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Samenvatting Anethesie

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in deze samenvatting vindt u de leerstof van anesthesie in graduaat verpleegkunde

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  • March 19, 2023
  • 6
  • 2022/2023
  • Summary
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Anesthesie

Begrip
- Kunstmatig opwekken van coma, controleerbaar in diepte en tijd
- Ontbreken van gewaarwording, gevoel

Soorten Anesthesie
- Algemene (narcose) anesthesie
- Sedatie anesthesie
- Lokale anesthesie
o Lokale oppervlakkige anesthesie
o Lokale infiltratie anesthesie
- (loco-)regionale anesthesie
o Epidurale/ peridurale/caudale anesthesie
o Rachi of spinale anesthesie
o Combinatie epidurale-spinale anesthesie
o Plexusanesthesie
- Hypnose

4 pijlers veilige anesthesie
- Hypnotica  pt weet van niks
- Analgetica  pt ervaart geen pijn
- Curares  pt ontspannen
- Neurovegetatieve stabiliteit  zorgt voor vitale en cognitieve parameters op peil houden

Keuze anesthesie techniek
- Aan de hand van ASA score
- ADH van verschillende factoren
o Leeftijd pt
o Toestand pt
o Soort ingreep
o Wensen van pt

Belang van sign in en time out
- Dit is nog ter controle van de anesthesist om problemen te voorkomen

Algemene anesthesie
- Verloop
o Voorbereiding pt  keuze anesthesie + materiaal nemen  installatie/monitoring
patiënt  inductie  onderhoud  uitleiding narcose  recovery/overdracht
o Pt in ruglig
o Electroden aanbrengen  bloeddrukmanchet aan
o Plethysmofraaf aan
o IV toegangsweg plaatsen

- Inductie
o Infuustherapie
o Pre oxygenatie (met 100% o²)
o Monitoring
o Medicatie

,  Hypnotica
 Analgetica (vb. fentanyl)
 Curare (bv. Nimbex)
 N.V stabiliteit

1. Patiënt gepreoxygeneerd naar 100%
2. Medicatie toedienen
3. AH valt uit = balon of masker beademing
4. PT wordt geïntubeerd
5. Larynxmasker-et-tube: fixatie kleefpleister
6. Ogen: kunsttranen + dichtkleven

- Onderhoud
o Via tube of masker
 O² (L/min)
 Vluchtig vloeibaar anestheticum (%)
 Lucht of N²O (lachgas) (L/min)
 Eventueel bijgeven
 Analgeticum
 Curare
 IV-anestheticum
 RR verhogende/verlagende medicatie
o Stabiliteit
 AH
 T°
 Hemodynamisch P°/RR

- Uitleiding
o Zelfstandig AH
 Vluchtig vloeibaar anestheticum afzetten
 Eventueel ook N²O
 O² debiet verhogen
 Bij reflexen en spontane ademhaling onder aspiratie debuteren
o Antagoneren
 Toedienen eventueel antidotum
 Dafalgan  lysomucil
 Morfine  Narcan
 Spuitpomp stopzetten
o Recovery
 Monitoring pijn, BWZ, bloedverlies en vitale PM

Soorten anesthetica
- Intraveneuze anesthesie ( = hypnotica)
o Propofol (= diprivan)  wit, vetemulsie, pijn bij inspuiten
o Ketamine (= ketalar)  hallucinaties
o Midazolam (dormicum)  werkt lang na

- Inhalatie-anesthesie of volatiele
o Vluchtig vloeibare anesthetica
 Via verdamper inhaleren
 Suprane

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