Anesteziološke smjernice za pripremu bolesnika za hitne kirurške operacije

master's thesis

• Title (english): Anaesthetic guidelines for preparation patients for emergency surgical operation
• Author: Antonija Mihelčić
• Mentor: Vesna Vegar-Brozović (mentor)
• Committee member: Ante Sekulić (predsjednik povjerenstva)
• Committee member: DINKO TONKOVIĆ (član povjerenstva)
• Committee member: Vesna Vegar-Brozović (član povjerenstva)
• Granter: University of Zagreb; School of Medicine; (Department of Anaesthesiology, Resuscitation and Intensive Care in Surgical Specialities); Zagreb
• Defense date and country: 2015-07-15, Croatia
• Scientific / art field, discipline and subdiscipline: BIOMEDICINE AND HEALTHCARE; Clinical Medical Sciences; Anesthesiology and Reanimatology

Abstract

Pacijente koji zbog svog stanja trebaju biti podvrgnuti hitnoj kirurškoj operaciji potrebno je u što kraćem vremenu pripremiti za zahvat. U slučaju životne ugroženosti liječenje se može provesti bez suglasnosti bolesnika ili najuže rodbine. Razgovor s pacijentom važna je karika prijeoperacijske procjene i planiranja anestezioloških postupaka jer daje važne informacije o sadašnjim i prijašnjim bolestima, terapiji, ranijim kirurškim zahvatima i eventualnim komplikacijama anestezije. Fizikalni pregled i laboratorijske pretrage daju precizan uvid u stanje pojedinog organskog sustava. Budući da su kardiovaskularne i plućne bolesti vodeći uzrok perioperacijskog mortaliteta i morbiditeta, procjena tih dvaju organskih sustava iziskuje posebnu pažnju. Također je važno učiniti procjenu živčanog sustava, funkcija jetre i bubrega, gastrointestinalnog, endokrinološkog i hematološkog sustava te mišićno-koštanog sustava u slučaju pozitivne anamneze. Kako bi se pacijenta što bolje pripremilo za anesteziju te kako bi se postigli optimalni uvjeti za kirurški zahvat, pristupa se premedikaciji. Ciljevi premedikacije su: anksioliza, analgezija, amnezija, smanjenje salivacije, smanjenje želučanog volumena i regulacija pH želučanog sadržaja, sprječavanje postoperativne mučnine i povraćanja i sprječavanje vagalnog refleksa prilikom intubacije. Za nadoknadu tekućina koriste se kristaloidne ili koloidne otopine, s ciljem povećanja cirkulacijskog volumena i krvnog tlaka te poboljšanja perfuzije i oksigenacije tkiva. Uvod u anesteziju može se postići intravenskim anesteticima (tiopental, propofol, ketamin, midazolam, etomidat), što je poželjno u slučaju hemodinamske nestabilnosti i mogućnosti povraćanja ili aspiracije, te inhalacijskim anesteticima (dušikov oksid, halotan, desfluran, izofluran, sevofluran, ksenon). U slučaju politraume uloga anesteziologa nerijetko je ključna za konačan ishod liječenja. Najčešće korištene ljestvice za procjenu ozljeda su Glasgow Coma Score (GCS) i Revised Trauma Score (RTS). Primarno zbrinjavanje politraumatiziranog pacijenta uključuje identifikaciju i zbrinjavanje za život opasnih ozljeda prema ABCDE pristupu.

Abstract (english)

Patients whose condition requires urgent surgery need to be prepared for the procedure as soon as possible. In case of vital threat, the operation can be performed without an informed consent. The preoperative talk is the essential part of the preoperative assessment because it gives important information about patient's illness, medical history and therapy, previous operations and complications of anesthesia. Physical examination and laboratory tests show the condition of organ systems. Since cardiovascular and pulmonary diseases are the main cause of perioperative morbidity and mortality, the evaluation of those two organ systems has to be done with great caution. It is important to evaluate the condition of nervous system, liver and kidney function, gastrointestinal, endocrine and hematology system, as well as muscular system if the patient's history indicates so. Premedication needs to be done in order to prepare the patient for anesthesia and to provide optimal conditions for surgery. This includes anxiolysis, analgesia, amnesia, reduction of salivation, reduction of gastric volume and gastric pH control, reduction of postoperative nausea and vomiting and reduction of vagal reflexes to intubation. Crystalloid and colloid solutions are used for fluid resuscitation, with the purpose to increase circulating volume and blood pressure as well as to improve tissue perfusion and oxygenation. Anesthesia can be induced by intravenous anesthetics (thiopental, propofol, ketamine, midazolam, etomidate), which are preferred in case of hemodynamic instability and the risk of vomiting and aspiration, or by inhalational anesthetics (nitrous oxide, halothane, desflurane, isoflurane, sevoflurane, xenon). In case of polytrauma, an anesthesiologist has the key role on the final outcome of the medical treatment. The most commonly used scales to classify and describe the severity of injuries are Glasgow Coma Scale (GCS) and Revised Trauma Score (RTS). The primary survey of polytrauma patients includes the identification and treatment of life threatening injuries by ABCDE protocol.

• Keywords: prijeoperacijska procjena; premedikacija; nadoknada tekućina; intravenski anestetici; inhalacijski anestetici; politrauma
• Keywords (english): preoperative assessment; premedication; fluid resuscitation; intravenous anesthetics; inhalational anesthetics
• Language: croatian
• URN:NBN: urn:nbn:hr:105:220959
• Study programme: Title: Medicine; Study programme type: university; Study level: integrated undergraduate and graduate; Academic / professional title: doktor/doktorica medicine (doktor/doktorica medicine)
• Type of resource: Text
• File origin: Born digital
• Access conditions: Open access
• Created on: 2016-03-29 10:35:10