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Samenvatting onderdeel 'anesthesie' 2e bach $13.49   Add to cart

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Samenvatting onderdeel 'anesthesie' 2e bach

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Tijdens het vak 'anesthesie en pijn' worden er 2 onderdelen gegeven. Deze samenvatting bevat het onderdeel anesthesie. Dit vak wordt gegeven in de 2e bachelor van geneeskunde, op de universiteit van Antwerpen. Om te weten welke hoofdstukken er in staan kan je kijken naar de inhoudstabel op de voo...

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  • November 14, 2024
  • 78
  • 2023/2024
  • Summary
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INHOUDSTAFEL
INHOUDSTAFEL .......................................................................................................................................................................... 1

ALGEMEEN PIJN & ANESTHESIOLOGIE ........................................................................................................................................ 3

DEFINITIE ALGEMENE ANESTHESIE ........................................................................................................................................................... 3
ELEMENTEN ANESTHESIE........................................................................................................................................................................ 4

FARMACOLOGIE VAN IV ANESTHETICA....................................................................................................................................... 7

HYPNOTICA......................................................................................................................................................................................... 7

FARMACOLOGIE VAN INHALATIE ANESTHETICA ....................................................................................................................... 11

WERKING ......................................................................................................................................................................................... 11
SOORTEN INHALATIE ANESTHETICA ......................................................................................................................................................... 12

FARMACOLOGIE VAN DE SPIERVERSLAPPERS ........................................................................................................................... 15

NEUROMUSCULAIRE JUNCTIE ................................................................................................................................................................ 15
SOORTEN SPIERVERSLAPPERS ................................................................................................................................................................ 16
MONITORING .................................................................................................................................................................................... 17

MONITORING ........................................................................................................................................................................... 21

DOEL: MONITORING ........................................................................................................................................................................... 21
KLINISCHE MONITORING ...................................................................................................................................................................... 21
MONITORING CIRCULATIE: ................................................................................................................................................................... 21
MONITORING ADEMHALING ................................................................................................................................................................. 23
MONITORING ANESTHESIEDIEPTE .......................................................................................................................................................... 24
NEUROLOGISCHE MONITOR.................................................................................................................................................................. 25
NEUROMUSCULAIRE MONITORING......................................................................................................................................................... 25
MONITORING LICHAAMSTEMPERATUUR ................................................................................................................................................. 26
MONITORING URINEDEBIET ................................................................................................................................................................. 26
MONITORING CONCLUSIES .................................................................................................................................................................. 26

PREOPERATIEVE OPPUNTSTELLNG ........................................................................................................................................... 27

PREOPERATIEVE CONSULTATIE .............................................................................................................................................................. 27
WAT WIL JE TE WETEN KOMEN? ............................................................................................................................................................ 27

LOCALE ANESTHETICA (LA) ....................................................................................................................................................... 31

SOORTEN ......................................................................................................................................................................................... 31
ZENUWGELEIDING .............................................................................................................................................................................. 31
FARMACOLOGISCHE BEGRIPPEN ............................................................................................................................................................ 32
METABOLISME .................................................................................................................................................................................. 32
CASUS ............................................................................................................................................................................................. 33

LOCOREGIONALE ANESTHESIETECHNIEKEN .............................................................................................................................. 35

REGIONALE TECHNIEKEN ...................................................................................................................................................................... 35
NEURAXIAAL ..................................................................................................................................................................................... 35
SPECIFIEKE ZENUWEN/ PLEXUS.............................................................................................................................................................. 38
IN VLAK WAAR ZENUWEN DOORLOPEN LA INJECTEREN .............................................................................................................................. 41

COMPLICATIES VAN LOCOREGIONALE ANESTHESIE .................................................................................................................. 43

VEEL VOORKOMENDE COMPLICATIES ...................................................................................................................................................... 43

1

, CONTRA-INDICATIES NEURAXIALE TECHNIEKEN ......................................................................................................................................... 46

LUCHTWEG, OXYGENATIE EN VENTILATIE ................................................................................................................................ 47

MOEILIJKE LUCHTWEG ........................................................................................................................................................................ 47
ADEMHALING .................................................................................................................................................................................... 50

VASCULAIRE ACCES .................................................................................................................................................................. 53

INLEIDING ......................................................................................................................................................................................... 53
BESLISBOOM ..................................................................................................................................................................................... 53
SOORTEN IV KATHETERS ...................................................................................................................................................................... 54
MEEST VOORKOMENDE COMPLICATIES ................................................................................................................................................... 56
CASUSSEN : WELKE LIJN VOORSTELLEN? .................................................................................................................................................. 57
TAKE HOME MESSAGE IV ACCES ............................................................................................................................................................ 57

HOMEOSTASE ........................................................................................................................................................................... 59

VOCHTBELEID .................................................................................................................................................................................... 59
ELEKTROLYTEN .................................................................................................................................................................................. 60
BLOED EN STOLLING............................................................................................................................................................................ 60
LICHAAMSTEMPERATUUR .................................................................................................................................................................... 61
ZUUR BASE EVENWICHT ....................................................................................................................................................................... 62
GLYCEMIE......................................................................................................................................................................................... 63
BESLUIT ........................................................................................................................................................................................... 63

PERI-OPERATIEVE COMPLICATIES ............................................................................................................................................. 65

VOORNAAMSTE COMPLICATIES (<24H) .................................................................................................................................................. 65

PIJNSTILLING BIJ DE PARTUS..................................................................................................................................................... 73

FYSIOLOGISCHE VERANDERINGEN TIJDENS ZWANGERSCHAP ........................................................................................................................ 73
PIJNSTILLING BIJ DE PARTUS.................................................................................................................................................................. 74
BORSTVOEDING ................................................................................................................................................................................. 78




2

, ALGEMEEN PIJN & ANESTHESIOLOGIE
DEFINITIE ALGEMENE ANESTHESIE
- Medicamenteus geïnduceerde
- Omkeerbare
- Onderdrukking van het centraal zenuwstelsel
- Veranderingen in gedrag en/of perceptie op schadelijke stimuli

ELEMENTEN ALGEMENE ANESTHESIE
- Bewusteloosheid en/of sedatie
o Amnesie; kunnen zich achteraf niets herinneren
- Pijnstilling
- Spierverslapping
- Protectie tegen autonome reflexen
o Vagale reactie, bradycardie OCR, salivatie, stress respons
- Peroperatieve stabilisatie
o Hemodynamisch
o Respiratoir (oxygenatie, ventilatie)
o Vochtbeleid
o Stolling
o Glycemiecontrole
o Zuur-base
- Antagonisatie

PREMEDICATIE
- Doel
o Anxiolyse
o Pijnbestrijding
o Voorkomen complicaties
- Minder toegepast dan vroeger want patient moet zich kunnen identificeren op de operatietafel + moet de juiste kant
kunnen aanduiden
- Ouders mogen altijd bij kinderen meegaan
- Bij zware ingrepen zoals bv cardio of thoraco-abdominale nog wel
- Welke ?
o Enkel sedativen/ anxiolytica bij patienten die extreem angstig zijn
o Parasympaticolyticum: ter preventie van bradycardie
o Chronische medicatie: medicatie die de pt al gebruikt
o Anti-aspiratie: vooral bij zwangere
o PONV profylaxe (post operative nausea & vomiting)
o Anti-thrombotische profylaxe
o Anti-allergie

TYPES ANESTHESIE
- Algemene anesthesie
- Locale en regionale anesthesie
 Worden vaak gecombineerd


INDUCTIE VAN SLAAP, HOE ?

- Meestal bij volwassenen IV en IV onderhouden worden
- IV induceren en dan overschakelen op inhalatie onderhoud
- Bij kinderen vnl. inh alatie inductie en onderhoud
- Inhalatie inductie en IV odnerhoud: bij patienten die moeilijk aan te prikken zijn want inhalatie geeft vasodilatatie
- Inhalatie inductie en onderhoud met een ander volatiel
INHALATIE ANESTHATICA
- Zeer frequent toegepast onderhoud anesthesie
- Vooral bij kinderen (vasodilatatie, EMLA)
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