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Samenvatting Anesthesie
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Volledige samenvatting van het deel 'Anesthesie' gebaseerd op de powerpoints en hoorcolleges. Gegeven in 2e bachelor.
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Anesthesie1. Inleiding: basis van de algemene anesthesie ...................................................................................... 3
1.1 Algemene anesthesie .................................................................................................................... 3
1.2 Antagonisatie................................................................................................................................. 2
2. Farmacologie van intraveneuze anesthetica ....................................................................................... 2
2.1 Werkingsmechanisme hypnotica .................................................................................................. 2
2.2 Verschillende hypnotica (IV anesthetica) ...................................................................................... 4
3. Farmacologie van inhalatie-anesthetica ............................................................................................. 9
3.1 Inleiding ......................................................................................................................................... 9
3.2 Werking van de inhalatie-anesthetica........................................................................................... 9
3.3 Verschillende soorten.................................................................................................................. 12
3.4 Keuze volatiel .............................................................................................................................. 14
4. Farmacologie van de spierverslappers .............................................................................................. 14
4.1 Inleiding ....................................................................................................................................... 14
4.2 Indeling spierverslappers ............................................................................................................ 16
4.3 Monitoring ................................................................................................................................... 18
4.4 Antagonisatie............................................................................................................................... 19
5. Luchtweg, oxygenatie en ventilatie ................................................................................................... 21
5.1 Inleiding ....................................................................................................................................... 21
5.2 Preoperatieve evaluatie van de luchtweg ................................................................................... 21
5.3 Controle van de luchtweg ........................................................................................................... 23
6. Vasculair access ................................................................................................................................. 30
6.1 Inleiding ....................................................................................................................................... 30
6.2 Beslissingsboom .......................................................................................................................... 30
6.3 Soorten IV katheters.................................................................................................................... 33
6.4 Complicaties met IV katheters .................................................................................................... 37
7. Monitoring ......................................................................................................................................... 38
7.1 Inleiding ....................................................................................................................................... 38
7.2 Verschillende aspecten monitoring............................................................................................. 39
7.3 Conclusie ..................................................................................................................................... 48
8. Perioperatieve homeostase .............................................................................................................. 48
8.1 Vochtbeleid ................................................................................................................................. 48
8.2 Elektrolyten ................................................................................................................................. 51
8.3 Bloed en stolling .......................................................................................................................... 53
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, 8.4 Lichaamstemperatuur ................................................................................................................. 56
8.5 Zuur-base evenwicht ................................................................................................................... 59
8.6 Glycemie ...................................................................................................................................... 60
8.7 Besluit .......................................................................................................................................... 61
9. Preoperatieve oppuntstelling (consultatie) ...................................................................................... 61
9.1 Inleiding ....................................................................................................................................... 61
9.2 Onderdelen van de preoperatieve consultatie ........................................................................... 62
10. Preoperatieve cardiovasculaire evaluatie ....................................................................................... 69
10.1 Inleiding ..................................................................................................................................... 69
10.2 Risicostratificatie ....................................................................................................................... 69
10.3 Beleid ......................................................................................................................................... 71
10.4 Cardioprotectieve maatregelen ................................................................................................ 72
10.5 Voorbeeldvragen ....................................................................................................................... 75
11. Pijnstilling bij de bevalling ............................................................................................................... 76
11.1 Inleiding ..................................................................................................................................... 76
11.2 De vaginale bevalling ................................................................................................................. 77
11.3 Neuraxiaal: bevallen .................................................................................................................. 79
11.4 Keizersnede (sectio) .................................................................................................................. 82
11.5 Borstvoeding en pijnstilling ....................................................................................................... 84
12. Perioperatieve anesthesiologische complicaties ............................................................................ 85
12.1 Respiratoire complicaties .......................................................................................................... 85
12.2 Cardiovasculaire dysfunctie....................................................................................................... 88
12.3 Anafylaxie .................................................................................................................................. 89
12.4 Bloeding ..................................................................................................................................... 90
12.5 Maligne hyperthermie............................................................................................................... 90
12.6 Neurologische dysfunctie .......................................................................................................... 91
12.7 Restcurarisatie ........................................................................................................................... 92
12.8 PONV (postoperative nausea and vomiting) ............................................................................. 92
12.9 Pijnstilling .................................................................................................................................. 95
12.10 Temperatuursveranderingen .................................................................................................. 95
12.11 Ionen/glycemie stoornissen .................................................................................................... 95
12.12 Positionering............................................................................................................................ 95
12.13 Brand ....................................................................................................................................... 96
12.14 Menselijke fouten.................................................................................................................... 96
13. Lokale anesthetica ........................................................................................................................... 96
13.1 Inleiding ..................................................................................................................................... 96
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, 13.2 Farmacologische begrippen ...................................................................................................... 98
13.3 Metabolisme.............................................................................................................................. 99
13.4 Praktisch gebruik ..................................................................................................................... 100
14. Locoregionale technieken ............................................................................................................. 101
14.1 Neuraxiale technieken............................................................................................................. 101
14.2 Specifieke zenuwen/plexus blokkeren .................................................................................... 105
14.3 Plane blocks ............................................................................................................................. 109
15. Complicaties van locoregionale technieken .................................................................................. 110
15.1 Inleiding ................................................................................................................................... 110
15.2 Casussen .................................................................................................................................. 111
1. Inleiding: basis van de algemene anesthesie
1.1 Algemene anesthesie
= peri-operatieve geneeskunde
• (1) Preoperatieve oppuntstelling van patiënten (vb. hogere leeftijd & veel comorbiditeiten:
heel belangrijk ze zo goed mogelijk op punt te stellen)
• (2) Taken op IZ na bv. majeure chirurgie
• (3) Op spoed belangrijk voor de opvang van subarachnoïdale bloedingen & trauma’s
• (4) Vaak ook verdere specialisatie in de behandeling van pijn (acuut/chronisch)
• …
Definitie
• = medicamenteus geïnduceerde, omkeerbare onderdrukking van het centraal zenuwstelsel.
• Gevolg: veranderingen van gedrag/ perceptie op schadelijke stimuli (zoals chirurgie)
→ meer dan patiënten onder anesthesie brengen in een operatiekwartier.
3 belangrijkste pijlers:
• (1) Bewusteloosheid en/of sedatatie
o Met een amnesie
• (2) Analgesie (pijnstilling)
• (3) Spierverslapping
o Beveiligen van LW, immobilisatie v stembanden, anti-hoest
o Vlotte heelkunde door verminderde tonus vd spieren
Bijkomende aspecten van anesthesie:
• Protectie tegen autonome reflexen (onderdrukken)
o Vb. operatie aan het oog: occulocardiale reflex met extreme bradycardie –
hartstilstand → zullen hier met anesthesie op ingrijpen.
o O.a. ook: vagale reactie, bradycardie OCR, salivatie, stress respons
3
, • Peroperatieve stabilisatie (tijdens de operatie)
o Hemodynamisch (vb. bij acuut bloedverlies: moet dit compenseren samen met de
chirurg)
o Respiratoir (oxygenatie, ventilatie)
o Vochtbeleid
o Stolling oppuntstellen (anders bij minste probleem van bloeding geen stolling)
o Glycemiecontrole
o Zuur-base controle
• Antagonisatie
o Vraag: hoe kunnen we al de effecten t.g.v. anesthesie antagoneren?
1.1.1 Premedicatie
Doel:
• (1) Wegnemen van angst = anxiolyse
• (2) Voorkomen van pijn (pre-emptief)
• (3) Voorkomen van complicaties
Algemeen:
• Minder toegepast dan vroeger! → verklaring: patiënt moet zich tot net voor de anesthesie
nog kunnen identificeren en markeren waar de operatie moet plaatsvinden (markage &
identificatie).
o Enkel nog bij zeer zware ingrepen (vnl. cardiaal & thoraco-abdominaal)
• Bij kinderen: aanwezigheid ouders = beter dan medicatie
Verschillende producten:
• (1) Sedativum of anxiolyticum (op indixatie!)
• (2) Parasympathicolyticum: Atropine/Glycopyrrolate (IM of IV)
o Antisialogeen (minder speekselproductie)
o Vagale reacties inhiberen: tegen bradycardie
▪ Belangrijk bij kids: CO erg afhv HR
o Anti-bronchospastisch
• (3) Farmaca als voorbereiding op de operatie (meestal):
o Chronische medicatie die de patiënten sowieso al nemen
▪ Vraag: welke GM moeten gestopt worden en welke mogen doorgenomen
worden?
o Postoperatieve nausea & vomiting (PONV) profylaxe
o Anti-trombotische profylaxe → kousen of LMWH
o Anti-aspiratie (zwangeren!)
o Anti-allergie (indien bij vorige anesthesie(s) een allergische reactive)
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