التخدير العام
DESCRIPTION
General Anaesthesia AutherDr.Husni AjajTRANSCRIPT
. 1
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VAPORIZER
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3CO2+H2OH2CO 2 3+ 2 2 3+ 2
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76
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351
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Propafol " " 0891 6891 " " " " .
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" " . ) ( Cremopher el " " ( ) Anaphylactoid " " 02 ) 01 / ( 05 1 % ) 01 / ( 2 % ) 02 / ( 001 1 % .
651 02 04 " " " " " " . ) ( EEG ) ( ECT " " . . .
" " " " . ) > 04 % ( " " " " " " .
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751 " " Opiodes " " . " " ) ( " " .
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561 " " 51- 02 . :- " " " " ) (pH " " .
:- " " ) ( . 08 % 5.2 % . " " " " .
:- ~ " " ) ( " " . . ~ "
661 " . " " . ~ " " ) ( EEG " " . . .
) ( 11 - 51 .
.
01 02
761 2/ 8 01 / 5.0 52.0 / 51 03 . 2 5.2 / 3 5.3 / 5.1/ . 01 . . 2 3 .. 3 7 / 6 /. 5.2 3 /
. . .
51 42 . . " " 5 .
861 . " " .
. 0 21 1 0 8 12 0 0 01 04 0 0 8 08 51 02
5.2 % Thiopental %1 Methohexital Propofol Etomedate
961
071
, . . , , ) (curare . , ) ) curare , .
171 . 2491 ) Johnso and ( Grifth . ( 6491 ) Halton and Gray 0001 6 .
) ( acetyl choline . ))Axon )) Nerve Ending ) ( Synapatic Knob ) (Presynaptic membrane .)(Postsynaptic membrane
271 :- , .
) ) Neurotrasmitters )Nerve (cell , ) (. , )) Cholinergic ) (Choline ) (Acetylation ) -Cholin (acetyltransferase . ) (Choline estrase
:- . .
371 ) (Depolarization . , , .
:- 1- :- . 2- . 3- . 4- . 5- .
1- Depolarizing muscle Relaxants * Succiny/cholin . 2- non Depolarizing muscle : - ---------------------- *Long - acting --------d-tubocurarine -----Metacurin
471--------- Gallamine ------- Pancuronium ------- Pipecuronium ----- Doxaurium
- --------------* Intermediate - acting ------------ Atracurium ------ Cisatracurium ------------ Vecuronium ------------ Rocuronium - -------------------* Short- acting -------- Mivacurium --------- Rapacurorium
. . . . 1. 2. 3. 4.
5. . . . . 6. 7. 8.
571
:- 1- . 2- Twich Fasciculatio n . 3- . 4- . 5 - . 6- . 7- . 8- Fading . 9- ) ) Daul block .
:-1- . 2- - .x 3- . 4- . 5- . 6- .
6717- . Mysthenia gravis 8- . 9- . 01- . 11- . 21- . 31- .
:-1- 51% 04% 01 51 . 2- Homogen 0003:1 08% 02% .
:-1- . 2- . 3- . 4- . 5- . 6- . 7- . 8- . 9- .
:-
771 . . . . . 1- 5.1 / . . . . . 1. 2. 3. 4. 5. 1. 2. 3. 4. . 5. 6.
:-
) Dominant) . . )5.0( 51 . . 24 . ) (sarcoplasmic reticulum .
871 .
:-1- 57% . 2- . 3- . 4- . 5- . 6- . 7- . 8- . Tetany 9- . 01- . 11- .
:-1- . 2- . 3- 001% . 4- . 5- 03-04 0.6% .
9716- 81.0% . 7- :- - 1-2 / 5 . - 8 84 . 8- . 9- . 01- . 11- . 21- 84 . 31- : .
:. 1( ] [ .
0812( ))))Twich .
3( )))).fading
4( .))Post- Titanc ((Facilitation 5( .
6( 1-2 . 7( . . . . .
8( 9(
01( 11(
Tobocorarine 2491 3 03 06 :- 5.0 52.0 / . :- . . . .
181 . 05% 01-02% .
Pancronium :- 4691 . . 02-04 3 04% . . . . . :- 1.0-50.0 / .Pavelon
: Pipecuronium . 0891 . . . 07% 02% .
-:
281 . .
. . . . 08 . .
:-
Rocuronium bromide . . . 06-09 6.0 / . 03-04 . . . .d-tubocurarine Gallamine Pancuronium Pipecuroniu m
:-
Doxacuriu m
(ED(mg/kg
52.0-5.0 3-2
2.1 3-2
50.0 3-2
70.0 3-2
520.0 4-3
381 % % % %54 %59 %06 %66 %07
%04-01
%0
%04-01
%02
%03
/ No
/ No
%04-01 No
%02 No
/ %6
2891 . , . , . 54% . .
Atracorium
2-3 02-52 . .
:-
481 06-09 . 40% . . . :- 5.0 /.
. . . 0.1 / .
Vecuronium
.
51-03 . . 42 . .
581 . .
2-5.2 . 8% . . . 01-02 51 . . . . . .
:-
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681 ) ,, ( . ) ( .
. . :- 53 . :- 5 . 3-5 . 02-03 . 2.1 .
. 3- :-edrphonium :- 5.0-1 . edrophoniam .
Pyridostigminie
781 57% , 59% , 09% . ) ) Train of four 1-3 . .
. . . . . . . . .
881 .
981
. .
091 :- 1. . 2. . . 3. 4. . 5. . 6. . .
:- . 1.
2. .
191 3. . 4. . 5. . 6. . 7. . . 8. 9. . 01. . 11. .
:- . . . 1. 2. 3.
4. .
:-
291 :- " " . :- . / :- ) , Diuretics , Digoxin , Antibiotics , Inhibitors , Oxidase . ( Monoamine ) 1 ( ) ( Marivan , Warfrin ) ( Heparin . . . . .
391 , .
D V T
491 :- :- . 1. ) / / / 2. ( . . 3. ) / / 4. / ( . 5. . :- 6. : / . / . / . / . / .
E . 000,001:1 0053:1 004:1 00052:1 0001:1 053:1 1G 11G 111G
59153:1 61:1 64:1 42:1 G1V GV
:- . :- ) ( . .
~ . :- ~ . Murmurs , Thrill , Triple ) ( C V P ) (Odema .
.
:- . 1.
691 51 . 2. 3. ~ Valsalva test , 04 / . 01 ,. . 4. :- . . . . 5. . :- . . 6 . . . .
791 .
:-- / , )0( .
)1( . )2( . )3( . )4( . :- 1 2 . 3 4 .
- . - . - .
:- :- . .
:-
891. Hemoglobin (Hb) , (HCT) Hematocrit ) . ( Urine Analysis 1. 2. 3. .Blood Urea , Creatinine
) ( 4. ) . ( Pregnancy test ) . ( Serum glucose level 04 . 04 . 5. 6. 7.
:- / . Prothrombine time 1. 2. / Partial thromboplastine time / . bleeding time / . Platelet count 3. 4.
04 5. / . Chest X ray / . Liver function test / Tuberculin test /. Serum Electrolyte / . Lung function test / . Stress ECG 6. 7. 8. 9. 01.
11. / Echo . cardiography
:- 1- ) CBC ) Complete blood count / 41 61 % 21 51 %
991 Hb 9 % 4 11 Mchc mean corpuscular hemoglobin con cerntration 03 04 / 001 ) ( Mchc 07 : Mcv mean corpuscular valume 69 ~ ) ( . :- 72 13 7.1 1.2 . ~ : RBC Red blood cell 4.5 / 3 . 8.4 / 3 . 6 / 3 .
CBC 05 . 2- ~ . Blood urea , creatinine :- 62 / 001 003 / 001 " " 1.1 / 001 / . 3- . : Urine analysis
002 . 4- : 06 . Serum glucose level 001 / 001 . . . . 5- : : Electro Cardiography 04 04 . 6- : : Chest X Ray 04 7_ . : Prothrombin time 21 61 ) ( . 8- : : Bleeding time 1 7 ) ( . 9- -: : Platelet cunt 000.051 000.054 / 3 ) ( . 01- : : Liver function test LFT
102 LFT . ( ) Fibrinogen , Globulin , Albumin " " 5.0 2 mg / dl ( . 11- : : Serum Electrolyte :- )1( ~ 031 051 / : . 001 002 / . )2( ~ 5.3 5.5 / . )3( ~ 8 9 01 / . 5.2 5.7 / . )4( ~ 89 701 / . 001 002 .
:
202 . ) ( . . . . .Heart Failure : Congestive . : Complete Heart block
/ / . .
:- 1-
302 Syncytial Virus Endocarditis .Myocarditis 2- . 3- : - . - ) ( Dyspnea . - . - . 4- :- . . . ) (
402 Angiocardiogram Angiocardiography . Congestive Heart failure ) ( :-
1.
. . Digoxine Ischemic heart disease
2.
:-
.
502 03% 5 % 2.1% ) (Tarahan . ( ( Invasive monitoring 04% . 2002 . 4-
602
:- 011 42 . .
. . ) 011/ ( .
, . :- . . . .
702 . . . .
:- . . .
:-1. . 2. . 3. .
802 1.
. 2. . 3. . 4. . 5. .
:- - ~ .
902- ~ Obstructive ) ( Restrictive ) ( Pulmonary fibosis ) ( Alveolitis fibrosis . Kypho - Scoliasis :- - . - . - . :- Aspirin . Atenolol 3- :- . .
012 . . ( ) . 4- :- . 5- :- Chest Pain .
:- . . . . . . :- : :-
1121- . 2- . 3- . : :- :- . . .
.
:- 1. :- . .
. 2. . 3. :-
212 . Isoprenaline . Salbutamol 4. Bisolvan . :- : :- :- 1. . . 2. 3. . Surfactant 4. . 5. ) ( . . . 6. 7.
8. 52% . . : ) ( :-
312 ) ( Epidural Spinal :- Thiopentone, Tbocurarins Midazolam, Ketamine, Etiomedate, Diprivan Bronchospasm Aminophyline ,Atropine Ipratropium .
:- 01 / 001 . . ) / / ( 3.2 Diphosph Glycerate .
:- ) ( :-
412 . Prothrombine . Manitol . .
:- . ) Low sub ( arachnoid epidnral Gallmine .
:- 003 / :- . 05
512 081 % . 42 .
:- , " " Creatinine . :- : / . / . :- 1- 01 % 005 + 01 + 01 kcl / meg 4 . 2- 01 + 01 + 005 01% . 3- :- .
612 ) ( Sliding Scale . 1 2 / 01 01 005 01% . 05 05 / / 1 2 / . :- 2 4 6 8 01 0/0 051 0/0 051 002 = = 0/0 002 052 = = 0/0 052 003 = = 0/0 003 053 = = 0/0 004 054 = =
.
1- .
7122- . 3- . 4- . 5- . 6- . 7- . 8- . 9- . :- :- - . - . - . . 01- . 11- .
812
:- . 1. 2. . . 3. 4. . . 5.
:- 1- ) (Alfa Amino Butyric Acid . :- - / 01 02 5 __ 01 , 4 8 . - / 51 07 001 / 03 06 .
2- Phenothiazine
912- Promethazine ~ . - ~ Trimeprazine Tartarate 2 4 / .
3- Anticholinergic Agents :-* Atropine :- 1. 3 . . . . 2. 3. 4.
6.0 50.0 / . * ~ Hyocine Hydrobromide . 01 03 . * ~ Glycopyrolate . 2.0 4.0 ) 4 8 / (.
4 _ .
5- Anti free Redicals .
022 1. . 2. . 3. 6 . 4. . 5. ) ( . 6. . 7. . 8. . 9. .
122
222 , . . .
1- . 2- . 3- . 4- . 5- . 6- . 7-
322 . 8- . 9- . 01- .
:- 1- . 2- . 3- . 4- . 5- . 6- . 7- . 8- )) (( . 9- .
:- 1- . .
422 . 2- . 3- . 4- . 5- . 6- . 7- . 8- . 9- . 01- .
, .
522 , . . . . ) ( . ) ( " " . 2 3 04 % 06 001% .
. .
. . .
622 . . . . .
.
:- 1- - . -. 2-: . 3- : , . 4- : . 5- .
" " - - 2 5.2 / . - . - 03 09 . - . :- ) (
722 1- . 2- . 3- . 4- . 5- . 6- . 7- . 8- . 9- . 01- .
822 .
.
922 :- . .
. . . . .
032
132
. . .
232 . . .- .
. . . . . .
.
,
332 , , , . , .
432 )) - - (( ) ....( )) ((. .
:- 1- . 2- . 3- . 4- .
:-)) ((
532 , . .
: :- .
Total Intraveanous anaesthesia
632Target contorl (( )) inufusion , . :- 5 001 , 2 001 8 001 7 4 - , , .
:-1-
732 . 2- , , , , . 3- . , .
1- :- (( PRPOFOL ))DIPRIVAN
2 :- . 3- :- .
832 . . 1- 2-
3- 4-5- 6- 7- 8-
. . . . .
.
.
" - ) ( -
932 1% ) 1 1% ( . - + + . :- 1(
: 52 05 .
: 5 / 52 . 52 04 / = 8 / . 53 / = 7 / . 4 ~ 52 / = 5 / . :- 2(
: 8.0 2.1 / ) 1 2 ( . :- 57.0 5.1 / . 5.0 1 / . 3.0 5.0 / . :- 01 :- :-
" " 5 .
042 :- 1- .
2- 3-
.
. 4- . 5- .
6-
. 1-4 . .
7-
142 :- . :- . :- . :- . :- . :-
242 . :- , . . . , . : )) :-(( / / // . :- - . - . - . - . -.
342 :- - . - . - . - . - . , , .
442
. .
542 :-
1- 2- 3-
.
.
1 5.2 .
4-
.
5-
.
:- 1- 51 . 2- . 3- .
6424- .
1- simus position , . : - . - . - . -
742
2- : 54 , 42
1-: : 1 1.0 ) ( 01 :- .
842- . - . - . - . - . : - . - . - . : . .2- : 800.0 / 50.0 / 01 1 5.0 / 52.0
942/. : * 440.0 / 5-01 . . * .
1- 001% 5.2 1 ) ( . 2- : -
052. - . . 3- 42 . 4- )( . 01 .
251
252
: 1-:- 001 02 04 . . 2- :- . . .
:- 1. . 2- . 3- - :- 1- .
3522- . 3- . 4- . 5 - . 6- . 7- . 8- . 9- . 01- . - :- 1- . 2- . 3- . 4- . 5- . 6- . 7- . 8- . 9- . - 1- . 2- . * :- - - - B.P -
452
* :- 1- . 2- . 3- ) 5%- N.S . 4- 5- 6- 7- 8- 9- 01- 52% 11- 21- 31- :- , :- 1- . 2- . 3- . 4- .
552 2O 4-6 . 5- . 4 . 02 . :- 1- . 2- . 3- . 4- . :- 1- . 2-
652 . * :- 1- . 2- . 3- )( 4- . 5- ) ( 6- . 7- . 8- .
:- 1- . 2- . 3- .
7524- . . 5- . 6- . 7- .
1- -
852 ) (. :- . .
2( 02 . .
2- :-
1-
. 2- .
3- 4-
.
) (.
9525- .
6-
.
7-
. :- 1- 6 %. 2- . 3- . 4- . 5- . 6- . 7- . :-
062 ) ( .
4- :- 1- . . 2-
162 .
5- :-1- . 2- . 3- . 4- . 5- .
:- 1- . 2- . 3- . 4- . 5- . 6- .
6- :-- : :- 1- .
2622- . 3- . 4- . 5- - . - :- 1- . 2- . 3- . 4- . 5- 06 3 . 6- . 7- )) (( 8- . :- 1- . 2- . 3- . 4- .
3625- 2O . 6- . 7- . 8- . 9- .
* - :- 1- . 2- . 3- .
- )( :- :- 1- . 2- . 3- )(
462:- 1- . 2- . 3- .
- . :- 1- 2- 3- . 4- . 5- . 6- . :- 1- . 2- . 3- . 4- .
- :-
562 . :- 1- . 2- . 3- . 4- . 4- .
* . :- 1- . 2- . 3- . :- 1- . 2- .
6623. . 4. . 5. .
* :- 1- ) - - ( . 2- . 3- . :- 1- . 2- . 3- . 4- . :- .
* :-
7621- . 2- . 3- . 4- . 5- . 6- . 7- . 8- . 9- . :- 1- 2- 3- . 4- . :- 1- . 2- .
* :- 1- . 2- . 3- . 4- . :- . 1-
862 . . . 5.83 . . 2-
3-4-
:-
1-
- ) ( . - . - . - 2- :- . 3- :- . 4- :-
962
.5- : - :- . - :- 1- . 2- . - :- . - :- . - . 7- :- 4 :- 1- .
0722- . :- :- 1- : . 2- . 3- 01 . 4- 01 . 5- . 6- . 7- . 8- . 9- . 01-:- .
*
172 .
:- . 1-
2-
.
272
273
472
275