2 English reference intravenous anesthesia
Intravenous anesthesia can use a single drug or a combination of multiple drugs for various types of surgery. Preparation before anesthesia is the same as inhalation anesthesia.
3 thiopental sodium 1. 2.5% solution prepared with normal saline for intravenous injection. The injection speed should not be too fast to be injected into arteries or blood vessels. The respiratory tract should be kept unobstructed when taking medicine, and the occurrence of laryngeal spasm and respiratory and circulatory inhibition should be paid attention to.
2. It is used for general anesthesia induction (68mg/kg), short operation and anticonvulsant, and the single dose for adults generally does not exceed1g..
3. Patients with asthma, airway obstruction, dyspnea and throat and neck infections are prohibited from using thiopental. It is not suitable to use thiopental sodium alone if it is difficult to keep the respiratory tract unobstructed after long-term operation on mouth, throat and neck. Surgery for hypovolemia, cardiac insufficiency and constrictive pericarditis should be used with caution.
Sodium 4- hydroxybutyrate is 1. The first dose is 50 100mg/kg, and children can reach 10 125 mg/kg. The maintenance time is about 60min, and the supplementary dose is half of the first dose.
2. The drug has low toxicity and is suitable for patients with liver or renal insufficiency, shock and critical illness. Because it has no analgesic effect, it needs to be used in conjunction with other anesthetics.
3. Single application, especially when the injection speed is too fast, is prone to muscle tremor and seizures, which can be prevented by using sedatives. Bradycardia and hypokalemia may also occur, which should be paid attention to.
4. Use with caution in patients with severe hypertension, epilepsy and severe arrhythmia.
Ketamine 1. Atropine and sedative should be given before operation.
2. Short action time, no muscle relaxation, no damage to liver and kidney function, mainly suitable for body surface surgery, burn wound treatment, pediatric surgery, and other * * * compound applications.
3. Patients with severe hypertension, intracranial hypertension or intraocular pressure, severe heart failure, coronary heart disease, respiratory dysfunction or family history of psychosis are not suitable for application.
4. The first dose was 2mg/kg intravenous injection, which took effect for 3060s and lasted for1015 min; Intramuscular injection of 46mg/kg took effect in 34 minutes and lasted for about 25 minutes. It can also be made into 0. 1% 0.2% solution for continuous intravenous drip.
5. The injection speed should not be too fast. If respiratory depression or pause occurs during anesthesia, oxygen inhalation or artificial respiration should be performed.
6. After extensive use of ketamine, observation should be strengthened during the recovery period. Delirium, restlessness, respiratory depression, delayed awakening and extrapyramidal symptoms that may occur in individual patients should be dealt with in time. Combined use of diazepam (diazepam), especially midazolam, can reduce or prevent delirium during recovery.
Propofol (diprivan) 1. It can be used for anesthesia induction and maintenance (especially short operation) and sedation in ICU.
2. The induced dose was 65438 0.52.5 mg/kg. Anesthesia can be maintained by intermittent intravenous administration (1mg/kg every 6min) or continuous intravenous drip [80150μ g/(kg min)]. This medicine has a poor analgesic effect. If it is used for anesthesia maintenance, it should be combined with inhalation of * * * or analgesic drugs.
3. When the dose is large, it is easy to cause blood pressure to drop, so it is necessary to speed up the infusion and apply antihypertensive drugs when necessary. Elderly patients and patients with cardiac insufficiency should reduce the dose.
Etomidate 1. It is mainly used for general anesthesia induction (the dose is 0. 150.3mg/kg) and short operation, and can also be used for anesthesia maintenance and sedation.
2. When used alone, some patients will have muscle tremor, which can be alleviated by using droperidol and fentanyl before operation.
3. Pain and phlebitis may occur at the injection site, which can be alleviated by diluting with normal saline.
4. Another side effect of this drug is to inhibit the stress response of adrenal cortex, which should be paid attention to.
8 midazolam 1. It can be used as preoperative medication, anesthesia adjuvant and anesthesia inducer.
2. The induction dose of general anesthesia is 0. 150.2mg/kg, and the average dose of epidural or other nerve block auxiliary drugs is 0. 1mg/kg.
3. The drug can lower blood pressure, and the dosage varies greatly among individuals, so the dosage for the elderly should be reduced.
9 procaine 1. The general anesthesia effect of procaine is weak, so it is not suitable to be used alone. When used as intravenous anesthesia, it is often used for major operations such as chest and abdomen. People who are allergic to procaine should be banned. Patients with myasthenia gravis, hepatic insufficiency, atrioventricular block, digitalis, neostigmine and other drugs, as well as patients with limited infusion, should use it with caution.
2. Used for intravenous drip 1% 2% solution to maintain anesthesia, and 400mg of succinylcholine can be added every 500ml. The rate was 0.71mg/(kg 30 min), and the plasma concentration reached a steady state in about 30 minutes. Anesthesia maintenance can be combined with analgesia and inhalation.
3. Poisoning caused by too fast dropping speed should be avoided. Under general anesthesia, the main toxic reaction is the decrease of blood pressure.
Fentanyl 1. Fentanyl drugs have a slight inhibitory effect on cardiovascular system, and it is easier to maintain circulatory stability when used in heart surgery and critically ill patients.
2. The anesthetic dose for open heart surgery is 3070μg/kg, which is given intravenously at different times according to the patient's condition. Anesthesia maintenance is supplemented by a small amount or other muscle relaxants.
3. When used in critically ill patients, reduce the dosage according to the situation.
4. Muscle relaxants and artificial respiration can be used when high-dose rapid intravenous injection causes chest wall muscle stiffness, and atropine can be used to increase the heart rate when the heart rate slows down.
5. Pay attention to respiratory management after operation and keep proper ventilation until it returns to normal. We should also be alert to delayed respiratory depression and use antagonists when necessary.
1 1 antipsychotic analgesic anesthesia 1. Antipsychotic analgesia anesthesia refers to the anesthesia in which droperidol and fentanyl are combined with other general anesthetics. The dose of droperidol is 0. 1mg/kg, and the dose of fentanyl is 0.002mg/kg. Fentanyl/kloc-0 can be added every 30 minutes.
2. Atropine should be used before operation, and atropine can be used to treat bradycardia during operation.
3. Dropped blood pressure can be caused by droperidol, and blood volume should be supplemented before medication. The injection speed should not be too fast. If extrapyramidal reaction occurs, phenothiazine or scopolamine can be used to control it.
4. When the dose during anesthesia is too large, postoperative respiratory management should be strengthened.
12 antagonist 1. Physostigmine and Quexingning are used to awaken scopolamine, phenothiazine, sodium hydroxybutyrate and diazepam. The usual dosage of the former is 12mg, and the latter is 1020mg, which is slowly injected intravenously. Use with caution in patients with digestive tract and urinary tract obstruction, obstructive pulmonary disease and myocardial ischemia.
2. Naloxone can antagonize the respiratory inhibition of narcotic analgesics. The adult dose is 0. 10.2mg, and the dose should be increased if necessary. Use with caution in patients with coronary heart disease and cardiac insufficiency.
3. Almorphine is an antagonist of narcotic analgesics, but its efficacy is weaker than that of naloxone. The first dose for adults is 10mg intravenous slow injection, and half dose can be added when the effect is not obvious. Use with caution in patients with hypertension and cardiac insufficiency. When the dosage is too large, it can also inhibit breathing and should be paid attention to.
4. An Yixing is a competitive benzodiazepine inhibitor such as diazepam and midazolam. Used for central inhibition caused by diazepam and midazolam. The first dose of 0.2mg, the effect can not reach the required level of sobriety. For each additional dose of 0.65438 0 mg, the total dose shall not exceed 65438 0 mg.
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