Mary Allen
Chii chinofanira kutariswa panguva yeanesthesia uye yekutarisa, murwere nemuridzi vangave vakagadzirira sei uye sei matambudziko anofanirwa kugadziriswa nawo?
Makati anosiyana nembwa munzira dzakawanda, kwete chete nekuti haapinde nemufaro muhofisi yechiremba pedyo nevatenzi vadzo. Kune mimwe misiyano yeanatomical uye physiological: zvichienzaniswa nembwa, katsi dzine vhoriyamu diki yemapapu uye vhoriyamu diki yeropa nezvehuremu hwemuviri. Muviri wepamusoro, kune rumwe rutivi, wakakura mukuenzanisa, saka tembiricha inogona kudonha nekukurumidza.
Zvikamu, varwere vekati zvinosuruvarisa kuti vane ngozi yakawanda yeanesthesia kupfuura varwere vembwa. Izvi ndezvechokwadi kunyanya kune katsi dzinorwara. Ndeipi nzira yakanaka yekutarisana neizvi? Saka isu tinofanira here kuregedza varwere vedu vekati uye z. B. kuita pasina kubviswa kwemazino anorwadza? Aihwa! Mukupesana, isu tinofanirwa kushandisa kungwarira uye kungwara uye tinogona zvakare kushandisa imwe tekinoroji kuita izvi.
Ongorora zvinhu zvine ngozi
Kurongeka kwemurwere wega wega weanesthetic mune inonzi ASA classification (ona PDF) chikamu chechero anesthetic protocol.
Kune katsi pane zvakanyanya zvinotevera zvinokonzeresa njodzi - ndiko kuti, varwere ava vane njodzi yakawedzera yekufa:
- hutano husina kunaka (ASA classification, comorbidities)
- kuwedzera zera (ona PDF)
- Huremu hwakanyanya (underweight / overweight)
- kukurumidza kukuru uye chiyero chepamusoro chekuoma kwechiyero chakaitwa
Zvirwere zvinonyanya kukosha zvisingaperi mumakati zvine chokuita neanesthesia zvakare zvinowanzoitika:
- Chirwere chetachiona (chinenge nguva dzose hyperthyroidism / overactive mumakati)
- hypertension / yakakwira BP
- Chirwere cheitsvo (chronic renal failure)
Nekudaro, zvirwere zvekufema (semuenzaniso feline asthma), hosha dzechiropa, chirwere chetsinga, hosha dzeropa, kusagadzikana kweelectrolyte, uye zvirwere zvinotapukira zvinotorawo basa muanesthesia.
Zvinotevera zvinoshanda kune zera rose mapoka: kudzikisira kunetseka uye kudzora kwekushisa zvakakosha zvakanyanya pakuderedza njodzi.
Tinonyatsogadzirira sei?
Unganidza ruzivo rwakawanda sezvinobvira: Nhoroondo yezvokurapa inonyanya kukosha kune varwere vekati. Zvinotevera zvinokonzeresa njodzi zvinogona kubvunzwa muchidimbu parunhare: zera, rudzi, zvirwere zvinozivikanwa, mushonga, shanduko munyota/chido, uye zvakacherechedzwa. Izvi hazvitsivi kubvunzurudzwa kweanamnesis kana kuongororwa nachiremba wemhuka pakugadzwa kwekutanga uye pazuva rekuvhiya, asi zvinobatsira zvakanyanya pakuronga. Mukuwedzera, varidzi vakatoziviswa nezvezvinhu zvakakosha.
Kuongorora kwekutanga uye kubvunzana: Izvi zvakakosha pakuongorora kwakakwana kwemamiriro ehutano. Mukuwedzera kune kunyatsoongororwa kwekliniki, kuyerwa kweropa uye kuongorora ropa kunowanzoratidzwa. ITooptimally inoronga mushonga wekutindivadza, bvunzo dzekutanga (semuenzaniso kudzoreredzwa kwezino) kunofanira kuitika pane imwe nguva yakatarwa pachine nguva. Izvi zvine zvakanakira muridzi kuti mibvunzo inogona kukurukurwa murunyararo. Zvinowanzoda kumwe kunyengetedza, asi nenharo dziri pamusoro, zvinokwanisika kugonesa ruzhinji rwevaridzi kuti kushanya kwekutanga kune musoro. Iwo zviyero zvekatsi-inoshamwaridzika kudzidzira zvakare inovandudza ruzivo rwemuridzi uye katsi.
Tora kushushikana uye kusagadzikana zvakanyanya: Kushungurudzika uye kuzvidya mwoyo zvinokanganisa hurongwa hwemwoyo, migumisiro yeanesthetics, uye immune system. Kuzvidya mwoyo uye kushungurudzika zvinogona kukonzera kuwedzera kukuru kweropa. Izvi zvinoreva kuti kunyange murwere ane hutano anogona kuerekana ave neBP. Naizvozvo chinangwa chedu chinofanira kugara chiri katsi yakasununguka sezvinobvira. Nzira yakanakisa yekuzadzisa izvi iri munzvimbo yakadzikama, isina kunetseka uye nemaitiro ekushanda ekubata kwekatsi.
Rara wombokotsira zvinyoro nyoro
Kuzorora uye maitiro echinyakare akakoshawo pakugadzirira, induction of anesthesia, uye kugadzirira kuvhiya pamwe nekuchengetedza kweanesthesia.
Kuongorora kwehunyanzvi kunodzikisa njodzi
Izvo zvinonyanya kukosha zviratidzo zvezvose zvakadzika zveanesthesia uye kuvimbika kwevarwere vedu ndizvo zvakakosha parameters: kufema (kufema kwekufema uye kuzara kweokisijeni), mwoyo yemwoyo (chiyero chemwoyo, kuputika kwemhepo, BP), tembiricha uye mafungiro.
Reflexes inonyanya kubatsira pakuongorora kudzika kweanesthesia, nepo mamwe maparameter akakosha pakutariswa kweanesthesia. Kuti tikwanise kuita hunyanzvi hwekutarisisa, isu tese tinofanira kuziva zviridzwa zvedu zvakanaka uye takaisa mukati meyakajairika hunhu: izvo zvinodaidzwa. chinangwa parameters.
Matambudziko
Matambudziko anogona kuitika pamberi (preoperative), panguva (perioperative) uye mushure (postoperative) kuvhiya. Ndoita sei neizvi?
Preoperative Matambudziko
Kushushikana uye kutya: kazhinji nguva dzose inotungamirira kune nguva yakareba yekupinza uye nokudaro kune nguva yakareba yeanesthesia.
Kurutsa: Tinofanira kudzivisa kurutsa tisati kana panguva yokutindivadza pamwe chete neanonzi esophageal reflux (muto wegurokuro unopinda mugurokuro wopisa mucous membrane) panguva uye mushure meanesthetic.
Dhata pamusoro penguva yekutsanya yakakwana yekatsi ichiri kushaikwa. Hurefu hwenguva yekutsanya hunoenderana zvakanyanya nekuvhiyiwa kana kurapwa uye hutano hwemurwere. Maawa gumi nemaviri uye anopfuura anofanirwa kunyatsocherechedzwa kune kumwe kuongororwa ropa uyezve pakuvhiya pagumbo remudumbu. Kune mamwe matanho, nguva shoma (3-4 maawa mushure mekudya kwechiedza, nyoro) inogona kukwana. Kuongororwa kwakanyanya kwemunhu kunofanirwa kuitwa pano. Panyaya yemhuka diki kana chirwere cheshuga, manejimendi yekutsanya inofanira kukurukurwa neboka.
Perioperative Matambudziko
1. Oxygen saturation
- Tarisa pulse, neimwe nzira kurova kwemoyo kana Doppler chiratidzo
- kana isiripo: cardiopulmonary resuscitation
- pinza mweya nemaoko kuti utarise mafambiro emhepo (kuvharika kwemhepo, kuumbwa kwemucus, kuputika / kuputika, ...?) - kana zvichionekwa, gadzirisa chikonzero
- Tarisa kupihwa kweokisijeni kumurwere (leak cheki)
- Tarisa chigaro che sensor
2. Kudonha kwekushisa (hypothermia)
- Wedzera tembiricha yekamuri, ita shuwa inoshanda uye yakananga kupisa kupisa kubva pakutanga, uye mamwe maitiro ekuwedzera (gumbeze, masokisi)
- Chengetedza murwere akaoma, akaoma
- Kupihwa kweyakadziya infusion solution
- Hypothermia inogona kutungamira ku hyperthermia panguva yekumuka, saka ramba uchitarisa tembiricha mushure mekunge yadzikama!
3. Kurova kwemwoyo kunoderera zvakanyanya:
- Tarisa mishonga (narcosis/premedication), ingava mhedzisiro here?
- Tarisa BP - kana yakanyanya kuderera, infusion / mushonga kana zvichidikanwa (mukubvunzana)
- ECG - kana yakasiyana, mishonga inogona kudiwa (mukutaurirana)
- Tarisa kudzika kweanesthesia - kuderedza kana zvichidiwa
- Tarisa tembiricha - inodziya
4. Kuderera kweBP (hypotension)
- Tarisa kudzika kweanesthesia, kana zvichibvira deredza anesthetic (deredza gasi paunenge uchifema, pikisa zvishoma paunenge uchibaya)
- Bvumirana nachiremba wezvekuvhiya kana infusion kana mishonga inofanirwa kudzikamisa hurongwa hwekutenderera kweropa.
5. Kurova kwemwoyo kunowedzera zvakanyanya: HR> 180 bpm (tachycardia)
- Tarisa kudzika kweanesthesia
- Tarisa kukwana kwechubhu kana kupinda kwevenous
- hypoxemia.
- kuderera kweropa
- hypovolemia/kuvhunduka
- hyperthermia
6. Kukwira kwekushisa kwemuviri (hyperthermia)
- Kubviswa kwezvose zvinopisa
- kushingaira kutonhorera nematauro akanyorova, mafeni, nezvimwe.
- zvichida kuvandudzwa sedation
Postoperative Matambudziko
1. Kumuka kwenguva refu/kunonoka kumuka
- Iine 15-30 maminetsi apfuura mushure mekupora?
- Tembiricha yakajairika here kana kuti pamwe yakaderedzwa? (ona pamusoro)
- Mishonga yese yakapihwa
apikiswa? (ona anesthesia protocol) - kufema
2. Kusveta zvakanyanya (dysphoria)
- Katsi inoteerera uye inogoneka here?
- Katsi iri kurwadziwa here?
- Pane hypoxia here? (Chii chinonzi oxygen saturation?)
- Ndeapi mishonga yakashandiswa, uye ndeapi mhedzisiro inofanirwa kutarisirwa?
Muka zvinyoro nyoro
Varwere vedu vekati vanofanirwa kugariswa munzvimbo ine runyararo, ine rima ine mukana wekudzoka panguva yekudzoreredza uye kuti uwedzere kutariswa. Vanofanirwa kuramba vachitariswa ipapo, kusvika kusvika zviyero zvese zvakayerwa zvave zvakajairika, angangoita maawa matatu kusvika mana.
Nguva dzose kurwadziwa kunwisa kunokosha zvakare. Izvi zvinofanirwa kuitwa maminitsi makumi matatu ega ega uyezve, kana zvichidikanwa, kugadziriswa kwechiratidzo chemarwadzo.
Funga katsi ushamwari
Izvo zviyero zvekatsi-inoshamwaridzika tsika inovandudza kutevedzera katsi-muridzi. Izvi zvinonyanya kuoneka mukuti katsi nemuridzi havanyanyi kunetseka nekuti shamwari dzine makumbo mana dzinonzwa kushomeka uye shamwari dzine makumbo maviri dzinonzwa kutorwa zvakanyanya. Ongororo yevaridzi yakaratidza kuti vanoona zvakanaka kana katsi dzavo dzichinzwa dzakasununguka uye dzakasununguka mukuita. Izvi zvinoita kuti muridzi ade kuunza katsi kuti iongororwe kakawanda uye nguva nenguva.
Izvozvo zvinoratidzika sei mukuita?
Kushanya kwese kwevet kunofanirwa kunge kuri kupfupi uye kusagadzikana-kusununguka sezvinobvira. Izvi zvinototangira kumba. Muridzi anogamuchira mazano anokosha ekufambisa kusina kunetseka pachine nguva (nerunhare kana kuti pane imwe nguva yakatarwa), kutanga nekupinda mubhokisi, kusanganisira kudzidziswa kwebhokisi kana zvichidiwa, kusvika pakusvika pakudzidzira.
Kugadzwa kunorongwa nenzira yekuti hapana nguva yekumirira varwere uye maitiro akanyarara. Mukuita, kati inounzwa zvakananga munzvimbo yakanyarara. Special pheromones (katsi inotarisana nepheromone F3 chikamu), yakasimudzwa nzvimbo dzekupaka, kusviba nekufukidza bhokisi rekutakura, kana mwenje mudiki unogona kubatsira. Mukuwedzera, basa rinofanira kuitwa zvakadzikama, kushivirira, uye pasina mhirizhonga nguva dzose. Muridzi anounzawo magumbeze akapfavirira anounza kunhuwa kweanozivikanwa munzvimbo yaasingazivi. Kuva nechikafu kunogona kuvandudza kugamuchirwa kwechikafu mushure meanesthesia uye kubatsira kuita kuti gastrointestinal turakiti ishande.
Target parameters yeanesthesia - chii chakajairika?
- Kufema: 8-20 kufema / maminitsi
Verenga adspectorally - kureva kufema kunoonekwa - uye nguva dzose ongorora pamwe chete nekuzara kweokisijeni (usaise ruoko rwako pachipfuva chako, izvi zvinoita kuti kufema kunetse!).
- Oxygen saturation: 100%
Muchiitiko chekufema kwepamuviri, kushanduka kwakanyanya muhuwandu hwe90-100% kunofanira kuregererwa. Kuongorora ne pulse oximeter kana capnograph ndiyo yakanyanya kunaka (ita shuwa kuti pane shoma nzvimbo yakafa!).
- Pulse rate uye hutano: yakasimba, nguva dzose
Izvi zvinofanirwa kuongororwa neminwe kana kuburikidza neDoppler chiratidzo.
- Kumanikidzwa kweropa (systolic)> 90 mmHG uye
Chiyero chekuyeresa cheDoppler chakanyatsokodzera, sezvo ichiyera chaizvo uye kuwanda kwepuruzi uye mhando inogonawo kuongororwa.
- Tembiricha (yakajairika): 38-39 °C; mumhuka diki kusvika 39.5 °C
Kuyera kunoitwa nerectal thermometer kana tembiricha probe.
Inowanzobvunzwa Mubvunzo
Ko anesthesia ine ngozi sei mumakati?
Matambudziko akakomba ndiwo mhedzisiro: kufa nekudzipwa kana pneumonia inogona kuitika. Saka ita shuwa kuti mhuka yako haiwani chero chikafu 12-15 maawa isati yaitwa kuitira kuchengetedza njodzi iyi yakaderera sezvinobvira.
Inguva yakareba sei kitsi dzisingafaniri kunwa dzisati dzaitwa anesthetized?
Mhuka yako inofanira kunge ichitsanya pazuva reanesthesia. Muchiitiko chepamusoro, haifaniri kunge yadya chero chinhu maawa gumi nemaviri asati avhiyiwa. Unogona kumupa mvura kusvika maawa maviri isati yaitwa anesthesia.
Sei kati isingagoni kudya mushure meanesthesia?
Chero bedzi iyo anesthetic ichiri kushanda, pane ngozi yokuti kati inorutsa mushure mekudya. Nekudaro, kune zvakare maoparesheni mushure mekuti katsi haibvumidzwe kudya chero chinhu kwenguva yakareba. Naizvozvo, gara uchibvunza vet yako paanokurudzira kudya kwekutanga.
Sei makate ari pasi peanesthesia ane maziso akazaruka?
Maziso anoramba akavhurika panguva yeanesthesia. Kuti udzivise cornea kubva pakuoma, mvura yakasvibirira yemisodzi nenzira yegel yakajeka inoiswa mumaziso. Nekuda kweizvozvo, iyo cornea inogona kutaridzika ine mottled uye machena makristasi dzimwe nguva anoumba pamipendero yemaziso.
Ndeipi anesthesia yakanakira kitsi?
Mukati, semuenzaniso, veterinarians vanowanzosarudza jekiseni anesthesia ne ketamine uye xylazine yekukanda. Mishonga iyi inobayiwa mumamhasuru. Mushure memaminitsi mashoma, katsi yakarara uye iri munzvimbo iyo inogona kuvhiyiwa.
Inguva yakareba sei katsi isingasvetuke mushure mekucheka?
Mushure mekupera kwekuvhiyiwa, anobaiwa jekiseni rekumuka uye anogona kudzokera kumba zvakare. Katsi yako haifanirwe kubvumidzwa kubuda panze kwemaawa makumi maviri nemana anotevera kuitira kuti mhedzisiro yeanesthetic ipere.
Katsi inobviswa sei?
Kana katsi yave pasi peanesthesia, murapi wevet anoveura vhudzi pascrotum yemhuka uye anobvisa utachiona munzvimbo yacho. Ipapo chiremba wemhuka anoita zvidimbu zviviri muganda uye anosunga kubva pamidziyo uye vas deferens. Pakupedzisira, anobvisa machende.
Ko katsi dzinowedzera kunamatira mushure mekucheka here?
Kuchinja mushure mekutambisa katsi
Ivo vanogara vakabatikana zvakanyanya, vanotamba zvakanyanya, havanyanyi kuruma kana hutsinye, uye havarasi kure nekumba. Nenzira, kukanda hakuna simba pakubata mbeva. Kana katsi yako yakamboita izvi, anozozviita mushure.