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#46
30.05.2005, 22:30
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Так кто ж спорит? И я бы назначил наркотический анальгетик в послеоперационном периоде. Я просто не знаю правовую базу относительно "наркоты" в медучереждениях США. Если можно ему с собой в бумажку завернуть, то пожалуйста - пусть грызёт на митинге:-)
А про дроперидол я давно ещё вычитал в какой-то американской статье, что даже в дозе 1,25 мг на этапе индукции в анестезию он достоверно снижает частоту п/о тошноты и рвоты. |
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#47
30.05.2005, 23:19
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#48
31.05.2005, 03:15
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#49
31.05.2005, 06:49
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#50
31.05.2005, 06:52
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#51
31.05.2005, 06:55
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#52
31.05.2005, 06:57
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#53
31.05.2005, 12:34
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Действующее вещество: Мидазолам* (Midazolam*) р-р для в/в и в/м введ. 5 мг/мл; Roche (Швейцария). |
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#54
31.05.2005, 18:48
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Цитата:
 Нет, блок сразу необязательно. Я предложил схему "Вариант 1 или Вариант 2". Я лично более склонен к установке ларингеальной маски: это быстрее, не доставляет пациенту практически никаких неудобств (в/в индукция, после которой ему всё равно, что с ним будут делать:-)), амнезия всего периода анестезии и операции. Проводниковая анестезия плечевого сплетения требует, по-моему, большего мануального навыка, чем постановка ЛМ, время наступления блока после введения анестетика 20-40 минут и, если пациент не седатирован или недостаточно седатирован (что ещё хуже, так как начинает елозить при такой тонкой работе иглой), то, на мой взгляд, сохранение у него в памяти ощущений прохождения электрического тока по нервам верхней конечности, непроизвольные и болезненные сокращения мышц в/к делают этот вариант в целом менее приемлимым по сравнению с 1-ым. P.S. Препарат называется ОНДАНСЕТРОН. Не изголяйтесь в названии!  |
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#55
31.05.2005, 18:57
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Так опять - кто ж спорит-то? Вы абсолютно правы. Только я действительно просил разъяснить юридический аспект легального назначения наркотических анальгетиков в госпиталях США, а не голых декламаций. Право-то каждый человек имеет, только как, каким препаратом это право реализовать? Можно или нельзя пациенту назначить наркотический анальгетик амбулаторно? Вот и всё, что я хотел уточнить. Papadoctor ответил. |
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#56
31.05.2005, 22:16
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Опиоиды не всегда обязательно. (Но артроскопия вроде бы достаточно болезненна... Сам не видел.) А "жертву фармакологических войн" жалко, приписали ни за что тяжелые аритмии...  Действительно эффективный и при соблюдении ряда условий безопасный антиэметик. У нас тоже пропал недавно.Говорят, дексаметазон неплохо помогает. Ондансетрон - дороговато, но это для нас. |
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#57
01.06.2005, 04:49
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#58
01.06.2005, 06:46
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For Outpatient Rotator Cuff Surgery, Nerve Block Anesthesia Provides Superior Same-day Recovery over General Anesthesia. Anesthesiology. 102(5):1001-1007, May 2005. Hadzic, Admir M.D., Ph.D. *; Williams, Brian A. M.D., M.B.A. +; Karaca, Pelin Emine M.D. ++; Hobeika, Paul M.D. [S]; Unis, George M.D. [S]; Dermksian, Jeffrey M.D. *; Yufa, Marina M.D. #; Thys, Daniel M. M.D. * *; Santos, Alan C. M.D., M.P.H. * * Abstract: Background: Both general and nerve block anesthesia are effective for shoulder surgery. For outpatient surgery, it is important to determine which technique provides more efficient recovery. The authors' goal was to compare nerve block with general anesthesia with respect to recovery profile and patient satisfaction after rotator cuff surgery. Methods: In this clinical trial, 50 consenting outpatients (aged 18-70 yr) were randomly assigned to receive either fast-track general anesthesia followed by bupivacaine (0.25%) wound infiltration or interscalene brachial plexus block (0.75% ropivacaine), each under standardized protocols. Blinded recovery room nurses assessed the need for pain treatment and rated patient eligibility for bypass of the phase 1 postanesthesia care unit and for discharge home. Patients were followed up for 2 weeks postoperatively. The primary outcome measures were postanesthesia care unit bypass and same-day discharge. Other same-day recovery outcomes included severity of and treatment for pain and time to ambulation. Postoperative outcomes at home included satisfaction with the anesthesia technique and absence of complications (at 2 weeks). Results: Patients who received nerve block (vs. general anesthesia) bypassed the postanesthesia care unit more frequently (76 vs. 16%; P < 0.001), reported less pain, ambulated earlier, were ready for home discharge sooner (123 vs. 286 min; P < 0.001), had no unplanned hospital admissions (vs. 4 of 25 patients who underwent general anesthesia; P = 0.05), and were more satisfied with their care. No complications were reported in either treatment group. Conclusions: Nerve block anesthesia for outpatient rotator cuff surgery provides several same-day recovery advantages over general anesthesia. (C) 2005 American Society of Anesthesiologists, Inc |
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#59
01.06.2005, 06:48
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#60
01.06.2005, 06:54
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Effect of Low-dose Droperidol on the QT Interval during and after General Anesthesia: A Placebo-controlled Study. Anesthesiology. 102(6):1101-1105, June 2005. White, Paul F. Ph.D., M.D. *; Song, Dajun M.D., Ph.D. +; Abrao, Joao M.D., Ph.D. ++; Klein, Kevin W. M.D. [S]; Navarette, Bryan M.S. [//] Abstract: Background: Since the effects of antiemetic doses of droperidol on the QT interval have not been previously studied, the authors designed a randomized, double-blind, placebo-controlled study to evaluate the intraoperative and postoperative effects of small-dose droperidol (0.625 and 1.25 mg intravenous) on the QT interval when used for antiemetic prophylaxis during general anesthesia. Methods: One hundred twenty outpatients undergoing otolaryngologic procedures with a standardized general anesthetic technique were enrolled in this study. After anesthetic induction and before the surgical incision, 60 patients were given either saline or 0.625 or 1.25 mg intravenous droperidol in a total volume of 2 ml. A standard electrocardiographic lead II was recorded immediately before and every minute after the injection of the study medication during a 10-min observation period. The QTc (QT interval corrected for heart rate) was evaluated from the recorded electrocardiographic strips. In 60 additional patients, a 12-lead electrocardiogram was obtained before and at specific intervals up to 2 h after surgery to assess the effects of droperidol and general anesthesia on the QTc. Any abnormal heartbeats or arrhythmias during the operation or the subsequent 2-h monitoring interval were also noted. Results: Intravenous droperidol, 0.625 and 1.25 mg, prolonged the QT interval by an average of 15 +/- 40 and 22 +/- 41 ms, respectively, at 3-6 min after administration during general anesthesia, but these changes did not differ significantly from that seen with saline (12 +/- 35 ms) (all values mean +/- SD). There were no statistically significant differences among the three study groups in the number of patients with greater than 10% prolongation in QTc (vs. baseline). Although general anesthesia was associated with a 14- to 16-ms prolongation of the QTc interval in the early postoperative period, there was no evidence of droperidol-induced QTc prolongation after surgery. Finally, there were no ectopic heartbeats observed on any of the electrocardiographic rhythm strips or 12-lead recordings during the perioperative period. Conclusion: Use of a small dose of droperidol (0.625-1.25 mg intravenous) for antiemetic prophylaxis during general anesthesia was not associated with a statistically significant increase in the QTc interval compared with saline. More importantly, there was no evidence of any droperidol-induced QTc prolongation immediately after surgery. (C) 2005 American Society of Anesthesiologists, Inc |
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