Endotracheal anesthesia. What is it, photos, video, reviews

Endotracheal anesthesia - type of anesthesia, is widespread throughout the world. Thanks to him the opportunity to perform complex surgical procedures on organs of the chest.

This anesthesia has its advantages and disadvantages. It is therefore important before surgery to learn basic information about the preparations for anesthesia, consult a general practitioner and undergo the necessary tests to rule out the possible consequences.

What is endotracheal anesthesia

Endotracheal anesthesia - it is the most common type of pain management, achieved through introducing into the human body volatile liquids or gases via an endotracheal drug Nature tube.

Inhaled anesthetics fall from the respiratory tract into the bloodstream. Further, their uniform dispersion is carried out in human bodies and deducing by diffusion laws.

The effectiveness of analgesics, duration of anesthesia and the rate of return to wakefulness depends on many factors:

• partial pressure;
• ventilation lung volume;
• diffusion capacity of the lungs;
• alveolovenoznoy pressure difference of a single component of the gas mixture;
• penetration of the blood cells in tissues and organs;
• blood volume in the lungs;
• human circulatory system.

The medicines acting as anesthetic endotracheal anesthesia must meet certain requirements.

These include the presence of:

• reserve, which is the source of oxygen;
• alarm, warning of reduction in pressure of oxygen;
• lock, which helps stop the delivery of nitric oxide in reducing the oxygen pressure;
• antiseptics;
• possibility of parsing the breathing circuit;
• the safe use of medical equipment for patients and physicians.

Modern techniques for endotracheal anesthesia consists of the following components:

• system having a high pressure (it supplies to major nodes apparatus compressed medical gases);
• Dosimeters that provide gradual dosing of oxygen and nitrous oxide;
• evaporators volatile drugs (required for aggregate formation anesthetic gas and oxygen);
• breathing circuit, which guarantees delivery to the patient and the removal from it of narcotics (Composed of recirculation valves adsorber, connection elements and special hoses breathing);
• devices for mechanical ventilation;
• measuring and control devices;
• laryngoscope;
• endotracheal tube.

Advantages and disadvantages

Endotracheal anesthesia - it is a serious and responsible action. Before surgery it is important to familiarize yourself with all its pluses and minuses.

Benefits	disadvantages
Increased controllability (easily possible to vary the depth of anesthesia, increasing the duration of maintenance of anesthesia as well as facilitate immediate patient awakening)	The dosage of painkillers made inaccurate (often with the help of old equipment)
It is possible to combine analgesics with mechanical ventilation process	Frequent air pollution operation unit pairs anesthetic drugs with different modes of operation for anesthesia equipment (other than the closed loop)
Excellent compatibility of drugs needed for general anesthesia	To obtain the desired result requires a complex medical apparatus, which is expensive
The total muscle relaxation (facilitates the process of continuous operations on the abdominal organs and chest)	The procedure requires implementation of a strict sanitary treatment (if improperly conducting it contributes to the spread of pathogenic microorganisms inside a hospital)
Separation of the respiratory and digestive systems is performed by means of an endotracheal tube (it provides prevention of aspiration of stomach contents)	When cleaning of accumulated tracheal fluid may cause damage to the mucosa of the oropharynx, tongue, hard and soft palate, teeth and damage to the vocal chords
There is always a possibility of the purification of the accumulated liquid from the trachea through an endotracheal tube	Improper positioning of an endotracheal tube often causes intubation right bronchus and esophagus
It uses a small number of drugs	After the surgery is disrupted airway and rekurarizatsiya

How is the step by step

The sequence of endotracheal anesthesia:

1. Immersion in anesthesia - is carried out by introducing analgesics required to obtain the deep sleep without anesthetic the exciting step; They use modern barbiturates, Fenton and Promedolum in combination with sombrevinom. After the introduction of the drug used for muscle relaxants, performed endotracheal intubation, the patient then translates mechanical ventilation for prevention of the normal gas exchange during surgery intervention.
2. Maintenance of anesthesia - period, is carried out throughout the entire operation. The main aim is to achieve the necessary components of anesthesia and environment for an experienced professional. Produced protecting the human body from the operational risks. Anesthesia is maintained at 1 x-surgery levels. Its main stage is reached with a mixture of nitric oxide and oxygen at a ratio of 2: 1, halothane, cyclopropane. To reduce muscle tone, commonly used muscle relaxants. The main condition endotracheal anesthesia - assisted ventilation of the lungs. Small portions introduced neuroleptics - droperidol and fentanyl 1-2 ml for 10-25 min. The anesthesiologist must wisely manage the components of anesthesia and the body's ability.

   

3. Awakening - the restoration of the former functions of the human organism begins at the moment when the anesthetist stops administering drugs. General anesthesia ends well before stopping infestation. First, experts removed the components of anesthesia, which are no longer needed. Further imposed last stitches. Patient is sent to the recovery room, continue to monitor its health.

The specifics of the children

Endotracheal anesthesia in children - this is a more complicated process. The most important difference between adults and children is the amount of oxygen consumed, which is among minors almost 2 times more. In children, increased secretion of mucus in the airways. Also, experts noted the presence of the narrow nasal passages, and more languages.

Due to the fact that the larynx is too high, and the epiglottis has a greater volume when tracheal intubation is advisable to use a straight blade, which will help raise the epiglottis.

Great importance is played size endotracheal tube, since the mucous membranes in children is very gentle, and large diameter instrument can affect the development of postintubatsionnogo edema with obstruction of the trachea after extubation.

To carry out operations on babies 10-11 years must use the phone without a flap with a small leak gazotoka around with ventilation - is mandatory. It is important to know that the water-salt balance in juvenile different variability. This is due to the everyday changes in body weight, the structure of cells and tissues.

The kidneys are underdeveloped, so the children do not tolerate water stress and quickly eliminate electrolytes. It is important to maintain the infusion when dealing with low blood loss. The process depends on the child's body weight: 4 ml / kg + 10 kg 2 ml / kg 10 kg. Next, 1 ml / kg for each kg above 20 kg. Supportive therapy helps replace fluid, which is necessary to the child.

After surgery, it is recommended to drink plenty of pure water to replenish fluid deficit themselves. In the hot operating box kids can overheat if their body before infestation temperature was increased. Hyperthermia often develops as a result of administration of atropine. The dosage of narcotic drugs in children is also different.

In most anesthetists the following principles:

• Neonatal - 1/10 of the adult dose;
• 1 to 6 months. - 1/5 dose;
• 7 - 12 months. - 1/4 of the dose;
• from 1 year to 3 years - 1/3 of the dose of an adult;
• from 4 to 7 years old - 1/2 dose;
• from 8 to 12 years - 2/3 of the adult dose.

Indications and contraindications

Indications for endotracheal (intubation) anesthesia are:

• carrying out surgical operations on the organs of the thorax, accompanied by accumulation of the operating gas or air in the pleural cavity;
• poor conductivity respiratory system channels;
• irritable bowel syndrome;
• the risk of aspiration of gastric contents into the respiratory tract;
• risk of rapid movement of liquids or gases in a direction opposite to the normal;
• operations on the abdominal organs;
• difficulty breathing because of a certain posture on the table;
• likely to use during the operational process of muscle relaxants and mechanical ventilation with intermittent positive pressure;
• Surgical intervention is carried out on the facial skeleton and head (often used in cosmetology centers for plastic surgery);
• nasal and ocular infestation;
• thyroid medication, upper ear, sinusitis (in this case provides endotracheal anesthesia obstruction of blood and other biological fluids in the respiratory tract);
• operations aimed at the treatment of intracranial diseases;
• dental treatment;
• lengthy processes that require the presence of microsurgical medical equipment;
• tendency to laryngospasm;
• frequent crashes in the CNS.

But there are situations where this method of anesthesia is contraindicated.

These include:

• chronic respiratory diseases;
• inflammation of the bronchi;
• acute respiratory viral infections;
• hemorrhagic gemostaziopatii;
• pneumonia;
• Malignant tumors of the oral cavity (there is risk of the spread of cancer cells throughout the body, so these people spend endotracheal anesthesia is possible only through a tracheostomy);
• with cardiovascular system problems;
• cachexia;
• anemia;
• old age;
• pregnancy;
• severe liver and kidney (anesthesia and cause additional toxicity pervert reaction anesthetics on the patient, and their decay products).

Consequences and complications

Endotracheal anesthesia - is an event during which rarely have side effects, adverse effects and other complications. Most often they are associated with serious conditions or patients with medical errors. Each step of this anesthetic is potentially dangerous in relation to complications.

During water anesthesia and intubation may occur:

• impossibility of introducing the endotracheal tube into the trachea to ensure airway conductance due to technical reasons;
• asphyxia regurgitation of gastric contents into the respiratory system;
• heavy pneumonia;
• damage to the hypopharynx, and a continuation of the larynx - trachea;
• incorrect fold endotracheal tube;
• sudden Limiting the available space in the airways, resulting in a failure of the ventilator;
• Light gap;
• inadequate oxygenation of the patient.

When anesthesia is maintained anesthetists may occur:

• violation of the heart (up until it stops and further death);
• left ventricular failure;
• anoxia;
• violation conductivity gas mixture;
• hemodynamic disorders (blood pressure);
• great loss of blood;
• overdose of narcotic medicines;
• painful shock (occurs when doctors violated by the use of narcotic drugs instructions);
• premature extraction of the endotracheal tube in combination with a sufficient monitoring of the patient (often causes suffocation).

It is important to remember that during surgery the patient requires close observation with the measurement of the main characteristics of his life. Only timely action can save a person from complications. Fortunately, they are very rare!

Most drugs

Endotracheal anesthesia - a well-known type of anesthesia.

For modern inhaled anesthetics include:

1. sevoflurane - a new generation of painkillers. It has a pleasant smell. It causes rapid shutdown of consciousness due to the fact that is poorly soluble in the blood. Often causes muscle relaxation. Under certain conditions, it exhibits nephrotoxicity. The cost of about 10 500 rubles. per 250 ml liquid;
2. desflurane - a drug similar to Isoflurane. It requires special evaporators. Poorly soluble in the blood, so anesthesia comes quickly. It used in bariatric surgery. Price about 12 400 rubles. per 240 ml;
3. isoflurane - means like Halothane. It has a sharp smell ether. It is not recommended to use it for handling patients with coronary artery disease. Effect on reducing the metabolic needs of the brain. It can be used for tserebroprotektsii in neurosurgery. The price of the drug ranges from 5,600 to 6,700 rubles. per 250 ml;
4. Halothane (Halothane) - a well-known drug, which includes a halogen. It has a narrow therapeutic effect. Great for children with obstruction and decreased minute ventilation. Has a pleasant smell, it does not contribute to respiratory irritation. It is very toxic agent. After surgery, it may be liver dysfunction and its other pathology. Estimated cost - 400 rubles. 50 ml of liquid;
5. Enflurane (ETRAN) - medication that quickly causes general anesthesia. Can inhibit the central nervous system to work, improve myocardial sensitivity to sympathomimetics and relax the muscles of the skeleton. Displayed with light. Often used in obstetrics - during cesarean section. Enflurane can only be used with the help of apparatus for anesthesia with a special evaporator.

Reviews of doctors and specialists

1. Dmitry Agapov It is an anaesthesiologist. He believes that the endotracheal anesthesia little effect on the condition and operation of the internal organs, provides controlled effect. This type of anesthesia is well suited to handle young children. They breathe through a mask inhalation anesthetic mixture and fall asleep without any problems.
2. Ekaterina Smirnova - anesthetist recommending endotracheal anesthesia to disconnect the patient unconscious. He will not feel the pain, the muscles relax completely. After surgery, completely missing memories of him.
3. Experienced specialist Irina Lapshin believes that the endotracheal anesthesia - the most powerful type of anesthesia, making the sick person completely immune to external stimuli. The set of drugs used in general anesthesia, prevents the sensation of pain. They immobilize the patient for the duration of the procedure.

Endotracheal (intubation) anesthesia - a forced immersion of the sick person in a medical sleep. It is only important to the operation carefully examine the information on this form of anesthesia, consult with your doctor and to pass the necessary tests in order to prevent the development of complications.

Author: Timohina Angelina

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