The method of anesthesia with xenon at endotracheal type

 

(57) Abstract:

Usage: medicine, anesthesiology for anesthesia with xenon at endotracheal type. The use of the invention allows to obtain the following technical result. Achieved reduction of consumption xenon 3-4 times and reduce the cost of anesthesia in several dozen times. Shortens the time of onset of anesthesia up to 4-5 minutes the Essence of the invention consists in carrying out premedication with atropine and seduksen, denitrogenization oxygen, induction of anaesthesia, diplegia, intubation, IVL with the transition to a closed circuit feed of xenon in the system anaesthetic apparatus and anaesthesia at low Gattaca. Denitrogenization carried out on a semi-open circuit when gasoline 6-8 l/min ventilation is carried out on a semi-open circuit when gasoline 6-8 l/min After the transition to the closed contour in the breathing bag is left not more than 500 ml of oxygen, xenon served in a volume equal to 1.3 M for 1.5-2 minutes Subsequent anesthesia is carried out at oxygen concentrations below 30%. Overflow breathing bag, and after anesthesia gazoenergeticheskuju mixture is removed in the device for recycling xenon.

The invention Rel is s numerous experimental and clinical studies on the use of an inert gas xenon (Xe) for anesthesia, confirming the existence of a strong narcotic properties than nitrous oxide. It was shown that Xe unlike it provides reliable anesthesia option mononarkoza when performing abdominal surgery. In addition, it has no toxicity, indiferente in the body, easy to operate, environmentally friendly and safe for patients and the surrounding personnel.

However, the high cost of xenon (7 dollars abroad and 1-2 dollars in our country for 1 l) limits its wide use in the practice of anesthesiology, especially abroad, because most countries have to import it.

In our country adjusted industrial production xenon high purity 99,999% (GOST 10219-77 with changes 1, 2).

There are large reserves of it, but the methods of anesthesia with xenon has not been studied and are in need of development.

There is a method of anesthesia with xenon at endotracheal type (E. Boomsma, J. Rupreht at all. Haemodynamic and neurohumotal effects of xenon anaesthesia. A comporison mith nitrous oxide-Anaesthosia, 1990, v. 45, p. 273-278), which consists in the fact that after the induction of anesthesia barbiturates and intravenous muscle relaxant patient inkubiruut, transferred to an artificial valve is of Sedona (Xe) with oxygen (O2) in the ratio of 0.7:0.3 to low Gattaca through the closed circuit. Every 20 min closed contour "washed" fresh portion gazenergeticheskaya mixture.

The disadvantage of this method is the high consumption of xenon (20-40 liters), which restricts the use of such expensive anesthesia.

As the prototype accepted method of anesthesia with xenon at endotracheal type (B. Lachmann, S. Armbruster, W. Schairer at all. Safety and efficacy of xenon in routine use as an inhalational anaesthetis Lancet, 1990, v. 335, p. 1413-15), which is that after premedication with atropine at a dose of 0.002 mg/kg are denitrogenization 100% O2perform anaesthesia induction by thiopentone at a dose of 2.5-5 mg/kg and fentanyl in a dose of 0.1 mg After diplegia pancuronium dose of 0.1 mg/kg of the patient inkubiruut, conduct IVL 100% O2within 6-8 min to denitrogenization, then move to a closed circuit with a small Gattaca gazenergeticheskaya mixture of Xe and O2in the ratio of 0.7:0.3, and which support the entire period of operation. However, every 20 min closed contour "washed" fresh portion gazenergeticheskaya mixture, and Xe is removed into the surrounding air without waste.

However, the known method has significant drawbacks.

Exhaust xenon not the undesirable factor for staff. In addition, the flow rate of xenon is 10 litres per hour (70-150 dollars), which makes anesthesia expensive and difficult to access.

The objective of the invention is to provide a highly effective method of anesthesia with xenon at endotracheal type that allows to reduce the consumption of xenon and reduce the cost of anesthesia.

The invention consists in that in the method of the anesthesia with xenon at endotracheal type, including premedication with atropine, denitrogenization pure oxygen, induction of anaesthesia, diplegia, intubation, re-denitrogenization by artificial ventilation of the lungs with subsequent transition to a closed circuit feed of xenon in the system anaesthetic apparatus and anaesthesia at low Gattaca and the ratio of xenon and oxygen to 0.7:0.3, and when carrying out sedation in the patient's body in addition enter seduxen, denitrogenization carried out on a semi-open circuit when gasoline 6-8 l/min for 5 min, artificial ventilation of the lungs is carried out on a semi-open circuit when gasoline 6-8 l/min for 3-4 min after the transition to the closed contour in the breathing bag is left not more than 500 ml of oxygen, xenon is fed into the system anesthesia machine is for 1.5-2 min, maintaining its concentration in gazenergeticheskaya mixture is not more than 70% with gas analyzer oxygen, subsequent anesthesia is carried out using low gasoline when the ratio of xenon and oxygen 0,3-0,2:0,3 maintaining the oxygen concentration not lower than 30% in gazenergeticheskaya mixture, which overflow the breathing bag is removed through an outlet channel in the device for recycling xenon, and after anesthesia and off xenon in anesthesia apparatus serves oxygen during Gattaca 6-8 l/min for 5 min, and the remains gazenergeticheskaya mixture is removed in the device for recycling xenon.

The use of the invention allows to obtain the following technical result.

When using the proposed method is achieved by reducing the consumption of expensive xenon 3-4 times in comparison with the known method.

Anesthesia in terms of utilization and regeneration of exhaled xenon becomes cheaper in a few dozen times, because 95% of the used xenon after regeneration can be reused.

Achieved better denitrogenization. The absence of nitrogen in a closed loop facilitates correct formation of g is and shortens the time of onset of anesthesia up to 4-5 minutes

Functional possibilities of application of xenon and simplified method of anesthesia, because there is no need to save energy and reduce its consumption.

Simplicity and environmental friendliness of the method is recommended for wide application in various fields: surgery, obstetrics and gynecology, traumatology and other

The technical result is achieved due to the utilization and regeneration of exhaled xenon with the possibility of its reuse.

Developed by the authors method of denitrogenization semi contour in gasoline 6-8 l/min promote a higher quality of nitrogen leaching and conduct adequate anesthesia.

Reducing the time of onset of anaesthesia is achieved by supplying xenon in a closed path in a volume equal to 1.3 M for 1.5-2 min immediately after denitrogenization.

The method is as follows.

Before the beginning of the operation to the V-shaped connector anesthetic apparatus in place of fixing the breathing bag with a rubber hose attached to the vacuum suction device for recycling xenon from gazenergeticheskaya mixture (patent RF N 2049487, class A 61 M 16/01, 19 are sedation by intravenous atropine in a dose of 0.1 mg to 10 kg and 10 mg seduksen for 10 min before induction of anaesthesia. During this period, through facial mask anaesthetic apparatus hold the inhalation of 100% oxygen in a semi-open circuit when gasoline 6-8 l/min for 5 min to denitrogenization breathing circuit.

Then perform anaesthesia induction with thiopental (4-6 mg/kg) or calypsol (2 mg/kg), diplegia with ListenOn (1.5 mg/kg), after which the patient inkubiruut and provide mechanical ventilation with 100% oxygen via a semi-open loop, using the valve Ruben, when gasoline 6-8 l/min for 3-4 min for a more reliable elimination of alveolar nitrogen. Then move on a closed path, leaving in the breathing bag is not more than 500 ml of oxygen for 1.5-2 min serves xenon through a specially calibrated float dosimeter in the amount equal to 1.3 vital capacity (VC) of the patient. During this period, the concentration of xenon in the system of the anesthesia apparatus is set at the level of 65-70% and oxygen 30-35% which is supported by using the oxygen analyzer. In subsequent anesthesia is carried out using low gasoline when the ratio of xenon and oxygen 0,3-0,2:0,3, periodically changing it if necessary, without reducing the oxygen concentration below 30% overflow breathing bag gazoenergeticheskuju sesamestreet oxygen in the system anaesthetic apparatus in the amount of 6-8 l/min for 5 min for complete elimination of xenon from the body of the patient and the breathing circuit of the anesthesia machine. The remains gazenergeticheskaya mixture is removed in the device for recycling xenon.

Example. Patient K., 42, Diagnosis: chronic calculably cholecystitis.

After performing the conventional preparation of the patient for surgery and anesthesia on the operating table held sedation by intravenous atropine 1 mg, seduksen 10 mg, fentanyl 0,1 mg Through facial mask anesthesia apparatus held inhalation of 100% oxygen in a semi-open circuit when gasoline 6 l/min for 5 min to dehydrogenization. Then realized anaesthesia induction with thiopental sodium 500 mg, mipagi the ListenOn 100 mg and tracrium 25 mg. After that, the patient was intubated. Conducted mechanical ventilation with 100% oxygen via a semi-open loop, using the valve Ruben, when gasoline 8 l/min for 4 minutes Then switched to a closed contour, leaving a breathing bag 500 ml of oxygen. A specially calibrated the dosimeter system anesthetic apparatus filed xenon in an amount equal to 1.3 VC sick for 2 minutes

The oxygen concentration was reduced to 40% of the flow of xenon is reduced to 2 l/min after 1 min, the oxygen concentration decreased to 30% which was controlled by the oxygen analyzer. Came anesthesia. CHN. All subsequent anesthesia was conducted with a small gasoline with control of oxygen concentration not lower than 30% overflow breathing bag gazoenergeticheskuju the mixture was removed through an outlet channel in the device for recycling xenon. After anesthesia xenon headlights turned off, as the anesthetic apparatus for 5 min was carried out by oxygen in an amount of 6 l/min Remains gazenergeticheskaya mixture was removed in a device for regeneration of xenon. After 4 min after anesthesia, the patient was fully conscious, extraurban. Hemodynamics during surgery stable (blood pressure=140/90, pulse 80, CO about 2-4. Anesthesia according to EMG, EEG and clinical picture is adequate. Total consumption Xe without disposal 12 HP Subjective feelings of the patient after recovery from anesthesia pleasant. There were no complaints.

The method of anesthesia with xenon at endotracheal type, including premedication with atropine, denitrogenization pure oxygen, induction of anaesthesia, diplegia, intubation, re-denitrogenization by artificial ventilation of the lungs with subsequent transition to a closed circuit feed of xenon in the system anaesthetic apparatus and anaesthesia at low Gattaca and the ratio of the Xeno is Yat seduxen, denitrogenization carried out on a semi-open circuit when gasoline 6 - 8 l/min for 5 min, artificial ventilation of the lungs is carried out on a semi-open circuit when gasoline 6 8 l/min for 3 to 4 min after the transition to the closed contour in the breathing bag is left not more than 500 ml of oxygen, xenon is fed into the system anaesthetic apparatus specially calibrated float dosimeter in the amount equal to 1.3 lung capacity of the patient within 1.5 to 2.0 min, maintaining its concentration in gazenergeticheskaya mixture is not more than 70% with gas analyzer oxygen, subsequent anesthesia is carried out using low gasoline when the ratio of xenon and oxygen 0,3 0,2 0,3, maintaining the oxygen concentration not lower than 30% in gazenergeticheskaya mixture, which overflow the breathing bag is removed through an outlet channel in the device for recycling xenon, and after anesthesia and off xenon in anesthesia apparatus serves oxygen during Gattaca 6 8 l/min for 5 min, and the remains gazenergeticheskaya mixture is removed in the device for recycling xenon.

 

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