
samathulithamaaya anastheshya

1926ll joonn lundy nirddeshicha shasthrakriyaykkide sasthrakriya cheiyunna rogikalkkulla oru anastheshya reethiyaanu balanced anastheshya. samathulithamaaya anaesthesiayude uddeshyam rogikale general anastheshyayaakkaan oru marunnu maathram upayogikkunnathinekkaal apakadakaramallennu mathramalla, anastheshya ejantukal undaakkunna prathikoola paarshwafalangal kuraykkukayum cheyyuka ennathaanu. vedana laghookarikkaanum peshikale visramikkaanum svayambharana prathiphalana adichamarthaanum rogikale sahaayikkunnathin rando athiladhikamo marunnukaloo saankethikavidyakalo prayogikkuka ennathaanu samatulita anaesthesiayude ashayam. mattoru vidhathil paranjaal, ithu sthirathayulla supradhana lakshanagal nilanirthunnathinulla oru anastheshya reethiyaanu. anaesthesiayude eee reethi upayogikkaan anastheshyakkaaran theerumaanikkumbol niravadhi gadakangal undaakunnu. eee gadakangalil rogikalude pradhana avayava pravartthanangal, pothuvaaya avastha, nashtaparihara sheshi enniva ulppedunnu, ennaal avayil maathram parimithappedunnilla. sasthrakriya vijaykaravum surakshithavum kaaryakshamavumakkaan sahayikkunna mathiyaya tharangalum uchithamaaya alavilulla ejantukalum krithyamaaya anastheshya reethiyum anastheshya vidagthan upayogikkendathundu.
samathulithamaaya anaesthesiayude pharmacokinetic thathwangal.
oru marunnu moolamundaakunna falangalaanu pharmacodynamicsinte bhagangal. ennirunnaalum, marunninte vitharanam, clearance, tissue, raktham allengil plaasmayile marunninte saandrata enniva pharmacokinetic savisheshathakalude pradhana bhagangalaanu. santhulithamaaya anaesthetic saankethikavidyakalude bhagamaaya anaesthetic kuthivayppu marunnu upayogichu, oru edavittulla doses poleyo orotta kuthivayppaayo nirmmikkam. eee samayat (sii. aarr. aii) sthiramaaya nirakk infusion nilanirtthanam. munkootty kaanavunna pharmacodynamic efakttukalum plasmayude munkootty kaanavunna saandrathayum nirddishta marunninte sii. aarr. aii. kku nalkaan kazhiyum. asthiramaaya anaesthetic nalkaan kazhiyunna neeravi krithyamaaya upakaranam upayogichu end-tidil sthiratha nilanirthunnathil ithinu saamyamund.
administration nirakk clearance nirakkinekkaal kooduthalaayirikkumbol, marunnu oru krii aayi vitharanam cheiyunnathiloode sthiramaaya oru samsthaana saandrata kaivarikkanaakum. koodaathe, marunnu shareerathil poornnamaayum santhulithaavasthayil vitharanam cheythittundenkil, athine sthiramaaya avasthayile vitharanathinte alavu ennu vilikkunnu. sii. aarr. aii. kku sesham loading doses nalkiyittundenkil, athinte kaalayalav saandrata sthiramaaya avasthayil nilanirtthum, ithu nirddishta marunninte 3 samaya sthiraangangal allengil 5 avasana ardhaayussin thulyamaanu. marunnu neekkam cheyyaanum vitharanam cheyyaanum vendi bolas dosinu kaaryakshamamayum falapradamaayum marunninte alavu niraykkaan kazhiyum. oru prompter sameepanathil sthirathayulla avastha kaivarikkunnathinum ithu prolsaahippikkum.
oru sii. aarr. aii. nalkunnathinu rund pradhana reethikalundu, avaa infusion nirakk lakshyamidukayum infusion nirakk sthiramaakkukayum cheiyunnu.
infusion nirakk sthiramaayi nilanirthunnathu thaarathamyena lalithamaanu, sariyaaya vitharanathinte adisthaanathilaanu sthiramaaya-avasthayude saandrata nedunnathennu karuthappedunnu. athesamayam, tissuekkalude poorithaavasthayum infusion nirakkum kaaranam, ithu clearance amithamakkaanum pratheekshichathinekkaal kooduthal plasmayude saandrata nedaanum saadhyathayund. athinaal, eee reethikk, samayam kadannupokumbol sii. aarr. aii krameekarikkendathu aavasyamaanu.
nirddishta nirakk sthiraangangale adisthaanamaakkiyaanu itharathilulla infusion nirakk maattunnath. eee nirakk sthiraangangal tissuekkalude pooritha avasthayude adisthaanathil compartmentukalile vaidyashaasthrathinte chalanangale niyanthrikkunnu, ithu munkaala pharmacokinetic padanangalil patana janasamkhya theerumaanikkunnu. nirddishta pharmacokinetic sthiraangangalekkurichu computer prograam syrinch pump ulkkollunna taargett niyantritha infusion systethekkurichum dhaaraalam arivu ariyendathinaal, klinikkal saahacharyangalil taargett infusionukal sajjeekarikkunnath valare budhimuttaanu. athinaal, infusion nirakk sthiramaakkunnathu infusion nirakk lakshyamidunnathinekkaal kooduthal vyaapakamaayi prayogikkunnu.
samathulithamaaya anaesthetic shasthrakriyaykkide mikkappozhum anaesthetic ejantukal upayogikkunnu.
santhulithamaaya saankethikavidyakalkkaayi upayogikkunna single anaesthetics upayogikkunnathinte alavu nilkkunna mayakkathinu upayogikkunna alavumaayi saamyamund. ennirunnaalum, tiwayk (motham intravinus anastheshya) upayogikkunna dosukale thaarathamyam cheyyuka, ithu ellaayppozhum orotta anastheshya upayogikkunnathinekkaal kuravaanu. anaesthesiayude dosukalkku oru mattamundaakum, athu anaesthesiayude aavashyamaaya samayam, asthirathaykkulla anaesthesiayude aavasyakathakal, anastheshya kuthivayppinte prathekshikkunna vedana, anaesthesiayude vividha marunnukal upayogicha anubhavam enniva mattu gadakangale ozhivaakkunnu.
american associationil ninnulla anastheshya kuthivayppu upayogikkunnathinekkur ettavum puthiya avalokanam anusarichu, 20 minitt dairkhyamulla oru hraswakaala anastheshyaykku, ettavum shupaarsha cheiyunna induction reethi mayakka marunnayi upayogikkunna sailasin upayogikkuka ennathaanu. koodaathe, sailasinu sesham diasepam, kettaamain enniva shupaarsha cheiyunnu. deerghakaalathekku 30 minittiladikam dairkhyamulla anastheshya, shasthrakriyayil vyaapakamaayi upayogikkunna ettavum saadhaaranamaaya anastheshya, gwyphenessin, kettaamain, sailasin allengil isofluorain ennivayude samyojanamaanu.
shasthrakriyaykkide yathaakramam sailasin, kettaamain ennee 2 saadhaarana anaesthetic ejantukalude pharmacokinetics inipparayunna reethiyil vivarikkum
sailan.
hraswakaala shasthrakriyaykk upayogikkunna ettavum vyapakamaaya anaesthetic ejantaanu sailasin.
pharmacokinetics
sailaasininte pharmacokineticsine anastheshya swaadheenichekkaam, kaaranam oru intravinus therapic sesham ekadesham 1 milligram/kilogram, sailaasininte ardhaayuss 118 minittayi vardhikkukayum clearance 6 millie/kilogram/minittayi kurayukayum cheyyum. sameepakaala padanatthinte adisthaanathil, 0.01 allengil 0.20 milligram/kilogram enna morphin kuthivachaal, ore samayam sirayil terminal ardhaayuss 150 minittayi vardhippikkaan kazhiyum, koodaathe clearance baadikkilla.
kettaamain.
deerghakaala shasthrakriyaykk upayogikkunna ettavum vyapakamaaya anaesthetic ejantaanu kettaamain.
pharmacokinetics
ekadesham 2.2 milligram/kilogram enna intravinus therapic sesham, 1 milligram/kilogram sailasinumaayi kalarthi sailaasininte ardhaayuss ekadesham 66 minittum rogikal halothaine-anastheshya cheyyumbol clearance ekadesham 31 millie/kilogram/minittumaan. sailasin, kettaamain enniva maathram kaikaaryam cheiyukayaanenkil, terminal ardhaayuss 42 minittum athinte clearance 27 millie/kilogram/minittum aayirikkum. kettaamaininte sii. aarr. aii oru manikkoor 2.4 milligram/kilogram/manikkoor enna nilayil sthiratha kaivarikkumbol, terminal ardhaayuss 46 minittum clearance 32 millie/kilogram/minittum aayirikkum.
samathulithamaaya anaesthesiayude gunangal.
general anastheshyayumaayi thaarathamyappeduthumbol, samathulithamaaya anastheshyaykku vividha gunangalundu. oru paridhivare, samathulithamaaya anastheshya prayogikkunnathu saadhaarana anastheshyayekkaal valare vilakuranjathaanu. randaamathaayi, ithu marananirakkum sambhavangalum kuraykkum. koodaathe, mrugadoktarmaarkku ithu kooduthal sthirathayulla pravartthana saahacharyangal vaagdaanam cheiyunnu.
samathulithamaaya anastheshya sasthrakriya moolam rogikalkku undaakunna apakadasaadhyatha kuraykkuka mathramalla, rogiyude surakshyum sukhavum vardhippikkukayum cheyyum. santhulithamaaya anaesthesiayude 3 pradhana gunangal rogikale shaantharaakkuka, rogikal anubavikkunna vedana kuraykkuka, anaesthetic ejantukal upayogichu prathikoola phalangal kuraykkuka ennivayaanu.
meditomedine, diasepam allengil midasolam, aspromassin thudangiya marunnukal upayogichu santhulithamaaya anastheshya rogikalkku shaantatha nalkum ennathaanu aadya nettam. shasthrakriyaykk munbu rogikale shaantharaakkendath valare pradhaanamaan, kaaranam ithu prasnangal pariharikkunnathinulla budhimuttukal kuraykkukayum rogikalude sammarddam kuraykkukayum cheyyum. namukkellavarkkum ariyaavunnathupole, sammarddam pravachanatheethamaaya niravadhi prathyaaghaathangalkku kaaranamakum, rogikal takipniya, hypertension, tachycardia ennivayaayirikkaam. iva anastheshya nalkia rogikalkku doshakaramaanu. koodaathe, uthkandayum sammarddavum nosiseptive vedanaykku kaaranamaayekkam. athinaal, samathulithamaaya anastheshya upayogikkunnathu rogikale prolsaahippikkum, ithu shasthrakriya kooduthal vijayakaramakkum.
randaamathe nettam samathulithamaaya anastheshya upayogikkunnathu prathikoola phalangal kuraykkum ennathaanu. ellah marunnukalum rogikale prathikoolamaayi baadhichekkaam. eee marunnukal valare surakshithavum upayogapradavumaanenkilum anaesthesiayude chila gurutharamaaya prathikoola phalangal inhalent anastheshya moolamaanu undaakunnath. samathulithamaaya anaesthetic ejantumaarude yadhaartha alavu upayogichu prathikoola phalangal oru paridhivare kuraykkaan kazhiyum.
samathulithamaaya anaesthesiayude moonnaamathe nettam rogikal anubavikkunna vedana kuraykkaan ithinu kazhiyum ennathaanu. vedana murivu unangunnath vaikippikkukayum vishapp kuraykkukayum maranathilekku polum nayikkukayum cheiyumennu amgeekarikkappettirikkunnu. sariyaaya alavil vedanasamhaarikal upayogikkunnathu inhalent anaesthesiayude alavu kuraykkukayum vedana kuraykkaan rogikale sahayikkukayum cheyyum.
samathulithamaaya anastheshya upayogikkunnathu shasthrakriyaykkum rogikalkkum oru vilayiruthal nadathendathundu. anuyojyamaaya tharatthilulla anaesthetic ejantukalum alavum thiranjedukkunnathaanu oru shasthrakriyaykkulla ettavum nalla reethi.
poochakalkkum naaykkalkkum samathulithamaaya anaesthetic saankethikavidyakal.
vyakthikalkkayi upayogikkunna samathulithamaaya anaesthesiayude saankethikavidyakal mithavum vijayakaramaayi vikasippicheduthathumaan. athesamayam, aadhunika saankethikavidyayudeyum samoohathinteyum purogathiyiloode, poochakalilum naaykkalilum upayogikkunna santhulithamaaya anaesthetic saankethikavidyakal kooduthal vyaapakamaayi prayogikkappettittundu, athaayath poochayudeyum naaykkaludeyum pravartthana samayat santhulithamaaya anaesthetic saankethikavidyakal upayogichu vyakthamaaya phalam kaivarichu.
vettinari shasthrakriyayil poochakalkkum naaykkalkkum general anastheshya nalkenda aavasyamilla. niravadhi humanities kaaranangalal, poochakaludeyum naaykkaludeyum general anaesthesiayude ettavum saadhaaranamaaya reethi inhalent anastheshya ejantukalaanu, kaaranam ithu kaikaaryam cheyyaan eluppamaanu, koodaathe anaesthesiayude aazham pravachikkaan kazhiyum. koodaathe, apratheekshithamaya enthengilum sahacharyam pettennundaayittundil anaesthesiayude aazham mattaanum krithyasamayathu veendedukkaanum kazhiyum. inhaleshan anastheshya abodhaavasthaykku kaaranamaakumenkilum, eee avasthayil, poochakalum naaykkalum doshakaramaaya uthejanam oorkkukayo thirichariyukayo cheyyilla, anaesthesiayude aazhathilulla aazham sasthrakriya kaalayalavil sambhavichekkaavunna doshakaramaaya uthejanathodulla prathiphalana prathikaranatthinte vaividhyathe thadayukayo thadayukayo cheyyum. eee prathiphalana prathikaranangal thadayunnathinu inhalent anaesthetic ejantumaarude saandrata vardhippikkendathundu, ithu cheruppakkaaraaya rogikalil gurutharamaaya hridaya, shwaasakosha vishaadathinu polum kaaranamakum. uyarnna alavil inhyaalant anaesthetic ejantukal gurutharamaaya systemic rogamulla rogikale vishaadarogikalaayi maattukayum rogaavasthayum marananirakkum vardhippikkukayum cheyyum. samathulithamaaya anaesthetic saankethikavidyakalumaayi thaarathamyappeduthumbol, inhalent anaesthetic ejantukaludeyum mattu marunnukaludeyum kuranja saandrata shasthrakriyaykkide upayogikkunnu, ithu doshakaramaaya uthejanathe maattum. mattoru vidhathil paranjaal, poochakalkkum naaykkalkkum samathulithamaaya anaesthetic saankethikavidyakal upayogikkunnathu rogaavasthayum marananirakkum phalapradamaayi kuraykkum. athinaal, eee saahacharyathil, poochakalkkum naaykkalkkum samathulithamaaya anastheshya saankethikavidyakal upayogikkunnathu general anastheshya upayogikkunnathinekkaal shasthrakriyaykk apakadasaadhyatha kuravaanu. teaching ashupathriyil ninnulla oru report anusarichu, samathulithamaaya anastheshya upayogikkunna poochakalkkum naaykkalkkum sankeernathakal anubhavappedumennum maranam thaarathamyena kuravaanennum, athaayath yathaakramam 1/9 umm 1/233 umm aanennum ithu kaanikkunnu.

