Zosankha za Anesthesia Yam'deralo mu Opaleshoni Yam'kamwa
Opaleshoni ya pakamwa ndi nthambi ya mano yomwe imaphatikizapo njira zambiri, kuyambira kuchotsa mano mpaka opaleshoni zovuta monga kuchotsa ma cysts kapena zotupa za pakamwa. Mankhwala oletsa ululu am'deralo ndi gawo lofunika kwambiri pa opaleshoni ya pakamwa, zomwe zimathandiza odwala kukhala omasuka komanso opanda ululu panthawi ya opaleshoniyi. Pali njira zosiyanasiyana zoletsa ululu zam'deralo zomwe zilipo, iliyonse ili ndi zabwino zake komanso zoyipa zake. Nkhaniyi ikambirana mitundu yosiyanasiyana ya mankhwala oletsa ululu am'deralo omwe amagwiritsidwa ntchito pa opaleshoni ya pakamwa , momwe amagwirira ntchito, zizindikiro zake, zotsutsana nazo, ndi zinthu zapadera zomwe ziyenera kuganiziridwa posankha mtundu woyenera wa mankhwala oletsa ululu.
Mitundu ya Anesthesia Yapafupi
1. Lidocaine
Lidocaine ndi imodzi mwa mankhwala oletsa ululu omwe amagwiritsidwa ntchito kwambiri pa opaleshoni ya pakamwa. Lidocaine imagwira ntchito potseka njira za sodium mu nembanemba ya maselo a mitsempha, zomwe zimaletsa zizindikiro za ululu kufika muubongo. Mankhwala oletsa ululu amenewa amayamba kugwira ntchito mwachangu, pafupifupi mphindi 2-5, ndipo amatha pafupifupi maola 1-2. Kuphatikiza apo, lidocaine nthawi zambiri amaphatikizidwa ndi epinephrine kuti awonjezere nthawi ya mankhwala oletsa ululu ndikuchepetsa kutuluka magazi panthawi ya opaleshoni. njira zochitira opaleshoni.
2. Articaine
Articaine, yomwe imadziwikanso kuti septocaine, ndi mankhwala oletsa ululu am'deralo omwe ali ndi mphamvu yayikulu yochepetsa ululu. Articaine imayamba kugwira ntchito mwachangu kwambiri, pafupifupi mphindi 1-2, ndipo imagwira ntchito kwa nthawi yayitali, kuyambira maola 1-2,5. Chimodzi mwa zabwino za articaine ndi kuthekera kwake kulowa m'mafupa bwino kuposa mankhwala ena oletsa ululu am'deralo. Izi zimapangitsa kuti articaine nthawi zambiri agwiritsidwe ntchito pochita opaleshoni yozama, monga opaleshoni ya mano anzeru.
3. Mepivacaine
Mepivacaine nthawi zambiri imagwiritsidwa ntchito kwa odwala omwe sangalandire epinephrine chifukwa cha matenda enaake, monga matenda a mtima. Mepivacaine imayamba kugwira ntchito mwachangu kwa mphindi 1-2 ndipo nthawi yopumira imatenga pafupifupi maola 1-3. Ngakhale kuti si yothandiza ngati articaine m'minofu yolimba, mepivacaine ikadali chisankho chabwino pa opaleshoni yambiri ya pakamwa.
4. Bupivacaine
Bupivacaine ndi mankhwala oletsa ululu am'deralo omwe amadziwika kuti amagwira ntchito kwa nthawi yayitali, ndipo amatha maola 4-8. Mankhwala oletsa ululu amenewa nthawi zambiri sagwiritsidwa ntchito ngati mankhwala oletsa ululu oyamba pa opaleshoni yosavuta ya pakamwa, chifukwa mankhwala oletsa ululu omwe amaperekedwa nthawi yayitali angayambitse kusasangalala pambuyo pa opaleshoni. Komabe, pa opaleshoni yomwe imafuna mankhwala oletsa ululu omwe amaperekedwa nthawi yayitali kapena odwala omwe akufuna kuchepetsa ululu pambuyo pa opaleshoni, bupivacaine ikhoza kukhala chisankho chabwino kwambiri.
5. Prilocaine
Prilocaine ili ndi mawonekedwe ofanana ndi a lidocaine koma ili ndi kuthekera kochepa kwa poizoni. Izi zimapangitsa kuti ikhale chisankho chabwino kwa odwala omwe ali pachiwopsezo chachikulu cha zotsatirapo zoyipa Mankhwala oletsa ululu am'deralo. Prilocaine imayamba kugwira ntchito kwa mphindi 2-4 ndipo imatenga pafupifupi maola 1-2.
Zizindikiro ndi Zotsutsana pa Kugwiritsa Ntchito Anesthesia Yam'deralo
Chizindikiro
Mankhwala oletsa ululu am'deralo amagwiritsidwa ntchito pa opaleshoni zosiyanasiyana za pakamwa kuti achepetse kapena athetse ululu. Zizindikiro zake ndi izi: kuchotsa dzino, kuchiza ziphuphu za mkamwa kapena zotupa, opaleshoni yoyika mano, ndi kukonzanso minofu yofewa mkamwa.
Zotsutsana
Zoletsa kugwiritsa ntchito mankhwala oletsa ululu m'deralo zimadalira mbiri ya matenda a wodwalayo komanso mtundu wa mankhwala oletsa ululu omwe wasankha. Zina mwa zotsutsana zomwe zimachitika kawirikawiri ndi izi:
– Kusamvana ndi mankhwala oletsa ululu am'deralo: Odwala omwe ali ndi mbiri ya kusamvana ndi zinthu zina zoletsa ululu, monga lidocaine kapena articaine, ayenera kupewa kugwiritsa ntchito mankhwala oletsa ululu awa.
– Matenda a m'thupi: Odwala matenda a mtima, kuthamanga kwa magazi, kapena matenda a chithokomiro ayenera kusamala akamagwiritsa ntchito mankhwala oletsa ululu okhala ndi epinephrine.
– Methemoglobinemia: Vutoli likhoza kuchitika pogwiritsa ntchito prilocaine ndi mitundu ina yambiri ya mankhwala oletsa ululu, kotero odwala omwe ali ndi mbiri ya methemoglobinemia ayenera kupewa kugwiritsa ntchito mankhwala oletsa ululu awa.
Zofunika Kuganizira Posankha Anesthesia Yapafupi
Kugwira Ntchito ndi Kuthamanga kwa Onset
Kusankha mankhwala oletsa ululu am'deralo nthawi zambiri kumadalira liwiro la kuyamba kwake ndi nthawi yomwe agwira ntchito. Mwachitsanzo, pa opaleshoni yosavuta komanso yachangu ya pakamwa, lidocaine kapena mepivacaine zingakhale zokwanira. Komabe, pa njira zovuta komanso zotalikirapo, articaine kapena bupivacaine zingakhale zoyenera kwambiri chifukwa cha nthawi yayitali ya mankhwala oletsa ululu.
Mbiri Yachitetezo
Chitetezo cha wodwala nthawi zonse chimakhala chofunika kwambiri. Kwa odwala omwe ali ndi mbiri ya ziwengo chifukwa cha mankhwala ena oletsa ululu kapena matenda omwe amakhudza kagayidwe ka mankhwala ndi kutulutsa kwake, kusankha mankhwala oletsa ululu kuyenera kuchitidwa mosamala. Mwachitsanzo, mepivacaine nthawi zambiri imalimbikitsidwa kwa odwala matenda a mtima chifukwa ilibe epinephrine.
Nthawi Yogwirira Ntchito ndi Kulamulira Ululu Pambuyo pa Opaleshoni
Pa opaleshoni ya pakamwa, nthawi yogwiritsira ntchito mankhwala oletsa ululu ndi yofunika kwambiri kuti opaleshoniyo iyende bwino popanda wodwalayo kumva ululu. Kuphatikiza apo, kuchepetsa ululu ndikofunikira. atachitidwa opaleshoni Bupivacaine ndi njira yabwino yogwiritsira ntchito pochiza ululu pambuyo pa opaleshoni.
Kupezeka ndi Chidziwitso cha Zachipatala
Kupezeka kwa mankhwala oletsa ululu m'chipatala komanso zomwe dokotalayo wakumana nazo zimakhudzanso kusankha mankhwala oletsa ululu. Mankhwala ena oletsa ululu m'chipatala sangakhalepo m'zipatala zonse, kapena dokotalayo akhoza kukhala ndi chidziwitso chochulukirapo ndi mitundu ina ya mankhwala oletsa ululu motero amakhala ndi chidaliro chogwiritsa ntchito.
Mapeto
Mankhwala oletsa ululu am'deralo amagwira ntchito yofunika kwambiri pa opaleshoni ya pakamwa, kupereka chitonthozo ndi kuchepetsa ululu panthawi ya opaleshoniyi. Ndi njira zosiyanasiyana zoletsa ululu zomwe zilipo, kuphatikizapo lidocaine, articaine, mepivacaine, bupivacaine, ndi prilocaine, madokotala a mano amatha kusintha mankhwala oletsa ululu kuti agwirizane ndi zosowa za wodwala aliyense. Zinthu monga liwiro loyambira, nthawi yogwira ntchito, chitetezo, komanso momwe wodwalayo alili ziyenera kuganiziridwa bwino kuti zitsimikizire kuti mankhwala oletsa ululu ndi abwino kwambiri.
Muzochitika zovuta zachipatala, kufunsa dokotala wa opaleshoni kapena katswiri wina wa zamankhwala kungakhale kofunikira kuti adziwe njira yabwino kwambiri yoperekera mankhwala oletsa ululu. Ndi kusankha koyenera kwa mankhwala oletsa ululu am'deralo, opaleshoni ya pakamwa ikhoza kuchitidwa bwino, mosamala, komanso momasuka kwa wodwalayo.
