RU2476222C1 - Method for anaesthesia in desomorphin addicted patients when treating thermal burns - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: invention refers to medicine, namely addictology, psychiatry and combustiology and may be used for anaesthesia in desomorphin addicted patients suffering thermal burns. After admission to hospital, the burns are localised with describing the aethiology, the comorbidity, the psychological and social characterisation of the patient. If observing the flame-caused injuries, and if the thermal injury localisation and severity are different from the circumstances described by the patient; if chemical burning smell and fly ash are seen, while the burns are found to be localised on face, neck, front and/or back trunk, hands, forearms; and in case of airway burn, signs of lymphangitis, phlebitis and thrombophlebitis, no criticism with persistent mental disturbances; if the patient is unemployed or does not study, desomorphine addiction is diagnosed. During a period of septic toxaemia, dressing procedures required a local anaesthetic to be used, while narcotic analgesics are introduced after the dressing procedures to be gradually replaced by non-narcotic analgesics.

EFFECT: improved anaesthesia.

1 ex

Description

The invention relates to medicine, in particular to narcology, psychiatry and combustiology.

Thermal burns are inextricably linked to pain. Suffering intensifies during dressings and surgical interventions, often multiple. Anesthesia is an important component of burning treatment. With superficial burns, pain is expressed mainly in the first hours and days after an injury. The pain that occurs immediately after a deep burn is noticeably reduced in the coming hours, and the victims are relatively little disturbed while the burn wound is covered with a scab. As it is rejected, and especially after the formation of granulating wounds, the pain syndrome becomes more pronounced.

Narcotic analgesics are commonly used to reduce pain. The need for these drugs in a specialized hospital for burned is three times greater than in the department of general surgery. However, their prolonged use and the large total doses received by the victims during treatment, in some of them lead to addiction and even drug addiction (Vikhriev B.S., Burmistrov V.M. Ozhogi (Manual for doctors). / L .: Medicine, 1986, - 272 p.).

According to the Federal Scientific and Methodological Center for Border Psychiatry, approximately 10% of patients in burn departments under treatment require psychiatric and narcological assistance. The number of such patients in recent years has tended to increase due to an increase in the number of victims of thermal burns as a result of the preparation of narcotic surrogates at home. One of the most common synthetic drugs available for preparation is desomorphine, and the phenomenon of desomorphine addiction is a social problem.

Desomorphine addiction is one of the new wave types of addiction, which is based on the artisanal production of desomorphine, which in the drug environment was called "crocodile". It became widespread after 2000, so the average age of modern desomorphine addicts is only 24-25 years. It began to spread especially rapidly after 2005, taking on the nature of a hidden pandemic. According to the level of consumption in Russia, the share of artisanal desomorphine in the total volume quickly rose to 25-28%, taking second place after heroin (55-58%).

The secret to the dynamics of increasing rates of burn injuries among "desomorphine" drug addicts lies in the recipe. Synthesis of a narcotic drug takes less than one hour, does not require sophisticated equipment and special knowledge in the field of chemistry. One dose of the drug is obtained from 10 tablets of codeine drug (codeine-containing preparations include Terpincode, Nurofen Plus, Solpodein, Codelac, etc.), containing 8-15 mg of codeine phosphate, various chemicals: industrial acids, alkalis, organic solvents (gasoline, etc.) and sulfur from matches, the synthesis of desomorphine requires heating them, which leads to fire and fire in a drug den. Sales volumes of the main component raw materials for the preparation of a narcotic surrogate, codeine-containing preparations, have more than doubled over the past ten years, while the number of people in the country who use these drugs for their intended purpose for the treatment of cough and migraines has not only not increased over this period of time but also decreased slightly. The wide distribution of desomorphine in recent years is largely determined by the contingent of its main consumers. In the face of declining incomes and an increase in the number of unemployed in the context of the economic crisis, desomorphine is becoming more attractive to the especially marginalized part of heroin addicts due to its cheapness and availability. The use of drugs and the lifestyle associated with this presupposes asocial behavior and, as a result, the high criminogenicity of drug addicts as a result of the extraction of material resources necessary for acquiring a drug. The employment rates of drug addicts are significantly lower than in the general population (T.B. Grechanaya, V.F. Egorov, I.A. Arkhipov, 1993). The same circumstance can explain the increase in the number of types of crimes such as theft, robbery, theft and others. Among other social anomalies among drug addicts, it is necessary to note the formation of a layer of people who systematically use drugs in a group, sometimes forming “families”, gathering in residential premises, called “houses”. In reality, society suffers, when a drug addict appears, families disintegrate and, often, the abuser’s entire social environment suffers. The lack of financial opportunities, the painful state of drug addicts that prevented them from working and making money, and, of course, the increased activity of law enforcement agencies in suppressing drug trafficking and organized drug crime led to limited availability of heroin and the search for drug addicts for new sources of substitution, finding a simple way to get “ cheap buzz ”- prepare a drug substitute at home from improvised means.

In addition to somatic burden due to the use of desomorphine, the injuries of drug addicts also increase. Among the types of injuries received in a state of drug intoxication or addictive behavior of drug addicts, thermal burns stand out.

When analyzing the victims who were admitted to the burn ward of the Municipal Clinical Hospital No. 18 of Ufa between 2009 and 2011, it was found that 13, 86% of patients aged 15 to 45 years old made a conclusion about their “Polydrug abuse”. These patients received thermal burns as a result of fire during the heating of chemicals during the preparation of narcotic surrogates. Desomorphine is used mainly in companies, which ultimately leads to the emergence of narcotic dens (http://m.wikipedia.org/wiki/%D0%94%D0%B5%D0%B7%D0%BE%D0%BC%D0% BE% D1% 80% D1% 84% D0% B8% D0% BD% D0% BE% D0% B2% D0% B0% D1% 8F_% D0% BD% D0% B0% D1% 80% D0% BA% D0% BE% D0% BC% D0% B0% D0% BD% D0% B8% D1% 8F).

Anesthesia of patients using narcotic drugs with thermal burns remains a problem in combiologists in connection with the formed mental and physical addictions in the patient. In the process of treatment, painful dressings and operations, a humane approach remains the basis of therapeutic cooperation between the sick and medical staff. In this regard, questions of the analgesia of such patients should not lead doctors to replace drugs and subsequent drug intoxication during treatment. Using traditional methods, the appointment of narcotic analgesics requires modification.

The following main features are characteristic of narcotic analgesics:

- strong analgesic activity, providing the possibility of their use as highly effective painkillers, especially for injuries;

- a special effect on the central nervous system, expressed in the development of euphoria, and the appearance of subsequent mental and physical addictions (drug addiction), which does not allow their prolonged use;

- the development of withdrawal symptoms in people with advanced physical dependence syndrome with the abolition of analgesics;

- with repeated use, addiction (tolerance) occurs, i.e. weakening of the action, when ever higher doses of the drug are required to achieve the analgesic effect (Shmidt A.A., Schmidt E.S. Pharmacotherapeutic reference book for painkillers. Series “Medicine for You”. Rostov-on-Don: “Phoenix”, 1998. - 416 p.).

The above features of narcotic analgesics and manifestations of mental and physical dependence, formed tolerance and withdrawal in narcological patients do not allow using therapeutic doses of drugs to achieve analgesic effect and sedation, but only replace the drug, leading to drug intoxication.

Mental dependence is understood as a condition in which the drug causes a feeling of satisfaction and mental uplift, which requires periodic, renewable or constant administration of the drug in order to experience pleasure or to avoid discomfort. Physical dependence is an “adaptive state”, which is manifested by intense physical disorders when the administration of the corresponding drug is stopped. Such disorders, that is, withdrawal symptoms, are a complex of specific symptoms and signs of a mental and physical property that are characteristic of the action of each type of drug.

The prototype of the invention is a method of pain relief for patients with thermal burns by prescribing drugs before dressings (Vikhriev B.S., Burmistrov V.M. Burns (Manual for doctors). / L .: Medicine 1986, - 272 p.). Prescription of narcotic drugs is carried out before manipulations to create an “analgesic background”, sedation or medical sleep. The therapeutic dose of narcotic drugs to anesthetize the process of dressings is calculated individually and depends on body weight, age, severity of the injury and the volume of interventions.

The objective of the invention is to develop a method for the anesthesia of patients with desomorphine addiction in the treatment of thermal burns.

The technical result is the achievement of an analgesic effect, sedation or drug sleep without drug intoxication.

The specified technical result is achieved by the fact that in the method of anesthesia of patients with thermal burns, including the administration of narcotic analgesics, according to the invention, upon admission to the hospital, the etiology and localization of burns, the presence of concomitant pathology are determined, the psychological and social portrait of the victim is determined, and if there is damage flame, inconsistencies in the localization of the burn injury and the severity of the burn disease to the patient’s description of the circumstances of its receipt, the presence of a burning odor substances and soot, localization of burns on the face, neck, front and / or rear surface of the trunk, hands, forearms, the presence of a burn of the respiratory tract, the presence of lymphangitis, phlebitis and thrombophlebitis, the absence of criticism with persistent mental disorders, the absence of a job or study is diagnosed desomorphine addiction in the subject, after which a patient using a local anesthetic during dressings of a burn disease septicotoxemia during the dressings, and narcotic analgesics are administered after dressings with gradual transition to non-narcotic analgesics.

The proposed method for the anesthesia of patients with desomorphine addiction in the treatment of thermal burns is as follows. Upon admission to the hospital, the etiology and localization of burns, the presence of concomitant pathology are revealed in the patient, the psychological and social portrait of the victim is determined. If there is damage to the flame, the localization of the burn injury and the severity of the burn disease do not describe the patient's circumstances of its receipt, the smell of burning chemicals and soot, localization of burns on the face, neck, front and / or back of the trunk, hands, forearms, burns of the respiratory tract , the presence of lymphangitis, phlebitis and thrombophlebitis, the absence of criticism with persistent mental disorders, the absence of a place of work or study diagnose a patient with desomorphine addiction. In the process of treating thermal burns in a patient with an established fact of desomorphine addiction in a hospital during the period of septicotoxemia of a burn disease before dressings, the appointment of narcotic drugs is excluded. A local anesthetic is used that acts on the surfaces of burns or granular wounds to reduce pain. A post-traumatic stress disorder is created and the “controlled” “crowding out” syndrome reduces the addiction of drug addicts to psychoactive substances (surfactants), and then motivation for medication to get rid of the pain syndrome and subsequent sleep is formed. A narcotic analgesic in this case is not considered by drug addicts as an opportunity to achieve drug intoxication. Narcotic analgesics are prescribed after bandaging with a gradual transition to non-narcotic analgesics, their use is aimed at ridding the patient of the pain syndrome and using the formed controlled process prevents drug intoxication, and with the help of the "crowding out" pain syndrome, the degree of drug dependence is reduced. Prescription of narcotic analgesics is carried out after bandaging in the ward is completed, thereby stopping the “pain syndrome” and drug sleep. The presence of pain and the expectation of a “pain syndrome” significantly exceeds the degree of mental and physical dependence, and the introduction of narcotic analgesics only leads to pain relief, without leading to drug intoxication.

In the available sources of scientific, medical and patent information, the authors did not find a way to anesthetize patients in the process of treating thermal burns, which consists in the fact that upon admission to a hospital, the etiology and localization of burns, the presence of concomitant pathology are determined, the psychological and social portrait of the victim is determined, and in the presence of flame damage, inconsistency of the localization of the burn injury and the severity of the burn disease to the patient’s description of the circumstances of its receipt, the presence of a burning odor substances and soot, localization of burns on the face, neck, front and / or rear surface of the trunk, hands, forearms, the presence of a burn of the respiratory tract, the presence of lymphangitis, phlebitis and thrombophlebitis, the absence of criticism with persistent mental disorders, the absence of a job or study is diagnosed desomorphine addiction in the subject, after which the patient is using a local anesthetic during dressings of a burn disease septicotoxemia, and narcotic analgesics are administered after fasting ennym transition to a non-narcotic analgesics. Thus, the claimed invention meets the criterion of "Novelty."

The authors found that the proposed method for the anesthesia of patients in the treatment of thermal burns, which consists in the fact that, upon admission to the hospital, the etiology and localization of the burns, the presence of concomitant pathology are determined, the psychological and social portrait of the victim is determined and, if there is flame damage, the burn localization does not match injuries and severity of a burn disease, a description of the circumstances of the patient receiving it, the presence of the smell of burning chemicals and soot, the localization of burns on the face, neck f, the front and / or back surface of the trunk, hands, forearms, the presence of a burn of the respiratory tract, the presence of lymphangitis, phlebitis and thrombophlebitis, the absence of criticism with persistent mental disorders, the absence of a job or study, the patient is diagnosed with desomorphine addiction, after which such a patient the period of septicotoxemia of a burn disease during dressings, use a local anesthetic, and narcotic analgesics are administered after dressings with a gradual transition to non-narcotic analgesics, both It ensures, to achieve the analgesic effect, sedation, or sleep medication without drugs. Thus, the claimed invention meets the criterion of "Inventive step".

The invention is illustrated by the following clinical example. A 38-year-old patient B. was admitted to the burn department of the Municipal Clinical Hospital No. 18 in Ufa on an emergency basis with a diagnosis of II-III AB burns of the degree of head, neck, trunk, hands 13% (3%). Mild shock. A burn of the airways. Entered intoxicated. He describes the circumstances of the injury as sloppiness in life - repair work using gasoline. Objectively: the victim was injured in everyday life, in flame, during the preparation of narcotic surrogates at home. From the patient came the smell of burning chemicals, soot on the body. When viewed on the upper and lower extremities, there are signs of lymphangitis, phlebitis and thrombophlebitis. Behavior in the absence of criticism with persistent mental disorders. Diagnosed with desomorphine addiction. During the period of burn shock, infusion therapy, inhalation, pathogenetic and symptomatic treatment was carried out in order to stop the withdrawal symptoms and the prevention of delirious phenomena, as well as encephalopathy, psychopharmacotherapy was used.

During the period of burn toxemia, detoxification therapy and psychopharmacotherapy were carried out in order to prevent delirious phenomena caused by the "mutual burden syndrome" of burn and drug intoxication, as well as dressings under anesthesia. During periods of shock and burn toxemia, treatment was carried out in the intensive care unit.

During the period of septicotoxemia of a burn disease, dressings were performed requiring analgesia by narcotic analgesics. Anesthesia with narcotic and non-narcotic analgesics was not prescribed prior to bandaging. Before removing the dressings from burn wounds, they were soaked with the addition of a local anesthetic (2% lidocaine hydrochloride solution). Assignment of narcotic analgesics (morphine 1% solution of 1 ml) was performed after completion of dressings in the ward, thereby achieving relief of “pain syndrome” and drug sleep. A narcotic analgesic (morphine 1% solution of 2 ml) was prescribed after dressings intramuscularly for 3 days from 14 days after the injury. On the 18th and 19th days after the injury, a narcotic analgesic (Promedol 1% solution of 1 ml) was administered intramuscularly after ligation. On the 20th day after the injury, no narcotic analgesic was prescribed, non-narcotic analgesics were used after dressings (analgin 50% 2 ml, diphenhydramine 1% 1 ml).

Narcotic intoxication from the use of narcotic analgesics was not achieved in connection with the “displacement syndrome” of mental and physical dependence of pain. Subsequently, when the dressings were performed, after their completion, narcotic analgesics were also replaced by non-narcotic analgesics (50% 2 ml analgin), during which a local anesthetic was used (2% lidocaine hydrochloride solution).

The formation of motivation for recovery and getting rid of addiction took place in parallel with the emergence of criticism of abuse and behavior.

The patient was discharged in satisfactory condition on the 40th day from the moment of the injury; during the follow-up examination one month after the discharge of anesthesia, it was not established.

This method was used to anesthetize 15 patients with desomorphine addiction during the treatment of thermal burns received in the burn department of the Municipal Clinical Hospital No. 18 in Ufa. In all cases, the proposed method has proven effective. The method is easily reproducible and when using it, the specified technical result is achieved. Thus, the claimed invention meets the criterion of "Industrial applicability".

Claims (1)

A method of anesthetizing patients with thermal burns, including the introduction of narcotic analgesics, characterized in that, upon admission to the hospital, the etiology and localization of burns, the presence of concomitant pathology are determined, the psychological and social portrait of the victim is determined, and if there is flame damage, the localization of the burn injury and the severity of a burn disease, the patient’s description of the circumstances of its receipt, the presence of the smell of burning chemicals and soot, the localization of burns on the face, neck, ne the middle and / or back surface of the body, hands, forearms, the presence of a burn of the respiratory tract, the presence of lymphangitis, phlebitis and thrombophlebitis, the absence of criticism with persistent mental disorders, the absence of a job or study, the patient is diagnosed with desomorphine addiction, after which such a patient during septicotoxemia A burn disease during dressings uses a local anesthetic, and narcotic analgesics are administered after dressings with a gradual transition to non-narcotic analgesics.