UMary Allen
Yintoni ekufuneka iqwalaselwe ngexesha le-anesthesia kunye nokubeka iliso, isigulane kunye nomnini banokulungiswa njani ngokufanelekileyo kwaye kufuneka kujongwe njani iingxaki?
Iikati ziyahluka kwizinja ngeendlela ezininzi, kungekuphela nje ngenxa yokuba azihambi ngolonwabo kwiofisi kagqirha ecaleni kweenkosi zazo. Kukho umahluko we-anatomical kunye ne-physiological: xa kuthelekiswa nezinja, iikati zinomthamo omncinci wemiphunga kunye nomthamo wegazi omncinci malunga nobunzima bomzimba. Umphezulu womzimba, kwelinye icala, mkhulu kakhulu xa uthelekisa, ngoko ubushushu bunokwehla ngokukhawuleza.
Ngokwezibalo, izigulane zekati ngelishwa zinomngcipheko ophezulu we-anesthesia kunezigulane zezinja. Oku kuyinyani ngakumbi kwiikati ezigulayo. Yeyiphi eyona ndlela yokujongana nale nto? Ngaba ke ngoko kunokuba singabulali izigulane zethu zekati kunye z. B. ukwenza ngaphandle kokutsalwa kwamazinyo abuhlungu? Hayi! Ngokwahlukileyo koko, kufuneka silumke yaye silumke ngokukhethekileyo yaye sinokusebenzisa obunye ubuchwepheshe kule njongo.
Vavanya izinto ezinobungozi
Ukuhlelwa kwesigulane ngasinye esine-anesthetic kwinto ebizwa ngokuba yi-ASA classification (jonga i-PDF) yinxalenye yeprotocol ye-anesthetic.
Kwiikati kukho ikakhulu ezi zinto zilandelayo zomngcipheko - oko kukuthi, ezi zigulana zinomngcipheko owongeziweyo wokufa:
- impilo enkenenkene (uhlelo lwe-ASA, izifo ezifanayo)
- ukwandisa ubudala (jonga iPDF)
- Ubunzima obugqithisileyo (ubunzima obungaphantsi/ubunzima)
- ungxamiseko oluphezulu kunye nobunzima obuphezulu bomlinganiselo owenziweyo
Izifo ezibaluleke kakhulu ezingapheliyo kwiikati ezinxulumene ne-anesthesia nazo ziqhelekileyo:
- Isifo se-thyroid (phantse rhoqo i-hyperthyroidism / i-overactive kwiikati)
- uxinzelelo lwegazi / uxinzelelo lwegazi
- Isifo sezintso (ukungaphumeleli kwezintso okungapheliyo)
Nangona kunjalo, izifo zokuphefumla (umzekelo i-asthma ye-feline), izifo zesibindi, izifo ze-neurological, izifo zegazi, ukungahambi kakuhle kwe-electrolyte, kunye nezifo ezosulelayo zidlala indima kwi-anesthesia.
Oku kulandelayo kuyasebenza ku yonke iminyaka amaqela: ukunciphisa uxinzelelo kwaye ulawulo lobushushu zibaluleke kakhulu ekunciphiseni umngcipheko.
Sizilungiselela kakuhle njani?
Qokelela ulwazi oluninzi kangangoko kunokwenzeka: Imbali yonyango ibaluleke kakhulu kwizigulane zekati. Ezi zinto zilandelayo zomngcipheko zinokubuzwa ngokufutshane ngefowuni: ubudala, ubuhlanga, izigulo ezaziwayo, amayeza, utshintsho kunxano/umdla wokutya, kunye nokuqwalaselwa okukhethekileyo. Oku akuthathi indawo yodliwano-ndlebe lwe-anamnesis okanye uviwo ngugqirha wezilwanyana ekuqeshweni kwangaphambili kunye nangomhla wokusebenza, kodwa kunceda kakhulu ngokucwangcisa. Ukongeza, abanini sele benziwe baqaphela imiba ebalulekileyo.
Uvavanyo lokuqala kunye nothethwano: Ezi ziyimfuneko kuvavanyo olululo lwemeko yempilo. Ukongeza kuvavanyo olucokisekileyo lweklinikhi, umlinganiselo woxinzelelo lwegazi kunye novavanyo lwegazi luhlala luboniswa. Ukucwangcisa ngokugqibeleleyo iyeza lokuthomalalisa iintlungu, iimviwo zokuqala (umz. phambi kokubuyiselwa kwezinyo) kufuneka zenziwe kwidinga elahlukileyo kwangaphambili. Oku kunenzuzo kumniniyo ukuba imibuzo inokuxoxwa ngoxolo. Idla ngokufuna ukucenga, kodwa ngezi ngxoxo zingentla, kunokwenzeka ukukholisa uninzi lwabanini-ndawo ukuba utyelelo lokuqala luyavakala. Imilinganiselo yokuziqhelanisa nekati emva koko iphucula amava omnini kunye nekati.
Thatha uxinzelelo kunye noxinzelelo ngokubalulekileyo: Uxinzelelo kunye nokuxhalaba kuphazamisa inkqubo ye-cardiovascular, imiphumo ye-anesthetics, kunye ne-immune system. Ukuxhalaba kunye noxinzelelo kunokubangela ukunyuka okukhulu koxinzelelo lwegazi. Oku kuthetha ukuba nesigulana esisempilweni sinokuba noxinzelelo lwegazi ngequbuliso. Injongo yethu ke ngoko kufuneka ihlale iyikati ekhululekile kangangoko kunokwenzeka. Eyona ndlela ingcono yokufezekisa oku kukwindawo ezolileyo, engenaxinzelelo kunye neendlela zokusebenza zokuphatha ikati.
Lala uze ulale kancinci
Ukuphumla kunye neenkqubo zesiqhelo nazo ziyimfuneko kwi-premedication, ukuqaliswa kwe-anesthesia, kunye nokulungiselela utyando kunye nokugcinwa kwe-anesthesia.
Ukubeka iliso kwiingcali kunciphisa umngcipheko
Ezona zibonakaliso zibalulekileyo zombini ubunzulu be-anesthesia kunye nokunyaniseka kwezigulane zethu iiparamitha ezibalulekileyo: ukuphefumla (isantya sokuphefumula kunye ne-oxygen saturation), i-cardiovascular (izinga lentliziyo, izinga lokubetha, uxinzelelo lwegazi), ukushisa kunye ne-reflexes.
Ii-reflexes ziluncedo kakhulu ekuhloleni ubunzulu be-anesthesia, ngelixa ezinye iiparameters ziyimfuneko ekubekweni kwe-anesthesia. Ukuze sikwazi ukwenza iliso lobuchwephesha, kufuneka sobabini sizazi kakuhle izixhobo zethu kwaye singenise amaxabiso aqhelekileyo aqhelekileyo: iiparamitha ekujoliswe kuzo.
Iingxaki
Iingxaki zingenzeka ngaphambi (kwangaphambili), ngexesha (i-perioperative) nasemva (i-postoperative) yokusebenza. Indlela yokujongana nale nto?
Iingxaki zangaphambili
Uxinzelelo kunye noloyiko: ngokuqhelekileyo ihlala ikhokelela kwixesha elide lokungeniswa kwaye ngaloo ndlela kwixesha elide le-anesthesia.
Ukugabha: Kufuneka sikuphephe ukugabha ngaphambi nangexesha lokuthotywa isibulali-zintlungu kunye nento ebizwa ngokuba yi-esophageal reflux (ijusi yesisu ingena kummizo kwaye itshise inwebu ye-mucous) ngexesha nasemva kwe-anesthetic.
Iinkcukacha malunga namaxesha okuzila ukutya afanelekileyo kwiikati zisanqongophala. Ubude bexesha lokuzila kuxhomekeke kakhulu kuqhaqho okanye unyango kunye nempilo yesigulane. Iiyure ezilishumi elinesibini nangaphezulu kufuneka ziqwalaselwe ngokungqongqo xa kuvavanywa igazi elithile kunye noqhaqho kwiphecana lesisu. Kweminye imilinganiselo, amaxesha amafutshane (iiyure ezi-3-4 emva kokukhanya, ukutya okumanzi) kunokwanela. Uvavanyo lomntu ngamnye kufuneka lwenziwe apha. Kwimeko yezilwanyana ezincinci okanye ezinesifo sikashukela, ulawulo lokuzila ukutya kufuneka luxoxwe kunye neqela.
Iingxaki zePerioperative
1. Ukuhluthwa kweoksijini
- Jonga ukubetha kwentliziyo, ngenye indlela ukubetha kwentliziyo okanye isignali yeDoppler
- ukuba ayifumaneki: ukuvuselela i-cardiopulmonary
- khupha umoya ngesandla ukujonga ukuhamba komoya (iindlela zomoya ezivalekileyo, ukumila komfinya, ukukrazuka/ukukrazuka, …?) – ukuba kuyabonakala, lungisa unobangela
- Jonga unikezelo lweoksijini kwisigulana (ukukhangela ukuvuza)
- Jonga isihlalo soluvo
2. Ukuhla kobushushu (hypothermia)
- Ukwandisa ubushushu begumbi, qinisekisa ukunikezelwa kobushushu obusebenzayo kunye nokuthe ngqo ukusuka ekuqaleni, kunye nemilinganiselo eyongezelelweyo yokungenzi (ingubo, iisokisi)
- Gcina isigulane somile, somile
- Unikezelo lwesisombululo se-infusion efudumeleyo
- I-Hypothermia inokukhokelela kwi-hyperthermia ngexesha lokuvuka, ngoko qhubeka ujonga ubushushu emva kokuba buqhelekile!
3. Isantya sentliziyo sehla kakhulu:
- Khangela iyeza (i-narcosis/premedication), ingaba yimpembelelo yecala?
- Jonga uxinzelelo lwegazi - ukuba luphantsi kakhulu, ukumiliselwa / amayeza ukuba kuyimfuneko (ngokubonisana)
- I-ECG - ukuba iyahluka, amayeza anokuba yimfuneko (ngokubonisana)
- Khangela ubunzulu be-anesthesia - ukunciphisa ukuba kuyimfuneko
- Jonga iqondo lobushushu – lishushu
4. Uxinzelelo lwegazi luyehla (hypotension)
- Jonga ubunzulu be-anesthesia, ukuba kunokwenzeka ukunciphisa i-anesthetic (ukunciphisa igesi xa uphefumla, uchasene ngokuyinxenye xa utofa)
- Vumelana nogqirha wotyando ukuba ngaba i-infusion okanye iyeza liyimfuneko ukuzinzisa inkqubo yokujikeleza.
5. Izinga lentliziyo linyuka kakhulu: HR> 180 bpm (tachycardia)
- Jonga ubunzulu be-anesthesia
- Qwalasela ukulingana kombhobho okanye ukufikelela kwi-venous
- hypoxemia.
- uxinzelelo lwegazi oluphantsi
- hypovolemia/umothuko
- hyperthermia
6. Ukunyuka kobushushu bomzimba (hyperthermia)
- Ukususwa kwayo yonke imithombo yobushushu
- ngokukhutheleyo ukupholisa ngeetawuli ezimanzi, abalandeli, njl.
- mhlawumbi ihlaziywe ukuthomalalisa
Iingxaki zasemva kotyando
1. Ukuvuka ixesha elide/ukulibaziseka ukuvuka
- Ngaba i-15-30 imizuzu idlulile emva kokuchacha?
- Ngaba ubushushu buqhelekile okanye bunokuncitshiswa? (jonga ngasentla)
- Ngaba onke amayeza aye asetyenziswa
Uchasiwe? (jonga i-anesthesia protocol) - ukuphefumla
2. Uvukelo olugqithisileyo (dysphoria)
- Ngaba ikati iyasabela kwaye iyalawuleka?
- Ngaba ikati isezintlungwini?
- Ngaba kukho i-hypoxia? (Yintoni i-oxygen saturation?)
- Ngawaphi amayeza asetyenzisiweyo, kwaye yeyiphi imiphumo engalindelekanga elindelekileyo?
Vuka ngobunono
Izigulana zethu zekati kufuneka zihlaliswe kwindawo ezolileyo, emnyama kunye nethuba lokuhlehla ngexesha lesigaba sokubuyisela kunye nokubeka iliso ngakumbi. Kufuneka baqhubeke nokubekw'esweni apho, ubuncinci de onke amaxabiso alinganisiweyo aqheleke, ubuncinci iiyure ezintathu ukuya kwezine.
Ukufumana amanqaku rhoqo ngeentlungu nako kubaluleke kakhulu. Oku kufuneka kwenziwe rhoqo ngemizuzu engama-30 kwaye emva koko, ukuba kuyimfuneko, ukulungiswa kwesalathisi seentlungu.
Cinga ikati enobuhlobo
Imilinganiselo yendlela yokwenza ikati iphucule ukuthotyelwa komnini wekati. Oku kubonakala ngokukodwa kwinto yokuba ikati kunye nomninimzi abagxininisekanga kakhulu ngenxa yokuba abahlobo abanemilenze emine baziva bengasongelwa kangako kwaye abahlobo abanemilenze emibini baziva bethathwa nzulu. Uphando lwabanini lubonise ukuba babona kakuhle xa iikati zabo ziziva zikhululekile kwaye zikhululekile ekusebenzeni. Oku kwenza ukuba umnini azimisele ukuzisa ikati ukuze ihlolwe rhoqo kwaye rhoqo.
Ijongeka njani loo nto xa usenza?
Utyelelo lonke lwe-vet kufuneka lube lufutshane kwaye lungabi noxinzelelo kangangoko kunokwenzeka. Oku sele kuqala ekhaya. Umniniyo ufumana amacebiso axabisekileyo othutho olungenalo uxinezeleko kwangaphambili (ngomnxeba okanye kwidinga elilungiselelwe kwangaphambili), eqala ngokungena ebhokisini, kuquka uqeqesho lwamanqindi ukuba kuyimfuneko, de ufike kuqheliselo.
Ukuqeshwa kucwangciswe ngendlela yokuba akukho xesha lokulinda izigulane kwaye umsebenzi uzolile. Ngokwenza, ikati iziswa ngokuthe ngqo kwindawo ezolileyo. Iipheromones ezikhethekileyo (ikati ejongene ne-pheromone F3 iqhezu), iindawo zokupaka eziphakanyisiweyo, zibe mnyama ngokuvala ibhokisi yezothutho, okanye ukukhanya okukhanyayo kunokunceda. Ukongeza, umsebenzi ufanele wenziwe ngokuzolileyo, ngomonde, kwaye ngaphandle kobundlobongela ngamaxesha onke. Umniniyo naye uzisa iingubo ezinqabileyo ezizisa ivumba lesiqhelo kwindawo engaqhelekanga. Ukufumana ukutya kunokuphucula ukwamkelwa kokutya emva kwe-anesthesia kunye nokunceda ukuvuselela i-gastrointestinal tract.
Iiparamitha ekujoliswe kuzo kwi-anesthesia - yintoni eqhelekileyo?
- Ukuphefumla: 8-20 ukuphefumla / ngomzuzu
Bala ngokwe-adspectorally - okt impefumlo ebonakalayo - kwaye usoloko uyivavanya kunye nokugcwala kweoksijini (musa ukubeka isandla sakho esifubeni sakho, oku kwenza ukuphefumla kube nzima!).
- Ukugcwala kweoksijini: 100%
Kwimeko yokuphefumula ngokuzenzekelayo, ukuguquguquka okukhulu kwinqanaba le-90-100% kufuneka kunyanyezelwe. Ukubeka iliso nge-pulse oximeter okanye i-capnograph yeyona nto ingcono (qiniseka ukuba kukho indawo encinci yokufa!).
- Isantya sokubetha kunye nomgangatho: unamandla, rhoqo
Oku kufuneka kuhlolwe ngeminwe okanye nge-Doppler signal.
- Uxinzelelo lwegazi (systolic)> 90 mmHG kunye
Isixhobo sokulinganisa i-Doppler sifanelekile, njengoko silinganisa ngokuchanekileyo kwaye i-pulse frequency kunye nomgangatho nazo zinokuvavanywa.
- Ubushushu (uluhlu oluqhelekileyo): 38-39 °C; kwizilwanyana ezincinci ukuya kuma-39.5 °C
Umlinganiselo wenziwa nge-thermometer ye-rectal okanye iprobe yeqondo lokushisa.
Umbuzo obuzwa rhoqo
Iyingozi kangakanani i-anesthesia kwiikati?
Iingxaki ezinzulu ziziphumo: ukufa ngenxa yokuphefumula okanye i-pneumonia ingenzeka. Ngoko ke qiniseka ukuba isilwanyana sakho asikufumani ukutya kwiiyure ezili-12-15 phambi koqhaqho ukuze ugcine lo mngcipheko usezantsi kangangoko.
Iikati kufuneka zingaseli ixesha elingakanani ngaphambi kokuba zithotywe i-anesthetized?
Isilwanyana sakho kufuneka sizila ukutya ngosuku lwe-anesthesia. Kwimeko engcono, bekungamelanga ukuba itye nantoni na kwiiyure ezilishumi elinesibini phambi kotyando. Unokumnika amanzi ukuya kuthi ga kwiiyure ezimbini ngaphambi kwe-anesthesia.
Kutheni ikati ayikwazi ukutya emva kwe-anesthesia?
Ngethuba nje i-anesthetic isasebenza, kukho umngcipheko wokuba ikati iya kugabha emva kokutya. Nangona kunjalo, kukho imisebenzi emva koko ikati ayivumelekanga ukuba itye nantoni na ixesha elide. Ke ngoko, hlala ubuza ugqirha wakho xa ecebisa ukutya kokuqala.
Kutheni iikati phantsi kwe-anesthesia zivule amehlo?
Amehlo ahlala evulekile ngexesha le-anesthesia. Ukuthintela i-cornea ukuba yome, i-artificial tear fluid ngendlela ye-gel ecacileyo ibekwe emehlweni. Ngenxa yoko, i-cornea inokuvela i-mottled kwaye iikristale ezimhlophe ngamanye amaxesha zenziwe kwimida yeenkophe.
Yiyiphi i-anesthesia efanelekileyo kwiikati?
Kwiikati, umzekelo, oogqirha bezilwanyana bahlala bekhetha i-anesthesia ye-injection kunye ne-ketamine kunye ne-xylazine yokuthenwa. La machiza atofwa kwizihlunu. Emva kwemizuzu embalwa, ikati iye yalala kwaye ikwimeko apho inokuhlinzwa khona.
Ixesha elingakanani ikati ayinakutsiba emva kokuba i-neutering?
Emva kokuphela koqhaqho, ufumana inaliti yokuvusa kwaye angabuyela ekhaya kwakamsinyane. Ikati yakho akufunekanga ivunyelwe ukuba iphume phandle kwiiyure ezingama-24 ezizayo ukuze iziphumo zasemva kweyeza lokuthomalalisa iintlungu ziphele.
Ikhutshelwa njani ikati?
Emva kokuba ikati iphantsi kwe-anesthesia, i-vet icheba iinwele kwi-scrotum yesilwanyana kwaye ikhuphe iintsholongwane kwindawo leyo. Emva koko ugqirha wezilwanyana wenza amanxeba amabini amancinci esikhumbeni kwaye abophe kwiinqanawa kunye ne-vas deferens. Ekugqibeleni, ususa amasende.
Ngaba iikati zibambelela ngakumbi emva kokuqhawula?
Utshintsho emva kokunyathela kwiikati
Bahlala benamathele ngakumbi, badlala ngakumbi, abanamagqabantshintshi okanye banobundlobongela, kwaye abalahleki kude nekhaya. Ngendlela, ukuthenwa akunampembelelo ekubambeni iimpuku. Ukuba ikati yakho iyenzile le nto ngaphambili, uya kuyenza emva koko.