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Samenvatting - Inleiding tot de Anesthesiologie

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Geslaagd 1e zit - Dit is een samenvatting van het deel 'inleiding tot de anesthesiologie' dat tot het clustervak 'heelkundig zorgtraject' behoort. Deze samenvatting is gebaseerd op de cursus en mijn notities uit de les.

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  • December 14, 2020
  • 38
  • 2020/2021
  • Summary

3  reviews

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By: hannevanbruwaene • 2 year ago

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By: medicaldoggoKUL • 2 year ago

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By: bultiauwjacqueline • 3 year ago

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S A M E N VAT T I N G

INLEIDING TOT DE
ANESTHESIOLOGIE




1

, INHOUDSTAFEL
Inhoudstafel .........................................................................................................................................2

Inleiding ...............................................................................................................................................4

Geschiedenis van de anesthesie ..........................................................................................................4
1. Inleiding..........................................................................................................................................................................4
2. Geschiedenis van inhalatie anesthesie ...............................................................................................................................4
3. Geschiedenis van lokale en regionale anesthesie ...............................................................................................................5
4. Geschiedenis van de IV anesthesie ...................................................................................................................................5
5. Anesthesie in België .........................................................................................................................................................5

Peri-operatieve stress respons .............................................................................................................6

Pre-operatieve oppuntstelling ..............................................................................................................8
1. Inleiding..........................................................................................................................................................................8
2. Anamnese .......................................................................................................................................................................8
3. Klinisch onderzoek ..........................................................................................................................................................9
4. ASA classi catie ............................................................................................................................................................10
5. Technische onderzoeken ................................................................................................................................................10
6. Cardiale risicobepaling en oppuntstelling ........................................................................................................................11
7. Medicamenteuze voorbereiding .....................................................................................................................................12

Doel van anesthesie: hypnose, analgesie, spierverslapping en stabilisatie .......................................14
1. Slaap/bewustzijnsverlies ................................................................................................................................................14
2. Analgesie ......................................................................................................................................................................15
3. Spierverslapper .............................................................................................................................................................16
4. Kunstmatige luchtweg .....................................................................................................................................................16
5. Monitoring ....................................................................................................................................................................17

Farmacologie van hypnotica, analgetica en spierrelaxantia..............................................................18
1. Inleidende begrippen .....................................................................................................................................................18
2. Farmacologie van intraveneuze hypnotica .......................................................................................................................18
3. Farmacologie van volatiele anesthetica ...........................................................................................................................21
4. Farmacologie van opiaten ..............................................................................................................................................22
5. Farmacologie van niet-opioide analgetica .......................................................................................................................24
6. Farmacologie van spierverslappers (curares) ...................................................................................................................24

Locoregionale anesthesie ...................................................................................................................25
1. Fysiologie van zenuwimpulsgeleiding ..............................................................................................................................25
2. Farmacologie van lokale anesthetica ..............................................................................................................................25
3. Vormen van locoregionale anesthesie: spinaal, epiduraal en perifere zenuwblocks ...........................................................27
4. Complicaties van regionale anesthesie ............................................................................................................................28

Post-operatieve periode .....................................................................................................................30
1. Post-operatieve monitoring .............................................................................................................................................30
2. Post-operatieve analgesie ...............................................................................................................................................30
3. Recovery en ontslag uit PAZA/ziekenhuis ........................................................................................................................32
4. Post-operatief vochtbeleid...............................................................................................................................................32

Complicaties van anesthesie ..............................................................................................................35
1. Post-operatieve misselijkheid en braken (PONV) ..............................................................................................................35
2. Hypothermie .................................................................................................................................................................35




2

, 3. Post-operatieve cognitieve dysfunctie (POCD) ..................................................................................................................36
4. Awareness ....................................................................................................................................................................36
5. Maligne hyperthermie ....................................................................................................................................................37
6. Restcurarisatie ...............................................................................................................................................................37
7. Aspiratie .......................................................................................................................................................................37

Lange-termijn effecten van anesthesie ...............................................................................................38
1. Metastasering en herval van kanker ...............................................................................................................................38
2. Neuronale ontwikkeling bij herhaalde anesthesie ............................................................................................................38
3. Transitie van acute naar chronische pijn ..........................................................................................................................38




3

, INLEIDING
Peri-operatieve geneeskunde = teamwork
- Anesthesie
- Heelkunde
- Intensieve zorgen
➩ Op alle niveau’s een evolutie in expertise: verhoogde complexiteit heelkundige ingrepen
en mogelijkheden met SUCCES


G E S C H I E D E N I S VA N D E A N E S T H E S I E
1. I n l e i d i n g
Tot 1850: Niet veel mogelijkheden voor verdoving → slechts enkele kruiden en methoden

Medicamenteus Niet-medicamenteus

Mandragora Koude

Bilzenkruid Lokale druk

Alcohol Carotiscompressie

Opium Zenuwcompressie

Cocaïne

Chirurgie gebeurde in uitzonderlijke situaties (ondraaglijke pijn, misvormingen, kans op
overlijden zeer groot,…) MAAR heel traumatisch voor patiënt, groot risico op infectie en
dood

2. G e s c h i e d e n i s v a n i n h a l a t i e a n e s t h e s i e
Lachgas: Grondlegger van de anesthesie
Synthese in 1773 → 1800: ontdekking anesthetische eigenschappen
1845: Eerste experiment, maar mislukte (patiënt had wel pijn)

Ether: Synthese in 1540 → 1846: de eerste anesthesie uitgevoerd (ether dome)
Via een ether inhaler

Chloroform: Synthese in 1831 → 1847: ontdekking onesthetische eigenschappen → gebruik
bevalling

1850 - 1900: Verankering van de anesthesie
- Ether: over heel de wereld
- Lachgas: Hernieuwde interesse (THK)
- Chloroform
- Lokale anesthesie aan het einde van de 19e eeuw




4

, 3. G e s c h i e d e n i s v a n l o k a l e e n r e g i o n a l e a n e s t h e s i e
Lokale anesthetica: Ontwikkeld uit cocaïne
- Spinale pijnstilling
- Tropocaïne
- Lokale in ltratie
- Bier’s block: IV regionale anesthesie
➩ Groot succes omdat groot risico van narcose: ✧ Moeilijk regelen dosis
✧ Toxiciteit gassen
✧ Ademhalingsproblemen


4. G e s c h i e d e n i s v a n d e I V a n e s t h e s i e
Betere methoden werden ontwikkeld in de 20e eeuw!
Ontwikkeling van: - IV hypnotica
- Opiaten
- Neuromusculaire blokkers

Monitoring werd mogelijk: - Invasieve BP
- ECG
- Saturatie

Intubatie en luchtwegmateriaal (WOII) en ontwikkeling van ventilatoren (polio-epidemie) ➩ BOOM!

5. A n e s t h e s i e i n B e l g i ë
Sinds midden 2e eeuw: volwassen specialisatie

Deelaspecten: - Klassiek: narcoses in operatiezaal
- Dagziekenhuis
- Diagnostische en interventionele procedures
- Materniteit: arbeid en bevalling

Spelen ook een rol in intensieve geneeskunde, spoedgevallen en het chronisch pijncentrum




5

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