RU2228173C2 - Method for applying anesthesia in performing surgical operations on extremities - Google Patents

Abstract

FIELD: medicine. SUBSTANCE: method involves carrying out sedation in intravenous drop-by-drop mode. Sodium thiopental is administered with at a dose of 2 g in 200 ml of physiological salt solution by dropping the mixture at a rate of 30 ml/min to reach patient falling in sleep and then at a rate of 2.2 ml/min. EFFECT: reduced risk of complications; improved anesthesia control; avoided inhibitory influence upon the nervous system.

Description

The present invention relates to medicine, in particular to methods of anesthesia on the limbs.

There are various methods of anesthesia during operations on the extremities, for example, by conducting total intravenous anesthesia with the introduction of relanium, sodium hydroxybutyrate and fentanyl (see Zagrekov V.I. Non-inhalation anesthesia during operations on the extremities: Abstract of thesis, Candidate of Medical Sciences. - N. Novgorod, 1997).

However, this method leads to respiratory failure (up to apnea), causes nausea and vomiting in the postoperative period.

As a prototype, we chose a method of analgesia by conducting conduction anesthesia with the simultaneous administration of sodium thiopental, diazepam and sodium hydroxybutyrate for sedation intravenously (see Popov V.Yu. Options for conduction anesthesia of the brachial plexus in trauma patients: Abstract of Cand. Cand. Sciences.-Novosibirsk, 1999.- p. 9-10).

However, sedation with sodium thiopental causes a high risk of respiratory depression in patients, and when combined with sodium oxybutyrate with diazepam or with sodium thiopental, it manifests itself with motor excitement.

The task of the invention is the elimination of complications of anesthesia.

The problem is solved due to the fact that in a method that includes regional anesthesia and subsequent sedation by intravenous administration of thiopental and sodium hydroxybutyrate, sedation is carried out intravenously, moreover, thiopental is administered in a dose of 500 mg, and sodium oxybutyrate in a dose of 2 g in 200 ml of physiological saline and until the patient falls asleep, the mixture is dripped at a rate of 30 ml / min, and to maintain anesthesia - 2.2 ml / min.

The method of analgesia during operations on the limbs is as follows: the patient 30 minutes before the operation intramuscularly administered atropine 1 mg, diphenhydramine 20 mg Relanium - 10 mg, dipyrone 50% - 2.0 ml, promedol 2% - 1.0 ml are added to some patients. In the operating room, regional anesthesia (subrachnoid, conductor) is performed, after which the patient is injected intravenously with sodium thiopental 500 mg, sodium oxybutyrate 2 g in saline in a volume of 200 ml at a rate of 30 ml / min until the patient falls asleep. Until the end of the operation, the infusion of the mixture is continued at a rate of 2.2 ml / min.

Clinical examples.

1. Patient K., 47 years old, weight 70 kg (source. Bol. No. 199384), with a diagnosis of a fracture of the right ulnar bone. Was taken for surgery: osteosynthesis of the right ulnar bone plate. Premedication: Relanium - 10 mg, Analginum 50% - 2.0 ml, Diphenhydramine - 10 mg intramuscularly. The patient was taken to the operating room, where he underwent conduction anesthesia with lidocaine 1% - 400 mg and marcain 0.25% - 100 mg of axillary access to the median and ulnar nerves. The patient was started infusion of sodium thiopental, sodium oxybutyrate in physiological saline. At first, the infusion rate was 30 ml / min, 120 ml of the mixture was transfused (respectively thiopental sodium 300 mg, sodium oxybutyrate 1200 mg), after 4 minutes the patient fell asleep and the infusion rate was reduced to 2.2 ml / min. During the operation, blood pressure remained stable within 105 / 60-120 / 80 mm Hg, pulse from 72 to 85 beats per minute. Independent breathing, respiratory rate 20 per minute. Oxygen saturation was 96-98%. After the end of the infusion, after 6 minutes the patient woke up. After the end of the operation, the patient regained consciousness and ability to execute commands (raising a hand and a head on a command, answering questions). The patient is consciously transferred to the ward.

2. Patient S., 41 years old, weight 90 kg (source. Bol. No. 199049) with a diagnosis of fused ankle fracture. The operation was performed: removal of metal. Premedication: atropine 0.1% - 1.0 ml, diphenhydramine 1% - 2.0 ml, relanium - 10 mg intramuscularly. When entering the operating blood pressure 110/70 mm Hg, pulse 74 per minute. Blocked sciatic nerve blockade with lidocaine 1% - 200 mg, marcain 0.25% - 50 mg, femoral block with lidocaine 1% - 200 mg and marcain 0.25% - 50 mg. The block is complete. Then the patient began infusion of the mixture. After the injection of 100 ml of the mixture at a rate of 30 ml / min (respectively 250 mg of sodium thiopental and 1000 mg of sodium oxybutyrate), the patient fell asleep, and the infusion rate was reduced to 2.2 ml / min. During anesthesia, hemodynamics are stable, blood pressure held 110/70 mm Hg, pulse from 70 to 74 beats per minute. Independent breathing, respiratory rate - 18 per minute. Oxygen saturation 97-99%. At the end of surgery, the infusion of the mixture is stopped. Consciousness recovered 5 minutes after the end of the infusion. The patient was transferred to the ward.

3. Patient J., 73 years old, weight 63 kg (source. Bol. No. 198888) with a diagnosis of periosteal fracture of the neck of the left femur. Osteosynthesis by the Bogucharov construction under the C-arc. Premedication: atropine 0.1% - 0.5 ml, diphenhydramine 1% - 2.0 ml, promedol 2% - 1.0 ml intramuscularly. The patient was admitted to the operating room with a blood pressure of 150/100 mm Hg, pulse of 96 beats per minute, respiratory rate of 20 per minute. After infusion “backwater” with physiological saline in a volume of 1200 ml, subrachnoid anesthesia was performed at the L3-L4 level with a solution of marcaine spinalized 0.5% in a volume of 2.7 ml (13.5 mg). After performing anesthesia, an intravenous drip of the mixture (thiopental and sodium oxybutyrate) was started. After the introduction of 100 ml, sleep developed. After that, the infusion rate was reduced to 2.2 ml / min. The duration of the operation was 50 minutes During the operation, the patient's blood pressure remained stable, at figures 150 / 90-130 / 80, the pulse 84-96 beats per minute. Independent breathing, respiratory rate 20 per minute, oxygen saturation 96-98%. At the time of suturing the skin, the dropwise administration of sodium oxybutyrate with thiopental was discontinued, and 7 minutes after this the patient regained consciousness (performed commands, answered questions). After the operation, the patient was transferred to the ward.

The proposed method of analgesia during operations on the extremities is the most manageable and helps after the end of surgery to quickly restore the patient’s consciousness, which improves his quality of life in the postoperative period. The method allows you to save spontaneous breathing and persistent analgesia for several hours after surgery and does not exert a depressing effect on the circulatory and respiratory systems.

Claims (1)

An anesthesia method for operations on the extremities, which consists in conducting regional anesthesia and subsequent sedation by intravenous administration of thiopental and sodium hydroxybutyrate, characterized in that sedation is carried out intravenously, with thiopental being administered at a dose of 500 mg, sodium oxybutyrate at a dose of 2 g in 200 ml of physiological solution and drip the mixture until the patient falls asleep at a speed of 30 ml / min, and to maintain anesthesia - at a speed of 2.2 ml / min.