100% satisfaction guarantee Immediately available after payment Both online and in PDF No strings attached
logo-home
Samenvatting Inleiding tot de anesthesie $7.71
Add to cart

Summary

Samenvatting Inleiding tot de anesthesie

 24 views  0 purchase
  • Course
  • Institution

Volledige samenvatting van de lessen en het boek. Geslaagd in eerste zit.

Preview 4 out of 110  pages

  • April 16, 2023
  • 110
  • 2022/2023
  • Summary
avatar-seller
INHOUDSOPGAVE

1. examen ............................................................................................................................................................ 6

2. inleiding ........................................................................................................................................................... 6

3. De geschiedenis van de anesthesie .................................................................................................................. 7

Inleiding........................................................................................................................................................................ 7

Pre 1846: fundamenten v anesthesie ........................................................................................................................... 7
Industriële en wetenschappelijke revolutie ............................................................................................................ 7
Geschiedenis v inhalatie anesthesie ........................................................................................................................ 8
lachgas ................................................................................................................................................................. 8
Ether .................................................................................................................................................................... 8

1846-1900: verankering anesthesie ............................................................................................................................. 8
Chloroform............................................................................................................................................................... 8
Geschiedenis v lokale en regionale anesthesie ....................................................................................................... 9

20ste eeuw: consolidatie en groei ................................................................................................................................. 9

21STE EEUW: DE TOEKOMST ......................................................................................................................................... 9

2. De peri-operatieve stress respons .......................................................................................................................10

Heelkundige stress en anesthesie .............................................................................................................................. 10

De stress respons........................................................................................................................................................ 10

De peri-operatieve stress respons .............................................................................................................................. 11
De endocriene stress respons (examen) ............................................................................................................... 11

................................................................................................................................................................................12

De stress respons en metabolisme ............................................................................................................................. 13

De immunologische stress respons ............................................................................................................................ 13

De hematologische stress respons ............................................................................................................................. 14

De peri-operatieve stress respons .............................................................................................................................. 14

Veranderingen bij stress respons ............................................................................................................................... 14

3. De pre-operatieve oppuntstelling en risico stratificatie .......................................................................................15

De pre-operatieve evaluatie ....................................................................................................................................... 15

De anamnese.............................................................................................................................................................. 16
voorgeschiedenis ................................................................................................................................................... 16
systeemanamnese ................................................................................................................................................. 17
metabole equivalenten ..................................................................................................................................... 17
medicatie ............................................................................................................................................................... 18

Het klinisch onderzoek ............................................................................................................................................... 18

Technische onderzoeken (niet altijd) .......................................................................................................................... 19

Risico – stratificatie en classificatie (EXAMEN) .......................................................................................................... 21
1

, Risico scores ........................................................................................................................................................... 21
American Society of Anesthesiology score........................................................................................................ 21
NHYA ................................................................................................................................................................. 22
Lee’s Revised Cardiac Risk Index ....................................................................................................................... 22
GOLD klasse ....................................................................................................................................................... 23

Cardiale risicobepaling en oppuntstelling .................................................................................................................. 23
Pre-operatieve evaluatie en risicobepaling ........................................................................................................... 23
Patiënt gerelateerd risico .................................................................................................................................. 24
Heelkundig risico ............................................................................................................................................... 24
Pre-operatieve oppuntstelling en optimalisatie .................................................................................................... 25

Medicamenteuze voorbereiding ................................................................................................................................ 27
Sedativa – Hypnotica – tranquilizers ..................................................................................................................... 27
Reductie van maaginhoud en stijging van de zure maag pH ................................................................................. 27
Verlies tonus bovenste gastro-oesophagale sfincter ........................................................................................ 27
Risicopopulatie voor aspiratie (>25 ml – pH <2.5) ............................................................................................ 27
Richtlijnen preoperatief nuchter zijn ................................................................................................................ 28
Chronische thuismedicatie DOORGEVEN .............................................................................................................. 28
Corticosteroiden: Perioperatieve substitutie ........................................................................................................ 29
Mogelijke strategie ............................................................................................................................................ 29
Anti-diabetica ........................................................................................................................................................ 29

Klinische casus (zoals op examen) .............................................................................................................................. 30

4. Het doel van anesthesie: hypnose, analgesie, spierverslapping en stabilisatie ................................................31

Inleiding...................................................................................................................................................................... 31

5 Doelen van anesthesie ............................................................................................................................................ 32
Slaap/bewustzijnsverlies ....................................................................................................................................... 32
Stadia van Guedel.............................................................................................................................................. 33
Inhalatie - anesthetica ....................................................................................................................................... 34
Intraveneuze hypnotica ..................................................................................................................................... 34

Analgesie .................................................................................................................................................................... 34

Spierverslapper........................................................................................................................................................... 34

Fysiologische stabilisatie ............................................................................................................................................ 35

Monitoring ................................................................................................................................................................. 35

De kunstmatige luchtweg .......................................................................................................................................... 37
manuele maskerventilatie ..................................................................................................................................... 38
larynxmasker: supraglottic airway device ............................................................................................................. 38
laryngoscoop.......................................................................................................................................................... 39
Endotracheale tube ........................................................................................................................................... 39
Cormack en Lehane classificatie bij directe laryngoscopie ............................................................................... 39
Videolaryngoscopie ........................................................................................................................................... 40
Fiberoptische intubatie .......................................................................................................................................... 40
tracheostomie........................................................................................................................................................ 40

5. Farmacologie van hypnotica, analgetica en spierrelaxantia ............................................................................41

Inleidende begrippen.................................................................................................................................................. 41
Farmacodynamiek ................................................................................................................................................. 41
Farmacokinetiek .................................................................................................................................................... 43
Triade v alegemene anesthesie ............................................................................................................................. 44
2

,Farmacologie van intraveneuze hypnotica ................................................................................................................ 45
Inleiding en werkingsmechanisme ........................................................................................................................ 45
GABAA receptor ................................................................................................................................................. 45
NMDA receptor ................................................................................................................................................. 46
overzichtstabel .................................................................................................................................................. 46
Hypnotica - propofol .............................................................................................................................................. 47
Klinisch gebruik ................................................................................................................................................. 47
Farmacokinetiek ................................................................................................................................................ 47
Nevenwerkingen ............................................................................................................................................... 48
Hypnotica - etomidaat ........................................................................................................................................... 49
Klinisch gebruik ................................................................................................................................................. 49
farmacokinetiek................................................................................................................................................. 49
Nevenwerkingen ............................................................................................................................................... 50
Hypnotica ketamine ............................................................................................................................................... 51
Klinisch gebruik ................................................................................................................................................. 51
farmacokinetiek................................................................................................................................................. 52
Nevenwerkingen ............................................................................................................................................... 52
Benzodiazepines .................................................................................................................................................... 53
Hypnotica - midazolam...................................................................................................................................... 54

Farmacologie van inhalatie of volatiele anesthetica!!! ............................................................................................. 55
Farmacokinetiek en algemene effecten ................................................................................................................ 56
Farmacokinetiek ................................................................................................................................................ 56
Hemodynamica ................................................................................................................................................. 58
Effecten ............................................................................................................................................................. 59
Klinisch gebruik lachgas ......................................................................................................................................... 59
Klinisch gebruik Isoflurane ..................................................................................................................................... 60
Klinisch gebruik Sevoflurane .................................................................................................................................. 60
Klinisch gebruik Desflurane ................................................................................................................................... 60
Klinisch gebruik edelgassen ................................................................................................................................... 60

Farmacologie van opiaten.......................................................................................................................................... 61
analgetica-algemeen.............................................................................................................................................. 61
Klinisch gebruik ................................................................................................................................................. 61
Werkingsmechanisme ....................................................................................................................................... 61
Opioidreceptoren .............................................................................................................................................. 61
Analgetica – Toedieningswijze ............................................................................................................................... 63
Analgetica – farmacokinetiek ................................................................................................................................ 63
Analgetica – Andere orgaansystemen ................................................................................................................... 64
Analgetica .............................................................................................................................................................. 65
Opiaat – antagonist: µ-receptor ............................................................................................................................ 65

Farmacologie van niet-opioide analgetica ................................................................................................................. 66

Farmacologie van spierverslappers (neuromusculaire blokkers) ............................................................................... 66
Spierrelaxantia – Werkingsmechanisme ............................................................................................................... 66
Spierrelaxantia – Indeling ...................................................................................................................................... 66
Succinylcholine .................................................................................................................................................. 68
Niet depolariserende spierverslappers ............................................................................................................. 68
Spierrelaxantia – Neveneffecten ........................................................................................................................... 69
Succinylcholine .................................................................................................................................................. 69
Niet depolariserende ......................................................................................................................................... 69
Spierrelaxantia – Metabolisme .............................................................................................................................. 69
Spierrelaxantia – Antagonisten.............................................................................................................................. 70

3

, Cholinesterase – inhibitoren ............................................................................................................................. 70
Suggamadex (Bridion ®) .................................................................................................................................... 70

6. Locoregionale anesthesie ....................................................................................................................................71

Inleiding...................................................................................................................................................................... 71
Anatomie van een zenuwcel .................................................................................................................................. 71
Histologie van een zenuw ...................................................................................................................................... 72

Fysiologie v zenuwimpulsgeleiding ............................................................................................................................ 72

Farmacologie van lokale anesthetica ......................................................................................................................... 73
Concentratie .......................................................................................................................................................... 75
Additieven aan LA mengsels .................................................................................................................................. 76
Overzicht ................................................................................................................................................................ 76

Vormen locoregionale anesthesie: spinaal, epiduraal en perifere zenuwblocks ........................................................ 78
Centraal neuraxiale blocks ..................................................................................................................................... 78
Spinale anesthesie ............................................................................................................................................. 78
Epidurale anesthesie ......................................................................................................................................... 79
Combined spinal epidural anesthesie (CSE) ...................................................................................................... 79
Perifere zenuwblocks ............................................................................................................................................. 80
Het “Biers”block..................................................................................................................................................... 86

Complicaties ............................................................................................................................................................... 87

7. De postoperatieve periode ..................................................................................................................................90

Postoperatieve monitoring......................................................................................................................................... 90

Postoperatieve analgesie ........................................................................................................................................... 91

Recovery en ontstlag uit PAZA/ziekenhuis ................................................................................................................. 94

Postoperatief vochtbeleid .......................................................................................................................................... 96

8. Complicaties van anesthesie ..............................................................................................................................102

PONV ........................................................................................................................................................................ 103

Hypothermie ............................................................................................................................................................ 104

POCD ........................................................................................................................................................................ 105

Awareness ................................................................................................................................................................ 106

Maligne hyperthermie.............................................................................................................................................. 108

Restcurarisatie ......................................................................................................................................................... 108

Aspiratie ................................................................................................................................................................... 109

9. Lange termijn effecten van anesthesie ..............................................................................................................110

Metastasering en herval van kanker ........................................................................................................................ 110

Neuronale ontwikkeling bij herhaalde anesthesie ......................................................... Error! Bookmark not defined.

Transitie van acute naar chronische pijn.................................................................................................................. 110




4

The benefits of buying summaries with Stuvia:

Guaranteed quality through customer reviews

Guaranteed quality through customer reviews

Stuvia customers have reviewed more than 700,000 summaries. This how you know that you are buying the best documents.

Quick and easy check-out

Quick and easy check-out

You can quickly pay through credit card or Stuvia-credit for the summaries. There is no membership needed.

Focus on what matters

Focus on what matters

Your fellow students write the study notes themselves, which is why the documents are always reliable and up-to-date. This ensures you quickly get to the core!

Frequently asked questions

What do I get when I buy this document?

You get a PDF, available immediately after your purchase. The purchased document is accessible anytime, anywhere and indefinitely through your profile.

Satisfaction guarantee: how does it work?

Our satisfaction guarantee ensures that you always find a study document that suits you well. You fill out a form, and our customer service team takes care of the rest.

Who am I buying these notes from?

Stuvia is a marketplace, so you are not buying this document from us, but from seller gnkstdnt1. Stuvia facilitates payment to the seller.

Will I be stuck with a subscription?

No, you only buy these notes for $7.71. You're not tied to anything after your purchase.

Can Stuvia be trusted?

4.6 stars on Google & Trustpilot (+1000 reviews)

52510 documents were sold in the last 30 days

Founded in 2010, the go-to place to buy study notes for 14 years now

Start selling
$7.71
  • (0)
Add to cart
Added