Intra bone anesthesia

Description:

Intra bone anesthesia — a kind of intravenous local anesthesia. The anesthetizing substance entered vnutrikostno gets to venous system of an extremity from where diffuses in fabric. Intra bone anesthesia at extremity operations is applied. The extremity is isolated from the general blood-groove by a shshozheniye of elastic bandage or a cuff of a tonometer. The anesthetizing substance is entered on an upper extremity and by shoulder condyles, an elbow shoot, brush bones, on lower — into condyles of a hip, anklebone, a calcaneus. At an upper extremity operations the plait is imposed on a shoulder, at operation on foot — on the lower third of a shin, at shin operations — on the lower third of a hip and at hip operations — on an upper third of a hip.

Over the place of a puncture of a bone skin is infiltrirut by 0,25% novocaine solution, and then the same needle anesthetize glubzhelezhashchy fabrics and a periosteum. The needle with mandrin for a puncture of a bone is carried out through skin, cellulose and rotary motions get through a cortical plate into spongy substance of a bone. At operations on foot and a shin use 100 — 150 ml, on a hip — 150 — 200 ml, on an upper extremity — 100 — 150 ml of 0,25% of solution of novocaine. After removal of a plait toksiko-resorptive effect of anesthetic (weakness, dizziness, hypotension, nausea, vomiting) can be noted.

For the prevention of toxic effect of novocaine at bystry hit it into the general blood stream after the end of operation to the patient before removal of a plait is entered subcutaneously by 2 ml of solution of caffeine, then slowly remove a plait.

Potentiation of local anesthesia can be reached at an anesthesia combination to giving medicines of antipsychotic action (Droperidolum) and the general analgetics (fentanyl). At the combined anesthesia including local anesthesia and neuro лептаналгезию the effect of local anesthesia at simultaneous favorable impact of neuroleptics on the psychoemotional sphere of the patient increases.

The combination of a local anesthesia to the general analgesia reached by means of a metoksifluran, Penthranum without loss of consciousness of the patient is effective. In similar combinations the analgesic effect of local anesthetics and narcotic substance mutually amplifies.

Neyroleptanalgeziya and the general analgesia is applied to potentiation of different types of local anesthesia (infiltration, conduction, spinal, peridural). Thanks to a neyroleptanalgeziya and the general analgesia the dose and by that toxic effect of both local anesthetics, and narcotic substances decreases.

Complications of a local anesthesia are connected with allergic reactions to administration of anesthetic or overdose of anesthetic or adrenaline. Individual hypersensitivity to local anesthetics is shown in the form of skin rash, an itch, hypostasis like Quincke, laringo-or a bronchospasm. For treatment of allergic reactions use antihistaminic drugs, corticosteroids, antispasmodics.

The overdose of the anesthetizing substance at local anesthesia comes at hit of large amounts of anesthetic in a blood channel. Symptoms of overdose are the concern of the patient, a dermahemia, increase of pulse, increase in arterial pressure, a spasm. In hard cases at the accruing intoxication the coma, a collapse, an apnoea and hearts develop. Easy manifestations of overdose manage to be liquidated introduction of barbiturates, drugs, oxygen inhalation. In hard cases enter cordial and sosudotoniziruyushchy means, carry out transfu-chiya of antishock blood substitutes, artificial ventilation of the lungs, at a stop of cordial activity — a cardiac massage.

Prevention of complications of local anesthesia consists in clarification of anamnestic data on portability of drugs and observance of a technique of carrying out anesthesia.