhlinzwa ngokubulala izinzwa okuvamile ifana ne-neuraxial anesthesia, enezibalo ezingaba ngu-1,7 ngezinqubo ezingu-100.000 nezikhawu ezibanzi zokuzethemba. Kodwa-ke, kufanele kuqashelwe ukuthi i-anesthesia ejwayelekile isetshenziswa ngokuqondile ezimweni ezimbi kakhulu, ngakho-ke umongo oyisisekelo womtholampilo uhlukile.
Mayelana nokugulaI-anesthesia yendawo ngokuvamile ihlotshaniswa nokulahlekelwa igazi elincane, izehlakalo eziphansi zokutheleleka kwendawo yokuhlinzwa, ubuhlungu obungashesha kakhulu ngemva kokuhlinzwa, kanye nokuhlala esibhedlela isikhathi esifushane. Ucwaningo olukhulu lubonise ingozi enkulu kakhulu yokutheleleka kwendawo yokuhlinzwa ngokubulala izinzwa okuvamile, okunesilinganiso sokungezwani esisondele ku-3,7 uma kuqhathaniswa ne-neuraxial anesthesia.
Mayelana nemiphumela esheshayo yezingane ezisanda kuzalwaKodwa-ke, isithombe sihluke kakhulu. Ukuhlaziywa kwe-meta okuqhathanisa i-umbilical cord pH ezigabeni zokuhlinzwa ngokubulala izinzwa okuvamile ngokumelene nomgogodla noma i-epidural kubonise umehluko omncane kakhulu, okungenzeka ukuthi awubalulekile ngokombono womtholampilo. Noma kunjalo, ucwaningo lweqembu elikhulu luye lwaphawula ukuthi ukulalisa izinzwa okuvamile kwandisa ingozi yosana oludinga ukuvuselelwa okuthuthukisiwe noma intubation, kanye namathuba okuba nemiphumela ye-Apgar yemizuzu emi-5 ngaphansi kuka-7.
Lo mehluko ubonakala ugqama kakhulu Ezingxenyeni eziphuthumayo zokuhlinzwa ngenxa yokucindezeleka kombungu okusolwayo, isimo somntwana ngaphambi kokuhlinzwa sesivele sibi kakhulu. Ngakho-ke, kunzima ukuhlukanisa ukuthi iyiphi ingxenye yomphumela ongemuhle wengane esanda kuzalwa ngenxa yendlela yokubulala izinzwa nokuthi iyiphi ingxenye ye-pathology eyisisekelo eyenza kudingeke ukuhlinzwa kokuhlinzwa okuphuthumayo.
Umthelela wesikhathi eside ekukhuleni kwengane
Ngaphandle kwe-Apgar nentambo pHUmthelela ongaba khona we-anesthesia jikelele ekuthuthukisweni kwemizwa yezingane uyakhathaza. Izifundo zokulandelela zeminyaka eminingi zezingane ezizalwe ngokuhlinzwa ngaphansi kwamasu ahlukene okubulala izinzwa ziye zahlola ukuhlotshaniswa nokuphazamiseka kokufunda.
Eqenjini elikhulu Awukho umehluko ocacile otholakele phakathi kwezingane ezizalwe ngokubulala izinzwa zesifunda kanye nalezo ezizalwa ngokuhlinzwa ngokubulala izinzwa okuvamile mayelana nesigameko sokuphazamiseka kokufunda. Kodwa-ke, izinsana ezizalwa ngokuhlinzwa zine-neuraxial anesthesia zibonakale zinezinga eliphansi kancane lalezi zinkinga, okuye kwaholela ekucabangeni mayelana nomphumela ongase ube yi-neurotoxic wezinye izibulala-zinzwa ezivamile ohlelweni lwezinzwa olungavuthiwe.
Amaphaneli ochwepheshe ku-anesthesia yezingane Baye baxwayisa ngokuthi ukuchayeka kusenesikhathi emithini ethile yokubulala izinzwa evamile, ikakhulukazi phakathi nenkathi yokuzalwa, kungase kubangele izinguquko ekuminyana kwe-synaptic yobuchopho nemiphumela engaqinisekile. Kuze kube manje, abukho ubufakazi obuqand’ ikhanda bokukhubazeka okukhulu kwengqondo ngemva kokuchayeka okukodwa kokubelethisa, kodwa inkulumo-mpikiswano iyaqhubeka, futhi kukhona ukucindezela kokusebenzisa umthamo ophansi kakhulu osebenza kahle nokunciphisa ubude besikhathi sokuchayeka.
In practice emtholampiloLokhu kuhumushela ekulungiseni ngokunembile imithamo yemithi yokulutha ehogeliwe kanye nemithi yokubulala izinzwa, ukuqinisekisa ukufakwa ngokushesha kodwa ngokucophelela, ukunciphisa ukusetshenziswa kwezidakamizwa ezithile ezinamandla okucindezeleka okukhulu kumntwana osanda kuzalwa ngaphambi kokubopha inkaba, kanye nokucabangela ezinye izindlela ezingezona ezekhemisi ezifana ezinye izindlela zokwelapha lapho kufaneleka khona.
I-anesthesia jikelele kanye nempilo yengqondo yangemva kokubeletha
Eminyakeni yamuva bekugxilwe kakhulu isici esasinganakwa ngokwesiko: impilo yengqondo kamama ngemva kokuhlinzwa ngaphansi kwe-anesthesia jikelele. Ucwaningo lwakamuva olwenziwa eqenjini elikhulu labesifazane abangaphezu kuka-34 000 luthole ukuthi labo abahlinzwa ngesikhathi sokuhlinzwa ukwanda kwengozi yokucindezeleka kwangemva kokubeletha nesidingo sokulaliswa esibhedlela, kanye namathuba aphezulu okuba nemicabango yokuzibulala noma yokuzilimaza.
I-hypothesis abacwaningi abasebenza ngayo Inkinga iwukuthi ukulaliswa kwezinzwa okuvamile kuvimbela ukuthintana ngokushesha kwesikhumba nesikhumba futhi kubambezele ukuqala kokuncelisa, izikhathi ezimbili ezinamandla ngokomzwelo ezihambisana nokusondelana okuqinile kanye nokuphila kahle komama. Ngaphezu kwalokho, abesifazane abaningi babhekana ne-anesthesia ejwayelekile "njengokuphuthelwa" ngesikhathi sokuzalwa, okungaba umthombo wokukhungatheka, umuzwa wecala, kanye umuzwa wokulahlekelwa ukuzibamba.
Lokhu kungaphezu kwezinye iziciUkuphuthuma kwenqubo, ukwesaba izinkinga ezinkulu, ukululama kancane futhi okubuhlungu kakhulu, kanye nokuntuleka kolwazi lwangaphambili okungenzeka. Umphumela uba inhlanganisela yokuba sengozini yomzwelo engadala noma yandise izinkinga zempilo yengqondo ezivele zikhona.
Ngakho-ke, ababhali bale misebenzi Batusa ukuthi, lapho owesifazane ehlinzwe izinzwa okuvamile ngesikhathi sokuhlinzwa, ukuhlolwa kokucindezeleka kwangemva kokubeletha, ukwesekwa kwengqondo, usizo lokuqala ukuncelisa, kanye nezikhala zokuthi akhe kabusha indaba yakhe yokuzalwa nethimba lezokunakekelwa kwezempilo zinikezwe ngokushesha.
Izibalo ezikhethekile: i-preeclampsia nezimo eziphuthumayo ezinzima
Abesifazane abane-preeclampsia Bakha iqembu elisengozini enkulu lapho ukukhetha uhlobo lwe-anesthesia kubaluleke kakhulu. Ucwaningo lwabantu lubonise ukuthi, kulo mongo, ukulalisa izinzwa okuvamile kuhlotshaniswa ne- ukwanda kwengozi yokushaywa unhlangothi eminyakeni elandela isigaba sokuhlinzwa uma kuqhathaniswa ne-neuroaxial.
Nakuba imbangela eqondile ingaqondwa ngokugcweleKusolwa ukuthi ukushintshashintsha okukhulu komfutho wegazi ngesikhathi sokungeniswa, ukungena ngaphakathi, kanye nokukhipha izinzwa ngaphansi kwe-anesthesia ejwayelekile kungase kube nomthelela ekucupheni izenzakalo zemithambo ebuchosheni obuvele busengozini ngenxa yomfutho wegazi ophakeme kanye nokungasebenzi kahle kwe-endothelial okuyisici se-preeclampsia.
Ngakolunye uhlangothi, ezimweni zokopha okukhulu Ezimweni ze-hypovolemia enzima, i-anesthesia ejwayelekile ngokuvamile iyindlela ezinzile kakhulu ye-hemodynamically, njengoba igwema ukuvinjelwa okungazelelwe kozwela kwe-anesthesia yomgogodla futhi ivumela ukulawulwa kahle komfutho wegazi, umthamo we-intravascular, kanye ne-oxygenation.
Kafushane, ezimweni ezinzima zokubelethisa Ukukhethwa kwendlela yokubulala izinzwa akuyona indaba yokukhetha kodwa kunalokho ibhalansi yengozi yomuntu ngamunye kanye nenzuzo, kucatshangelwa ukugula komama, isimo sombungu, ukuphuthuma kwesigaba sokuhlinzwa, kanye nolwazi lwethimba. I-anesthesia ejwayelekile ihlala ibalulekile kulezi zimo eziningi.
Izidakamizwa ezisetshenziselwa i-anesthesia jikelele yesigaba sokuhlinzwa
Inhloso ye-pharmacological esigabeni sokuhlinzwa Ithambile: ithulisa ngokwanele futhi ibulala umama, ilawula impendulo ekucindezelekeni kokuhlinzwa kanye nokugcina ukuqina kwe-hemodynamic, kuyilapho inciphisa ukudlula kwezidakamizwa ku-fetus kanye nengozi yokucindezeleka kwengane esanda kuzalwa.
Ngokwemvelo, i-thiopental I-Thiopental ibe yi-hypnotic ejwayelekile yokungeniswa ngokushesha kwezokubelethisa, ngemithamo engu-3 kuye ku-7 mg/kg. Ngemithamo engaphansi kuka-4 mg/kg, ingozi yokucindezeleka kwezingane ezisanda kuzalwa iphansi, kodwa ngaphezu kuka-7 mg/kg, amathuba okuba neonatal asphyxia ayanda. Inkinga namuhla ukuthi i-thiopental inzima ukuyithola ezikhungweni eziningi, futhi i-propofol isetshenziswa kakhulu.
I-Propofol iyisidakamizwa esisetshenziswa kakhuluKodwa-ke, kudinga ukuqapha kwabesifazane abakhulelwe: kuvame ukukhiqiza i-hypotension encike kumthamo futhi inesikhathi esithe xaxa sokufinyelela umphumela wayo ogcwele, okungakhuphula ubungozi bokuqaphela kwangaphakathi uma kungalungiswanga kahle. Ucwaningo oluqhathanisayo lubonisa ukuthi imithamo ephezulu ye-propofol noma ukusetshenziswa kwe-midazolam ukuze ingeniswe ihlotshaniswa nemiphumela emibi kakhulu ye-Apgar ezinganeni ezisanda kuzalwa uma kuqhathaniswa ne-thiopental.
Ngakho-ke, ochwepheshe abaningi batusa Imithamo emaphakathi ye-propofol (cishe i-1,5-2 mg/kg) isetshenziswa ngesikhathi sokuhlinzwa, ikakhulukazi ezigulini ezintekenteke ngokwe-hemodynamically. I-Midazolam, naphezu kokusebenziseka kwayo kokunye ukuhlinzwa, inezinga elibalulekile lokudlula kwe-transplacental (cishe ama-66%) futhi ingabangela ukucindezeleka kwezingane ezisanda kuzalwa, ngokuvamile zibekelwe ukusetshenziswa kwangemva kokubeletha uma kunesidingo.
I-Ketamine ingaba usizo kakhulu Kwabesifazane abakhulelwe abanokushaqeka noma i-hypotension ephawulekayo, isetshenziswa ngoba igcina umfutho wegazi kanye nokuphuma kwenhliziyo. Kodwa-ke, ku-preeclampsia, kungase kubangele umfutho wegazi ophakeme kanye ne-tachycardia, futhi kwenze kube nzima ukuphaphama uma kuphakama inkinga enkulu yomoya; ngakho-ke, ukusetshenziswa kwayo kufanele kube ngabanye.
Ukugcinwa kwe-anesthetic nokuvimbela ukuvuswa kwe-intraoperative
Ukulandela induction kanye ne-intubationUkugcinwa kwezinzwa ezivamile endaweni yokuhlinzwa ngokuvamile kwenziwa ngenhlanganisela yezinzwa eziphefumulayo (i-sevoflurane, isoflurane) engxube ye-oxygen futhi, kuye ngesimo, i-nitrous oxide, kanye neziphumlisi zemisipha kanye nama-analgesics alungiselwe isikhathi sokubeletha.
Umgomo uwukuthola ukuhlushwa okuncane kwe-alveolar Ukugxila kwe-ionization ye-halogenated eduze no-0,7 kwanele ukugcina i-hypnosis ngaphandle kokubangela ukuphumula okukhulu kwesibeletho okungase kwenyuse ukopha. Ukuqapha kwe-bispectral index (BIS) kusiza ukugcina isiguli sisezingeni elifanele lokuluthwa ingqondo (amanani angaphansi kuka-60), kunciphisa ubungozi bokuphaphama.
El umsebenzi ngaphambi kokuhlinzwa Kubonakala sengathi inciphisa kancane izidingo ze-sevoflurane, okungenzeka ngenxa yokukhululwa kwama-endorphin nezinye izinto ezingapheli ezinemiphumela yokudambisa ubuhlungu kanye ne-sedative. Lokhu kudinga ukulungiswa okuguquguqukayo kokugxila kwegesi ehogeliwe ngokusekelwe ekuphenduleni komtholampilo nokufunda kwe-BIS.
I-Magnesium sulfateOkuvame ukusetshenziswa ku-preeclampsia, kunciphisa izidingo ze-propofol nama-halogenated agents, kuthuthukisa ukuzinza kwe-hemodynamic, futhi kunciphise impendulo ku-nociceptive stimuli. Kodwa-ke, ukusetshenziswa kwayo njenge-adjunct kubo bonke abesifazane abakhulelwe abanempilo akunconywa ngenxa yengozi yokudlula ngokweqile kanye nemiphumela emibi; igcinelwe ikakhulukazi iziguli ezinomfutho wegazi ophakeme.
Mayelana nama-opioidIzidakamizwa ezifana ne-remifentanil zivumela ukulawula okuphumelelayo kakhulu kwempendulo ye-hypertensive ku-laryngoscopy kanye ne-intubation, ikakhulukazi ezinganeni ezisanda kuzalwa. Kodwa-ke, ukudlula kwayo okuphezulu kwe-transplacental kuhlotshaniswa nokucindezeleka kokuphefumula kwe-neonatal okuvame ukudinga ukuvuselelwa. Ngakho-ke, amaqembu amaningi ayisebenzisa kuphela ezimweni ezikhethwe kakhulu futhi njalo ngemva kokwazisa i-neonatologist.
Iziphumuli zemisipha nokuphathwa komzila womoya okuthuthukile
Isiphumuli sendabuko sokuzikhethela Ngokulandelana okusheshayo kokungeniswa kwabesifazane abakhulelwe, i-succinylcholine iyisidakamizwa esikhethwayo, ngenxa yokuqala kwayo ngokushesha kanye nesikhathi esifushane, okuvumela ukutholakala komoya okuzenzakalelayo ngokushesha uma kuqhathaniswa nesimo "sokungangeni komoya, ungafaki umoya" kwenzeka.
Ngaphandle kwalokho, i-rocuronium ngemithamo ephezulu (1-1,2 mg/kg) inikeza izimo ezifanayo zokungena cishe kumasekhondi angu-60. Inzuzo yayo enkulu namuhla ukuthi ingashintshwa cishe ngokushesha nge-sugammadex, evula indlela yokuphuma ezinkingeni ezinkulu zomoya, ngezindleko zezindleko eziphezulu zezomnotho.
Imihlahlandlela enzima yokuphatha indlela yomoya Ku-obstetrics, baphikelela ekubekeni phambili i-oxygenation ngaphezu kwe-intubation ngazo zonke izindleko. Uma kwenzeka i-intubation ehlulekile, imizamo eminingi kufanele igwenywe; umzamo wesibili unconywa ngemva kokuthuthukisa isikhundla sesiguli, futhi uma lokhu kungaphumeleli, qhubeka nobuso be-mask ventilation, ukucindezela kwe-cricoid okuphumuzayo uma kunesidingo.
Amamaski esizukulwane sesibili se-laryngeal (I-Supreme, i-ProSeal) ibonise ukuthi iyithuluzi elisebenza ngempumelelo kakhulu futhi eliphephile ezigabeni zokuhlinzwa ezikhethiwe futhi njengesisindisi sempilo ekungeneni okunzima, okuvumela ukungena komoya okuvaleka kahle kanye nokubekwa kweshubhu lesisu ukuze kwehliswe ingcuphe ye-distension kanye nesifiso.
Uma konke lokhu kwehluleka ukufaka umoya-mpilo esiguliniEzimweni ezinjalo, amasu aphuthumayo afana ne-percutaneous cricothyrotomy futhi, ekugcineni, i-tracheostomy ephuthumayo kufanele isetshenziswe. Amaphrothokholi aqeqeshwe kahle kanye nokulingiswa komtholampilo kusiza ukuqinisekisa ukuthi lezi zimo eziyivelakancane ziphathwa ngokushesha nangendlela edidiyelwe.
I-Preoxygenation, isikhundla se-Sellick kanye nokuqondisa
Ngaphambi kokufakwa okulandelanayo okusheshayoI-Preoxygenation iyimpoqo kwabesifazane abakhulelwe ukwandisa isikhathi sokuphefumula esiphephile ngaphambi kokuba ukuphelelwa umoya kwenzeke uma kwenzeka kuba nobunzima bokuthi intubation. Kungenziwa ngokuphefumula okuvamile imizuzu engu-3 kusetshenziswa umoya-mpilo ongu-100%, noma ngokuphefumula okujulile okuyisishiyagalombili emzuzwini ongu-1 lapho isikhathi sinqunyelwe.
Kwabesifazane abakhulelwe kanye neziguli ezikhulupheleKubonisiwe ukuthi indawo ye-semi-recumbent (cishe amadigri angu-30) ithuthukisa amandla okusebenza ayinsalela yamaphaphu futhi yandise isikhathi sokubekezelela i-apnea uma kuqhathaniswa nendawo yokulala. Ngakho-ke, amaqembu amaningi enza i-preoxygenation futhi, uma kungenzeka, ukungeniswa endaweni eqondile kancane.
Indlela kaSellick Ingcindezi ku-cartilage ye-cricoid isetshenziswe amashumi eminyaka ukuzama ukuvimbela ukuphindaphinda kanye nokufisa kokuqukethwe kwesisu ngesikhathi sokungeniswa. Kodwa-ke, izifundo zokubheka zakamuva zikungabaze ukusebenza kwayo futhi yaze yayihlobanisa nokwanda okusobala kweziqephu zokuqalisa kabusha phakathi nokungeniswa.
Naphezu kwengxabano, iziqondiso eziningi Baqhubeka nokutusa ukucindezela kwe-cricoid yokungeniswa kokulandelana okusheshayo kwabesifazane abakhulelwe, njalo isetshenziswa ngabasebenzi abaqeqeshiwe futhi ikhululwe uma ivimbela ukungena komoya noma ukungena. Kuyaziwa futhi ngokucindezela ngokuyinhloko i-postcricoid hypopharynx kune-esophagus ngokwayo.
Ngaphezu kwalezi zinyatheloAmazwe amaningi afake njengomkhuba ojwayelekile ukulawulwa kwangaphambilini kwama-antacid angewona ama-particulate, ama-H2 antagonists, noma ama-proton pump inhibitors ukuze kukhuphule i-pH yesisu nokunciphisa ubulukhuni be-aspiration pneumonitis engaba khona. Nakuba ubufakazi bomthelela wabo oqondile ezenzakalweni zokulangazelela bulinganiselwe, lokhu kungenelela kubhekwa njengengozi ephansi futhi okungenzeka kube nenzuzo ephezulu.
Ukuvuswa kwe-intraoperative nokuphepha komama
"Ukuqwashisa" noma inkumbulo yokuhlinzwa Phakathi ne-anesthesia ejwayelekile, kuyinkinga engavamile kodwa ehlukumeza kakhulu. Ngomphakathi jikelele, kulinganiselwa phakathi kuka-0,1 no-0,2%, kodwa ezigabeni zokuhlinzwa ngaphansi kwe-anesthesia evamile, isigameko somlando sasiphezulu kakhulu futhi, nakuba siye sancishiswa kakhulu namuhla, sisaphakeme kunezinye izinhlobo zokuhlinzwa.
Izimbangela ziyi-multifactorial: ukungeniswa okulandelanayo okusheshayo ngezikhathi ezimfushane zokuphatha zokuluthwa, ukuvinjelwa kokusetshenziswa kwezidakamizwa ze-halogenated noma i-opioid ngaphambi kokuzalwa ukuze kuvikelwe umbungu, kanye nezinguquko zomzimba zokukhulelwa ezishintsha i-pharmacokinetics yezidakamizwa.
Ukusetshenziswa kokuqapha ukujula kwezinzwa (BIS) kanye nokusetshenziswa okuqinile komthamo omncane osebenzayo kwezivumelwano kuye kwehlise izehlakalo zokuphaphama ngemva kokuhlinzwa zaba cishe ku-0,26%, okungukuthi, ngaphansi ngokuphindwe kayikhulu kunezifundo zangaphambilini. Noma kunjalo, noma yisiphi isiguli esibika izinkumbulo kufanele silalelwe, umcimbi ubhalwe phansi, futhi unikezwe ukwesekwa ngokwengqondo uma kudingeka.
Ukunciphisa lobu bungoziOdokotela ababulala izinzwa bahlela ngokucophelela inhlanganisela kanye nesikhathi sokuphathwa kwe-hypnotics, inhalants, kanye ne-analgesics, bandisa ukugxila kwegesi uma intambo isiboshiwe, futhi basebenzise ama-adjuvants afana ne-magnesium uma kufanele, njalo igcina ukuqina kwe-hemodynamic komama.
Uhlolojikelele olusebenzayo: ukuthi i-anesthesia ejwayelekile ihlelwa kanjani esigabeni sokuhlinzwa
Ngomkhuba wangempela wezibhedlela eziningiI-anesthesia ejwayelekile yengxenye yokuhlinzwa igcinelwe izimo ezithile. Uma isikhathi sivuma, owesifazane uyaziswa, umlando wakhe wezokwelapha uyabuyekezwa, indlela yakhe yokuphefumula ihlolwe ngokucophelela (amaphuzu e-Mallampati, ukuvuleka komlomo, ukuhamba komlomo wesibeletho, ibanga le-thyromental), futhi kuyaqinisekiswa ukuthi yonke imishini edingekayo yomgwaqo womoya onzima iyatholakala.
Ezigabeni eziphuthumayo zokuhlinzwaUkulandelana okuvamile kuhlanganisa i-preoxygenation ejulile, ukuma kwe-supine ngokutshekela kancane kwesokunxele ukuze kugwenywe ukucindezelwa kwe-aortocaval, ukuphathwa ngokushesha kwe-hypnotic (i-propofol noma i-thiopental uma ikhona) kanye nesiphumuza imisipha (i-succinylcholine noma i-rocuronium ngemithamo esheshayo ye-intubation) ene-cuff ye-cricoid igcinwa kuze kube yilapho i-cricoid igcinwa
Ukuqala kokuhlinzwa kugunyazwe kuphela Ngemuva kokuqinisekisa ukungena ku-tracheal nge-auscultation kanye ne-capnography, ama-halogenated agents kanye nokukhipha umoya kuyalungiswa ukuze kugcinwe i-pCO2 kamama esondele ku-30-33 mmHg, ukugwema kokubili i-hyperventilation eyeqile kanye ne-hypercapnia, engathinta ukugeleza kwe-uteroplacental.
Ngemva kokuzalwa kanye clamping of the cordAma-opioid adingekayo alawulwa ukuze kuqinisekiswe ukulawulwa okuhle kobuhlungu (i-fentanyl, i-morphine, i-remifentanil ngokusho kwe-protocol yendawo), kanye ne-hypotension, i-hypovolemia, noma ukuphumula kwesibeletho kulungiswa ngamanzi, i-vasopressors, ne-oxytocics. Ekupheleni kwenqubo, ukuvinjelwa kwe-neuromuscular kuyahlehliswa, futhi ukukhishwa okuphapheme kuhlelwa, ngokuqaphela isiguli kanye ne-reflexes yokuzivikela ebuyiselwe.
Lonke lolu hlelo ludinga ukusebenzisana. phakathi kodokotela ababulala izinzwa, odokotela bokubelethisa, ababelethisi, odokotela bezingane nabahlengikazi, kanye nemfundo eqhubekayo, ukulingisa izimo ezibucayi kanye nokuhlaziywa kwamacala ayinkimbinkimbi ukuze kuthuthukiswe izimiso kanye nokuqinisa ukuphepha kwengane engumama nomntwana.
Ukubheka indikimba yobufakazi nolwazi lomtholampiloI-anesthesia ejwayelekile esigabeni sokuhlinzwa akusona isitha okufanele sigwenywe ngazo zonke izindleko, kodwa ithuluzi elinamandla okuthi, lapho lisetshenziswa ngokwahlulela okuzwakalayo, ukuqeqeshwa kanye nezinsiza ezanele, kusivumela ukuba sibhekane nezimo ezibucayi kakhulu zokubelethisa kuyilapho sigcina amazinga aphezulu kakhulu okuphepha kumama nosana olusanda kuzalwa.