Konsènan kote anestezi lokal yo

Anestezi lokal komen gen ladan anestezi aktualite, anestezi enfiltrasyon lokal, blòk rejyonal, ak blòk kondiksyon nè. Lèt la ka divize an blòk kòf nè, blòk epidural ak anestezi epinyè. Anestezi lokal nan venn se yon lòt fòm anestezi lokal 1.

1. Anestezi aktualite

(1) Defini eta san doulè ki pwodui lè w kontakte anestezi lokal la ak gwo efè osmotik ak mukoza lokal la pou bloke tèminezon nè yo supèrfisyèl nan mukoza a, ki rele anestezi aktualite. Anestezi lokal yo itilize nan anestezi aktualite yo difisil pou rive jwenn reseptè doulè anba epitelyal la, epi yo ka sèlman soulaje malèz ki te koze pa mukoza a. Li ka itilize pou anestezi sifas korn, kavite nen, gòj, trachea ak bronchi.

(2) Precautions ① Before applying the cotton pad impregnated with local anesthetic on the mucosal surface, squeeze out the excess liquid medicine to prevent the toxic reaction from being absorbed too much. Padding should be performed under a headlamp or laryngoscope to facilitate proper placement 2. ②The rate of absorption of local anesthetics by the mucosa of different parts is different. Generally speaking, the application of high concentrations and large doses of local anesthetics on large mucosal areas is prone to toxic reactions, and severe cases can be fatal. The absorption rate of local anesthetics from the mucosa is equal to that of intravenous injection, especially in the tracheal and bronchial spray method. The local anesthetics are absorbed the fastest, so the dose should be strictly controlled. Resuscitation kits and medicines. ③ Before topical anesthesia, atropine must be injected to dry the mucous membranes and avoid saliva or secretions that hinder the contact between local anesthetics and mucous membranes. ④The local anesthetic ointment applied to the outer wall of the tracheal tube is preferably water-soluble. It should be noted that the onset time of anesthesia should be at least 1 minute. Therefore, it cannot be expected that the tracheal tube can be prevented from choking once it is inserted. Spray topical anesthesia of the mucous membranes of the pharynx, larynx and trachea.

2. anestezi enfiltrasyon lokal yo

(1) Defini piki an kouch anestezi lokal sou liy ensizyon chirijikal la pou bloke tèminezon nè yo nan tisi a, ki rele anestezi enfiltrasyon lokal yo. Pran yon zegwi piki intradermal, bizote zegwi a tou pre po a, epi apre w fin antre nan po a, enjekte likid anestezi lokal la pou fòme yon blan zoranj -tankou yon ti mòn, epi pèse nan po a. epi enjekte dwòg la an kouch. Yo ta dwe mete zegwi a pike soti nan sit la ki te enfiltre dènye fwa a diminye doulè nan twou. Piki likid anestezi lokal yo ta dwe presyon pou fòme yon enfiltrasyon tansyon nan tisi a epi fè kontak anpil ak tèminezon nè yo pou amelyore efè anestezi a.

(2) Precautions ① The injection of local anesthetic should penetrate deep into the underlying tissue and infiltrate layer by layer. The nerve endings are most distributed in the membranous surface, subsarcolemma, and periosteum, and thick nerves often pass through. The amount of local anesthetic solution should be increased. The concentration can be increased if necessary. There are few nociceptive nerve endings in muscle fibers, and only a small amount of local anesthetic can produce a certain muscle relaxation effect. ② The puncture needle should be inserted slowly. When changing the direction of the puncture needle, the needle should be withdrawn to the subcutaneous surface first to avoid bending or breaking of the needle shaft. ③Aspirate before each injection to prevent the local anesthetic liquid from being injected into the blood vessel. After the injection of the local anesthetic liquid, it is necessary to wait for 4 to 5 minutes so that the effect of the local anesthetic is perfect. ④ Do not exceed the maximum amount of each injection to prevent local anesthetic toxicity. ⑤ It is not advisable to use local infiltration anesthesia for the site of infection and cancer.

3. Blòk rejyonal

Nan zòn chirijikal la, yo enjekte anestezi lokal alantou ak nan pati anba a pou bloke kòf nè yo ak tèminezon nè k ap antre nan zòn chirijikal la. Yo rele sa yon anestezi blòk rejyonal. Piki antoure ka fèt lè w antoure tisi ki resekte a, oswa alantou baz li. Pwen fonksyònman blòk rejyonal la se menm jan ak metòd enfiltrasyon lokal la. Avantaj prensipal la se ke li evite twou nan tisi patolojik, li apwopriye pou operasyon minè pou pasyan ekstèn, epi li apwopriye tou pou pasyan ki frajil oswa granmoun aje ki gen move kondisyon fizik.

4. anestezi lokal nan venn

(1) Defini tourniquet la sou pwent proximal manm nan, epi enjekte anestezi lokal nan venn soti nan pwent distal la pou bloke branch anba tourniquet la. Metòd anestezi a rele anestezi lokal nan venn. Li apwopriye pou operasyon distal manm kote yo ka mete yon tourniquet san danje. Akòz limit tourniquet la, tan operasyon an se jeneralman nan 1 a 2 èdtan. Metòd sa a pa ta dwe itilize si li konbine avèk maladi vaskilè ischemik grav manm. Se ekstremite ki pi ba a sitou itilize pou operasyon pye ak ti towo bèf. Yo itilize yon tourniquet ti towo bèf, ki ta dwe mete anba kou fibular la pou evite konpresyon nè peroneal supèrfisyèl la.

(2) Precautions The main complication of intravenous local anesthesia is the toxic reaction caused by a large amount of local anesthetics entering the systemic circulation after loosening the tourniquet or air leakage. Therefore, attention should be paid to: ① Carefully check the tourniquet and inflatable device before operation, and calibrate the pressure gauge; ② When inflating, the pressure should reach at least 100mmHg of the systolic pressure on the side, and monitor the pressure gauge closely; ③ Do not relax within 20 minutes after injection Tourniquet, it is best to take intermittent deflation method when placing tourniquet, and observe the patient's state of mind.

5. Nè ak blòk plèks

(1) Blòk plèks kòl matris Yo ka itilize blòk plèks kòl matris sipèfisyèl pou operasyon supraklavikilè kou sipèfisyèl, pandan y ap operasyon gwo twou san fon kou, tankou operasyon tiwoyid, endarterectomy carotid, elatriye, toujou mande pou blòk plèks kòl matris fon. Sepandan, paske kou a toujou innervated pa kat dènye pè yo nan nè kranyal, efè a nan blòk plèksus matris pou kont li se pa pafè, ak dwòg adjuvant yo ka itilize soulaje doulè.

(2) Blòk plèks brachial gen ladan blòk plèks brachial transsèvikal, blòk groove entèmiskilè, blòk plèks brachial supraklavikilè, blòk plèks brachial subklavi, ak blòk plèks brachial axillary. metòd apwòch. Efè blòk senk apwòch brachial plexus yo varye akòz anatomi chak pati, ak inervasyon chak pati nan ekstremite siperyè a diferan tou. Se poutèt sa, yo ta dwe chwazi apwòch blokaj ki pi apwopriye dapre innervation nan sit la chirijikal.

(3) Blòk nè nan ekstremite siperyè Blòk nè nan ekstremite siperyè sitou apwopriye pou operasyon avanbra oswa men, epi li ka itilize tou kòm yon remèd pou blòk plexus brachial enkonplè. Sitou enkli blòk nè medyàn, blòk nè ulnè ak blòk nè radial, ki ka bloke nan koud la oswa ponyèt. Si operasyon dwèt yo fèt, blòk nè entèdijital posib tou.

(4) Blòk nè nan ekstremite ki pi ba Tout anestezi ekstremite ki pi ba yo bezwen bloke plexus lonbèr ak plexus sakral an menm tan. Akòz bezwen pou plizyè piki ak operasyon enkonvenyan, li pa lajman itilize nan pratik klinik. Sepandan, blòk plexus lonbosakral yo ka itilize lè sit ki mande anestezi limite oswa lè anestezi neuraxial kontr. Anplis de sa, blòk plexus lonbosakral ka itilize tou kòm yon adjwen anestezi jeneral pou analgesi apre operasyon.

Although lumbar plexus block combined with intercostal nerve block can be used for lower abdominal surgery, it is rarely used clinically. Combined iliohypogastric nerve and ilioinguinal nerve block is a simple and practical method of anesthesia, which can be used for surgery in the area innervated by the iliohypogastric nerve and the ilioinguinal nerve. Hip surgery requires blocking of all lumbar nerves except the iliohypogastric and ilioinguinal nerves. The easiest way to do this is to block the lumbar plexus (lumbar plexus block in the psoas space). Thigh surgery requires anesthesia of the lateral femoral cutaneous nerve, femoral nerve, obturator nerve and sciatic nerve, and a lumbar plexus block in the psoas major space combined with sciatic nerve block can be performed. The lateral femoral cutaneous nerve and the femoral nerve can be combined or blocked separately for the anterior thigh surgery, and the "three-in-one" method can also be used. The lateral femoral cutaneous nerve block alone can be used for skin graft anesthesia, and the simple femoral nerve block is suitable for Postoperative pain relief for femoral shaft fractures, quadriceps plasty or ilium fracture repair. A combined lateral femoral cutaneous and femoral nerve block combined with a sciatic nerve block usually prevents tourniquet pain because the obturator nerve innervates very little skin. Open knee surgery requires block of the lateral femoral cutaneous nerve, femoral nerve, obturator nerve, and sciatic nerve. Combined femoral nerve and sciatic nerve block can also meet the surgical requirements. Distal knee surgery requires blocking of the saphenous nerve branches of the sciatic and femoral nerves, and ankle blocks can be used for foot surgery.

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