In recent years, expanded indications for surgical intervention
cancer patients who have tumors located in the head and
neck. Typically, such patients are marked metabolic instability,
limited reserves of circulatory and respiratory systems, especially after the course
radiotherapy and chemotherapy. Significantly increased the proportion of transactions with
using microsurgical techniques. Prolonged and traumatic remain
bone-reconstasctive surgery in the head with intracranial access
to the orbits (hypertelorism).
All this limits the ability to perform such surgical procedures
requiring a high professional level of anesthesia service monitoring.
increase the scale of operations contributed to the widespread introduction of the dental
practice of modern anesthesia, the basic design of which were "borrowed"
of general surgical anesthesia. At the same time when the operational
interventions in cranio-facial region have specific requirements for anesthetic
software. Analgesia in these patients is still one of the most
difficult for the anesthetic team, despitemorethan a century
its existence: October 16, 1846, the opening day of ether anesthesia, were
performed surgery for a vascular tumor of the submandibular and ankylosis
temporomandibular joint. Technical difficulties encountered
surgeons and anesthesiologists in the past, as a legacy left followed
generations of professionals who use general anesthesia in patients with pathology
maxillofacial region. Anatomo-topographic features of the maxillofacial
predetermined the development of special methods of anesthesia and contributed
search and development activities not only protect the patient from the surgical
aggression, but also allows the surgeon to extend the indications for operations and produce
them in amoreconducive environment. Difficulties encountered are due to
features of the execution of surgical interventions in the area of the skull bones, osteotomies
orbits of the skull, osteotomy of the upper jaw and mouth.
main anesthetic concerns should be considered: tracheal intubation
in cases where limited mouth opening, and it is not possible
perform classical laryngoscopy for introducing the tube into the trachea; summing
inhalation anesthetics to the upper airway and ensure effective
protect airway from aspiration, creating free from various devices,
adapters, tubing and connectors, the operative field in the maxillofacial region.
Practically unavoidable obstacle to the maintenance of adequate gas exchange
and the free flow of air through the upper airway of the patient during
awakening and in the postoperative period after extubation of the trachea. Urgent
task is to ensure the optimal level of anesthesia during surgery
"Metabolic care", ie timely and optimal correction of possible
metabolic changes during and after surgery. No less important is
maintenance of optimal parameters of the circulatory system and gas exchange at all
stages of anesthesia. The value of intraoperative blood loss largely determines the course
anesthesia and postoperative period, particularly in diseases such as neurofibromatosis
(Recklinghausen disease) and angiomatosis.
Stages of anesthesia.
Before anesthesia, all patients received premedication with the task - ensuring
sedative and potentiating effects. Scheme sedation should be individualized
and in general, differ little from the principles of sedation obscheanesteziologicheskih
in any field of medicine. Causes of sudden emotional stress of patients,
and often the trauma are anxiety before surgery, fear of pain,
possible effects of surgery, etc. This is reflected in the activities of all systems
body and explains the excitation of the central nervous system, reinforced
activity of the endocrine glands with the release into the bloodstream of large amounts of adrenergic
substances, the stimulation of different parts of the autonomic nervous system. Pronounced
emotional reaction contributes to depletion of compensatory mechanisms and poor
the course of anesthesia. To achieve sedation can be used barbiturates
(Luminal, Nembutal), nebarbiturovye hypnotics (noksiron) neyroplegiki (Promethazine)
neuroleptics (droperidol), sedatives (seduksen, elenium). With large
caution should be used for sedation of opiates (morphine, promedol)
causing depression of respiration and circulation.
In preparation for anesthesia should consider the use of dasgs,
inhibit unwanted reflexive reactions, in particular holinolitikov (atropine).
Due to the fact that atropine yields expressed vagolytic effect, it is
an important component of premedication. The anesthesiologist uses the ability of atropine
weaken the vagal response of the heart, prevent the development of bradycardia and asystole
sinus origin in the introductory phase of anesthesia. Valuable quality of atropine
is its bronchodilatory effect, used to weaken
and to prevent bronchospasm in tracheal intub? Oz as a primary anesthetic agent often
often used Halothane, metoksifloran, broadcast, dasgs NFA. In the maintenance period
anesthesia should be pasdent management of the components of anesthesia. Application farmaologicheski
multidirectional funds (an analgesic provides analgesia, dasg - a dream
during surgery, muscle relaxants - Muscle relaxation and control
gas exchange) provides a combined general anesthesia.
In the past two decades to maintain anesthesia in patients with diseases
maxillo-facial region often used neyroleptanalgezii. Under certain
reconstasctive operations on the soft tissues of the face, relatively short
and low-impact, desirability of maintaining spontaneous breathing. Today
time for maintenance of anesthesia is widely used galvanonarcosis.
assess the adequacy of anesthesia based on the results of analysis: the frequency
heart rate, blood pressure, blood gases, acid-base
state, EEG, EKG. One of the new techniques to assess the adequacy of anesthesia is
Variation pulsometry - a method of mathematical analysis of cardiac rhythm. With this
to spend as determining the concentration of adrenaline and noradrenaline. Criteria
assessing the adequacy of anesthesia consider data obtained from the integral rheography
and multichannel electrothermometry.
final stage of general anesthesia.
holding of this phase is planned before the end of the operation. By this time
Anesthesiologist restores the patient - the main indicators of homeostasis: gas exchange,
respiration, circulation, blood volume (CBV). In patients with postoperative
displacement of tissues in the maxillofacial region is not always possible to achieve adequate
breathing immediately after surgery. In these cases, extubation perform
in the intensive care ward after 6-8 hours, while promoting prolonged
mechanical ventilation.
After termination of anesthesia can be vomiting, regurgitation (passive
leaking of gastric contents into the trachea), and laryngo-bronchospasm. During this period,
anesthesiologist should be close to patients as long as the final
to stabilize the state and the patient will not be transferred to an intensive
therapy.