The method of anesthesia with xenon on mask type

 

(57) Abstract:

The essence of the method is that when applying a pretreatment agent, for example, atropine impose additional small tranquilizer, denitrogenization pure oxygen is conducted according to a semi-open circuit when gasoline 6-8 l/min, after switching to a closed contour in the breathing bag is left not more than 500 ml of oxygen, xenon is fed into the system anaesthetic apparatus in the amount equal to 1.3 VC patient for 1.5-2 min, maintaining its concentration is not more than 70%, after the onset of anesthesia face mask is removed, laryngeal and subsequent anesthesia with a small gasoline spend maintaining the oxygen concentration not lower than 30%. Overflow breathing bag remains gazenergeticheskaya mixture is removed in the device for recycling xenon. After the operation, xenon headlights off, and in the anaesthetic machine serves oxygen for 5 minutes When using the proposed method achieved better denitrogenization (leaching alveolar nitrogen), which leads to lower nitrogen levels up to 0.4%. The absence of nitrogen in a closed loop facilitates correct formation gazenergeticheskaya mixture Heh with O2and conduct of adequ is 3-4 times as compared with the known methods, when gazenergeticheskaya mixture is removed from the breathing circuit to the atmosphere.

The invention relates to medicine, namely to anesthesiology.

Starting from 1946 to 1955, in different countries conducted 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, indifferent in the body, easy to operate, environmentally friendly and safe for patients and the surrounding personnel.

However, xenon is relatively expensive gas. In our country the cost of 1 liter is $ 1-2 and abroad to 7 dollars. This fact limits its wide application in the practice of anesthesiology, especially abroad, as 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, the xenon anesthesia by mask type, including inhalation xenon-oxygen mixture in a ratio of 0.8:0.2 to through the mask anesthesia apparatus while maintaining spontaneous breathing of the patient (S. Cullen and E. Gross The Anestetik Properties of Xenon in Animals and Human Beings with Additional Observations on Krypton. Science, 1951, v. 113, p. 580-582).

The disadvantage of this method is the lack of control over the degree of denitrogenization and the oxygen concentration in the breathing circuit, the duration of saturation (10-20 min). High consumption of xenon (20-40 liters) makes anesthesia expensive and limits its application.

As the prototype accepted way of xenon anaesthesia by mask type (C. B. Pittinger, J. Moyers, S. Cullen, R. Feather, a Stone Gross. Clinicopatologic studies associated with Xenon anestisia of Anesthesiology, 1953, v. 14, p. 10-17), including premedication with atropine at a dose of 0.2-0.3 mg, holding denitrogenization 100% oxygen for semi-loop absorber for 10 min at Gattaca 5-10 l/min, connection in a system of closed circuit oxygen in the volume of 250-300 ml/min and xenon 900 ml/min for Approximately 10 min, the oxygen concentration in the breathing circuit is reduced to 20% and maintained subsequent to the period of anesthesia and surgery.

However, the known method has a number of disadvantages, the main of which one is ergicheskoi operations. In addition, the method of denitrogenization 100% oxygen for 10 min at semi-closed circuit, as shown by studies of T. M. Darbinyan with co-authors (T. M. Darbinyan et al. Closed contour under General anesthesia with artificial ventilation of the lungs, as well. "Anesthesiology and reanimatology", 1979, No. 9, S. 7-11) does not ensure complete elimination (removal) of the alveolar nitrogen and it remains in the circuit anesthesia apparatus at a concentration of 4.5 to 11.5% of which inevitably leads to a decrease in the concentration of xenon in gazenergeticheskaya mixture, to cases of inadequate anesthesia, as was the case in S. Cullen and Gross, when they had advanced introduces 50 mg meperidine intravenously to the patient calmed down.

In addition, when the mask method of anesthesia practically difficult to achieve complete sealing of the breathing circuit for the entire period of anesthesia, possible leakage of xenon. You need more flow. If we take into account that the authors of this method would use the smallest gazook Xe with O2(1,5: 0,5) conditionally closed circuit, and in this case, the total consumption Xe would be 30 l/h

The objective of the invention is to provide a highly effective method of anesthesia with xenon on mask type, posnet invention is in the method of the anesthesia with xenon on mask type, including premedication with atropine, denitrogenization pure oxygen for 10 minutes, the connection of xenon in a closed loop system, the establishment of a laryngeal mask with the further maintenance of anesthesia until the end of the operation, premedication additionally include small tranquilizer, for example, seduxen, denitrogenization pure oxygen is conducted according to a semi-open circuit when gasoline 6-8 l/min, after switching to a 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 volume equal to 1.3 vital capacity (VC) of the patient for 1.5-2 min, maintaining its concentration in gazenergeticheskaya mixture is not more than 70% with gas analyzer oxygen, after the onset of anesthesia face mask is removed, laryngeal and subsequent anesthesia with a small gasoline spend (when the ratio of oxygen and xenon 0,3: 0,3-0,2), 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, etc is giving 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 achieved better denitrogenization (leaching alveolar nitrogen), which results according to the research of M. Navratil (1967) to reduce nitrogen levels up to 0.4% No nitrogen in a closed loop facilitates correct formation gazenergeticheskaya Xe mixture with O2and carrying out adequate anesthesia.

Submission of Xe in a closed path in a volume equal to 1.3 M for 1.5-2 minutes (immediately after denitrogenization), leads to rapid formation of the necessary gazenergeticheskaya mixture, the saturation of the organism, the rapid onset of anesthesia (4-5 minutes) and transfer to a closed circuit with the establishment of small Gattaca. This reduces the starting loss of anesthetic.

Changing the face of the laryngeal mask during the initial period of anesthesia contributes to the achievement of full integrity in the system, closed loop, prevents leakage of Xe and frees the hands of the anesthesiologist.

When using the proposed method achieved SOCA mixture is removed from the breathing circuit into the atmosphere.

Significant difference between the proposed method xenon anesthesia from known methods is the utilization and regeneration of exhaled xenon without discharge into the surrounding atmosphere and the possibility of its reuse. The method of anesthesia in these conditions becomes several tens times cheaper, as utilized more than 95% of spent Xe, which after regeneration can be reused.

In connection with utilization and regeneration of exhaled Xe expand the functionality and simplified method of anesthesia, because you can use less sophisticated methods xenon anesthesia with constant suction gazenergeticheskaya mixture in system utilization and regeneration and to reduce the consumption of xenon.

Simplicity and environmental friendliness of the proposed method can be used in various fields: surgery, obstetrics and gynecology, traumatology and other

The method is as follows.

Before the beginning of the operation to the V-shaped connector anesthetic apparatus in place of attaching the breathing bag with a rubber hose attached to the vacuum suction device for recycling xenon from gazouli for surgery and anesthesia on the operating table are sedation by intravenous introduction of atropine (at a dose of 0.1 mg to 10 kg), the seduksen 10 mg (or other effect). Then produce inhalation of 100% oxygen through a special mask anaesthetic apparatus according to a semi-open circuit when gasoline 6-8 l/min for 10 min to denitrogenization breathing circuit. Then move on a closed path, leave in the breathing bag is not more than 500 ml of oxygen and fed into the system anesthetic apparatus Xe specially calibrated float dosimeter in the amount equal to 1.3 VC this patient for 1.5-2 minutes During this period, the concentration of Xe in the anesthetic circuit of the apparatus will be set in the range of 65-70% and oxygen 30-35% that must be monitored by a gas analyzer for O2. In the next set small gazook 0.2 and Xe in the ratio of 0.3: 0.3 to 0.2 and after fast enough (4-5 min) onset of anesthesia, oppression swallowing and gag reflexes, facial mask is removed, install the laryngeal mask, which provides reliable sealing of the closed path, and frees the hands of an anaesthetist. Subsequent anesthesia is carried out at a small gasoline O2and Xe (0,3:0,2) periodically changing the ratio (if necessary) with constant monitoring of the level of O2in the circuit, keeping it within 30%
is the northward.

At the end of anesthesia and disable Xe in the anaesthetic machine begin to apply O2in the amount of 6-8 l/min for 5 min for complete elimination of Xe from the body of the patient. The remains gazenergeticheskaya mixture is removed in the device for recycling xenon.

Way passed clinical trials in the Department of anesthesiology and resuscitation of RMAPO MH and MP of the Russian Federation at the 10 operations.

Example. Patient P. 24, East. B. N 23209. Diagnosis: left-sided inguinal hernia. An operation of Greenacre 6 November 1992 Anesthesia with xenon on mask type was carried out as follows.

Before the beginning of the operation to the V-obraznomu connector anesthetic apparatus attached to the vacuum suction device for recycling xenon.

After performing the conventional preparation of the patient for surgery and anesthesia on the operating table held a sedation by intravenous injection of 1 mg of atropine and 10 mg seduksen. Then spent the inhalation of 100% oxygen through a special mask anaesthetic apparatus according to a semi-open circuit for 10 min at Gattaca 8 l/min to denitrogenization breathing circuit. Then switched to a closed contour. In the breathing bag left 500 ml of oxygen. On red for 2 minutes After 2 min, the oxygen concentration decreased 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, corresponding to 1 to level 3 stage.

After 5 min after the inhalation of xenon began the operation.

Premedication: atropine 1 mg, diphenhydramine 10 mg, fentanyl 0,1 mg. Denitrogenization 100 O2within 10 min via mask anaesthetic apparatus according to a semi-open system. At 9.30 included Xe in the amount of 1.3 VC. After 2 min, the concentration of O2decreased to 40% of the stream Xe reduced to 2 l/min and after 1 min the concentration of O2decreased to 30% came anesthesia, corresponding to 1 to level 3 stage. After 5 min after the inhalation of Xe operation began. The duration of 70 minutes, the duration of anesthesia 77 minutes After 4 minutes after turning off Xe patient is fully conscious. Hemodynamics during surgery remained stable, BP 130/80, pulse 70-80, O24 about. FiO230% of the Total consumption Xe without recycling 14 HP Subjective feelings from anesthesia in a patient with a pleasant, pain in the wound when you cough sample was not tested.

The method of anesthesia with xenon on mask type, including premed what about the circuit, the establishment of a laryngeal mask with the further maintenance of anesthesia until the end of the operation, characterized in that the pretreatment additionally include small tranquilizer, for example, seduxen, denitrogenization pure oxygen is conducted according to a semi-open circuit when gasoline 6 8 l/min, after switching to a 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 vital capacity (VC) 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, the onset of anesthesia, after the onset of anesthesia face mask, remove, enter laryngeal and subsequent anesthesia with a small gasoline carried out at the ratio of oxygen and xenon 0,3 0,3 0,2, maintaining the oxygen concentration not lower than 30% in gazenergeticheskaya mixture that crowded when the breathing bag is removed through an outlet channel in the device for recycling xenon, and after the operation and shutdown of xenon in the anaesthetic machine serves oxygen in an amount of 6 to 8 l/min for 5 min, and the remains gazenergeticheskaya mixture delete

 

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