If the child needs operation with an anesthesia of
Very often the anesthesia frightens people even more, than operation. Uncertainty, possible unpleasant feelings at falling asleep and awakening frighten and numerous talk on unhealthy consequences of an anesthesia. If all this concerns your child. What is a modern anesthesia? And as far as it is safe for a children`s organism?
In most cases we know about an anesthesia only that operation under its influence is painless. But in life can happen so that this knowledge will appear insufficiently, for example if the issue of operation for your child is resolved. What it is necessary to know about an anesthesia?
the Anaesthesia , or the general anesthesia , is the medicamentous impact on an organism limited in time at which the patient is in an unconsciousness when to it the anesthetizing drugs, with the subsequent restoration of consciousness, without pain in the field of operation are injected. The anesthesia can include carrying out to the patient of an artificial respiration, ensuring relaxation of muscles, statement of droppers for the purpose of maintenance of constancy of the internal environment of an organism by means of infusion solutions, control and compensation of blood loss, an antibiotikoprofilaktika, prevention of postoperative nausea and vomiting and so on. All actions are directed to that the patient transferred surgery and “woke up“ after operation, without testing a condition of discomfort.
Types of an anesthesia
Depending on a way of carrying out the anesthesia happens inhalation, intravenous and intramuscular. The choice of a way of an anesthesia lies on the anesthesiologist and depends on a condition of the patient, on a type of surgery, on qualification of the anesthesiologist and the surgeon, etc., for the same operation different general anesthesia can be appointed. The anesthesiologist can mix different types of an anesthesia, trying to obtain an ideal combination for this patient.the Anaesthesia conditionally shares
on “small“ and “big“, everything depends on quantity and a combination of preparations of various groups.
can be carried To a “small“ anesthesia inhalation (hardware - mask) an anesthesia and an intramuscular anesthesia. At hardware - a mask anesthesia the child receives the anesthetizing preparation in the form of inhalation mix at independent breath. The anesthetizing drugs injected in an organism in the form of inhalation are called inhalation anesthetics (Ftorotan, Izoflyuran, Sevoflyuran). This type of the general anesthesia is applied at low-traumatic, short operations and manipulations, and also at different types of researches when short-term switching off of consciousness of the child is necessary. Now the inhalation anesthesia is most often combined with local (regionarny) anesthesia as in the form of a monoanaesthesia it is insufficiently effective. The intramuscular anesthesia now is practically not applied and consigns to the past as the anesthesiologist cannot operate action on an organism of the patient of this type of an anesthesia at all. Besides, the preparation which is generally used for an intramuscular type of an anesthesia - Ketamin - is according to the latest data not so harmless to the patient: it switches off for long term (practically for six months) long-term memory, interfering with full development of the child.
the “Big“ anesthesia is a multicomponent pharmacological impact on an organism. Includes application of such medicinal groups as narcotic analgetics (it is not necessary to confuse to drugs), muscular relaksant (the preparations which are temporarily weakening skeletal muscles), somnolent preparations, local anesthetics, a complex of infusion solutions and as necessary blood preparations. Medicines are entered as intravenously, and is inhalation through lungs. To the patient during operation the artificial ventilation of lungs (AVL) is carried out. whether
contraindications Are?is not present
of Contraindications to an anesthesia, except refusal of the patient or his relatives of an anesthesia. At the same time many surgeries can be carried out without anesthesia, under local anesthesia (anesthesia). But when we speak about a comfortable condition of the patient during operation when it is important to avoid psycho - an emotional and physical stress, - the anesthesia is necessary, that is knowledge and abilities of the anesthesiologist is necessary. And absolutely not necessarily the anesthesia at children is used only during operations. The anesthesia can be required at a set of diagnostic and medical actions where it is necessary to clean concern, to switch off consciousness, to give the chance to the child not to remember unpleasant feelings, absence of parents, the long compelled situation, the stomatologist with brilliant tools and a drill. Everywhere, where the tranquility of the child is necessary, the anesthesiologist - the doctor whose task includes protection of the patient against an operational stress is necessary. >
Before planned operation it is important to p to consider also such moment: if the child has an accompanying pathology, then it is desirable that the disease was out of an aggravation. If the child had the sharp respiratory viral infection (SRVI), then the period of restoration makes at least two weeks, and it is desirable not to perform planned operations as the risk of postoperative complications considerably increases in this period and during operation there can be trouble breathing, the respiratory infection first of all affects airways.
Before operation the doctor - the anesthesiologist will surely have a talk with you on abstract subjects: where the child as he was born whether vaccination is done and when as he grew as developed, than was ill whether there is an allergy was born, will examine the child, will study the clinical record, will scrupulously study all analyses. He will tell what will happen to your child before operation, during operation and during the next postoperative period.terminology has some
of Premedikation - psychoemotional and medicamentous training of the patient for the forthcoming operation, begins some days before surgical intervention and comes to the end just before operation. The main objective of a peremedikation - to remove fear, to reduce risk of development of allergic reactions, to prepare an organism for the forthcoming stress, to calm the child. Drugs can be entered through a mouth in the form of syrup, in the form of spray into a nose, intramuscularly, intravenously, and also in the form of microenemas.
of Kateterization of a vein - statement of a catheter in a peripheral or central vein for numerous introduction of intravenous medical supplies during operation. This manipulation is made before operation.
the Artificial Ventilation of Lungs (AVL) - a way of delivery of oxygen to lungs and further to all body tissues by means of the device of artificial ventilation. During operation temporarily weakening skeletal muscles that is necessary for an intubation. the Intubation - introduction to a gleam of a trachea of an incubatory tube for carrying out artificial ventilation of lungs during operation. This manipulation of the anesthesiologist is aimed at providing delivery of oxygen to lungs and protection of airways of the patient.
Infusional therapy - intravenous administration of sterile solutions for constancy maintenance vodno - electrolytic balance of an organism of volume of the circulating blood on vessels, for reduction of consequences of operational blood loss.
Transfusion therapy - intravenous administration of the preparations made of blood of the patient or blood of the donor (the eritrotsitarny weight, freshly frozen plasma and so forth) for compensation of irreplaceable blood loss. Transfusion therapy is an operation on the compelled introduction in an organism of alien matter, it is applied according to strict vital indications.
of Regionarnaya (local) anesthesia - a method of anesthesia of a certain part of the body by leading of solution of local anesthetic (the anesthetizing preparation) to large nervous trunks. One of options of regionarny anesthesia is epiduralny anesthesia when solution of local anesthetic is entered into okolopozvonochny space. It is one of the most difficult manipulations in workmanship in anesthesiology. The simplest and known local anesthetics are a Novocaine and Lidocaine, and modern, safe and possessing the longest action, - Ropivakain.
the child for an anesthesia
the Most important - the emotional sphere. Not always it is necessary to speak to the child about the forthcoming operation. The exception is made by cases when the illness disturbs the child and he consciously wants from it to get rid.
the Most unpleasant for parents is a hungry pause, i.e. in six hours prior to an anesthesia it is impossible to feed the child, in four hours it is impossible even to give to drink water, and water is understood as the transparent, not aerated flavourless liquid and taste. The newborn who is on breastfeeding can be fed in four hours prior to an anesthesia last time, and for the child who is on artificial feeding, this term is extended till six o`clock. The hungry pause will allow to avoid such complication during the beginning of an anesthesia as aspiration, i.e. hit of contents of a stomach in airways (the speech about it will go further).to Do to
an enema before operation or not? The patient`s intestines before operation have to be emptied that during operation under the influence of an anesthesia there was no involuntary otkhozhdeniye of a chair. Especially this condition has to be met at intestines operations. Usually three days before operation to the patient appoint the diet excluding the meat products and products containing vegetable cellulose sometimes add a depletive to it in the afternoon on the eve of operation. In this case the enema is not necessary if it is not demanded by the surgeon.
In an arsenal of the anesthesiologist many devices for derivation of attention of the child from the forthcoming anesthesia are available. It and respiratory bags with the image of different animals, and front masks with a smell of strawberry and orange, is electrocardiogram electrodes with the image of nice muzzles of favourite animals, - that is all for comfortable falling asleep of the child. But nevertheless parents have to be near the child until until he falls asleep. And the kid has to wake up near parents (if the child is not transferred after operation to the intensive care unit and intensive therapy).
After the child fell asleep, the anesthesia goes deep to a so-called “surgical stage“ at which achievement the surgeon begins operation. Upon termination of the operation “force“ of an anesthesia decreases, the child wakes up.
What happens to the child during operation? He sleeps, without feeling any feelings, in particular painful. The condition of the child is estimated by the anesthesiologist clinically - on the integuments visible to mucous membranes, eyes, he listens to lungs and heartbeat of the child, monitoring (supervision) of work of all vitals and systems is used, if necessary are carried out laboratory the express - analyses. The modern monitor equipment allows to trace the heart rate, arterial pressure, breath frequency, content in the inhaled and exhaled air of oxygen, carbonic acid, inhalation anesthetics, blood saturation by oxygen in a percentage ratio, degree of depth of a dream and extent of anesthesia, level of relaxation of muscles, a possibility of carrying out a painful impulse on a nervous trunk and much, many other. The anesthesiologist carries out infusional and as necessary transfusion therapy, besides preparations for an anesthesia antibacterial, styptic, antiemetic drugs are injected.
the Exit from an anesthesia
the exit Period from an anesthesia lasts no more than 1,5 - 2 hours while the drugs injected for an anesthesia work (you should not confuse to the postoperative period which lasts 7 - 10 days). Modern preparations allow to reduce the exit period from an anesthesia to 15 - 20 minutes, nevertheless by convention the child has to be under supervision of the anesthesiologist within 2 hours after an anesthesia. This period can be complicated by dizziness, nausea and vomiting, pain in the field of a postoperative wound. At children of the first year of life the habitual mode of a dream and wakefulness which is restored within 1 - 2 weeks can be broken.Tactics of modern anesthesiology and surgery dictates to
early activization of the patient after operation: as soon as possible to get up, as soon as possible to begin to eat - within an hour after short, low-traumatic, uncomplicated operation and during three - four hours after more serious operation. If the child after operation is transferred to the intensive care unit and intensive therapy, then further supervision over a condition of the child is undertaken by the resuscitator, and the continuity in transfer of the patient from the doctor to the doctor is important here.As well as than to anesthetize
after operation? In our country purpose of the anesthetizing preparations is carried out by the treating surgeon. It can be narcotic analgetics (Promedol), not narcotic analgetics (Tramal, Moradol, Analginum, Baralgin), nonsteroid anti-inflammatory (Ketorol, Ketorolak, the Ibuprofen) and febrifugal preparations (Panadol, the Nurofen).
the Modern anesthesiology seeks to minimize the pharmacological aggression, reducing time of action of preparations, their quantity, bringing a preparation out of an organism practically in an invariable look (Sevoflyuran) or completely destroying it by enzymes of the organism (Remifentanil). But, unfortunately, the risk all the same remains. Though it is also minimum, complications nevertheless are possible.the question Is inevitable
: what complications can arise during an anesthesia and to what consequences they can lead?
Anaphylactic shock - allergic reaction to introduction of preparations for an anesthesia, on transfusion of preparations of blood, at introduction of antibiotics and so forth. The most terrible and unpredictable complication capable to develop instantly can arise in response to introduction of any preparation at any person. Meets frequency of 1 on 10 000 anesthesia. It is characterized by sharp lowering of arterial pressure, work violation warmly - vascular and respiratory systems. Consequences can be the most fatal. Unfortunately, it is possible to avoid this complication only if earlier the patient or at his immediate family had a similar reaction to this preparation and it just exclude from an anesthesia. Anaphylactic reaction it is difficult and heavy to treat, the basis is made by hormonal preparations (for example, Adrenaline, Prednisolonum, Dexamethasone).
One more terrible complication which cannot almost be warned and prevented is the malignant hyperthermia - a state at which in response to introduction of inhalation anesthetics and muscular relaksant body temperature considerably increases (to 43 °C). Most often it is congenital predisposition. The fact that development of a malignant hyperthermia - extremely rare situation consoles 1 on 100 000 general anesteziya.
Aspiration - hit of contents of a stomach in airways. Development of this complication is most often possible at the emergency operations if from the moment of the last acceptance of food by the patient there passed not enough time and there was no full depletion of a stomach. At children aspiration can arise in time hardware - a mask anesthesia at passive flowing of contents of a stomach in a mouth. This complication threatens with development of heavy bilateral pneumonia and a burn of airways by sour contents of a stomach.
Respiratory insufficiency - the pathological state developing at violation of delivery of oxygen to lungs and gas exchange in lungs at which maintenance of normal gas composition of blood is not provided. The modern monitor equipment and careful supervision help to avoid or in time to diagnose this complication.
It is warm - a vesselpack insufficiency - a pathological state at which heart is not capable to provide adequate blood supply of bodies. As independent complication occurs at children extremely seldom, most often as result of other complications, such as anaphylactic shock, massive blood loss, insufficient anesthesia. The complex of resuscitation events with the subsequent long rehabilitation is held.
Mechanical damages - complications which can arise during the manipulations which are carried out by the anesthesiologist whether it be a trachea intubation, a vein kateterization, statement of a gastric probe or an uric catheter. At more skilled anesthesiologist of these complications arises less.
Modern preparations for an anesthesia passed numerous preclinical and clinical tests - at first at adult patients. And only after several years of safe application they are resolved in children`s practice. The main feature of modern preparations for an anesthesia is a lack of collateral reactions, fast removal from an organism, predictability of duration of action from the entered dose. Proceeding from it the anesthesia is safe, has no remote consequences and can repeatedly repeat.
Undoubtedly, on the anesthesiologist huge responsibility for the patient`s life lies. Together with the surgeon he seeks to help your child to cope with an illness, sometimes individually being responsible for preservation of life.