Đang chuẩn bị liên kết để tải về tài liệu:
How to Survive in Anaesthesia - Part 8

16 tuần mang thai, một dãy cảm ứng nhanh chóng và đặt nội khí quản. Thứ hai, dễ bay hơi thuốc gây mê thư giãn tử cung. Điều này làm tăng mất máu và nguy cơ thủng tử cung. Vì vậy, một số gây mê sẽ không sử dụng các đại lý dễ bay hơi. Thay vào đó, gây mê tĩnh mạch (propofol) với bổ sung bởi oxit nitơ và oxy được đưa ra. | emedicina How to Survive in Anaesthesia is 16 weeks pregnant then endotracheal intubation is unnecessary. If the patient is 16 weeks pregnant a rapid sequence induction and endotracheal intubation is recommended. Secondly volatile anaesthetic agents relax the uterus. This increases blood loss and the risk of perforation of the uterus. Therefore some anaesthetists will not use volatile agents. Instead intravenous anaesthesia propofol with supplementation by nitrous oxide and oxygen is given. Laparotomy General anaesthesia for operations on the uterus and the ovaries is similar to that described in abdominal anaesthesia Chapter 24 . Regional anaesthesia is an excellent technique for gynaecological surgery with the benefit of good postoperative analgesia. The innervation of the uterus is up to T10. If manipulation of the bowel occurs or there is haemorrhage in the paracolic gutters the patient may experience discomfort. An extension of neural blockade to T4 as for a Caesarean section is then needed to relieve pain. Hysteroscopy In this procedure clear irrigating fluid is used to expand the uterus and allow telescopic visualisation of the contents. Although the risks are usually slight acute water intoxication can occur see Box 23.4 . Conclusion You will undertake a lot of anaesthesia for gynaecological surgery in the early months of your career. Always assume that the gynaecologists have no knowledge of anything that occurs outside the pelvis preoperative assessment must be meticulous and do not underestimate their ability to cause severe blood loss. 132 emedicina 23 Anaesthesia for urological surgery Urological surgical lists provide supervised experience in anaesthetising elderly patients with medical problems. They are useful for learning basic regional techniques such as spinal anaesthesia. Transurethral resection of the prostate TURP This involves resection of the prostate by a modified cystoscope which cuts tissue and coagulates blood vessels. The procedure is .