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How to Survive in Anaesthesia - Part 4

Rất khó để làm cho một trường hợp để tiếp tục sử dụng các giải pháp này. Sự căng thẳng của phẫu thuật làm tăng glucose máu lưu thông để bổ sung glucose nhiều hơn tĩnh mạch làm trầm trọng thêm sự xúc phạm trao đổi chất. Hơn nữa, khi đường cuối cùng là bị oxy hóa nước và carbon dioxide, truyền dịch sau đó tương đương với nước (glucose 5%) hoặc một giải pháp rất yếu nhược trương (4% glucose + 0,18% natri clorua giải pháp). | emedicina Monitoring in anaesthesia Anaesthetist The anaesthetist must be present throughout the whole surgical procedure and be readily available to recovery room staff until the patient leaves the theatre complex. This responsibility is solely the anaesthetist s and is applicable in general and regional anaesthesia and also in some sedation techniques where the anaesthetist is involved. An adequate record must be made of the whole anaesthetic process from the induction to full recovery of the patient. Errors can occur for a variety of reasons ranging from inexperience and lack of training to tiredness boredom and inattention. Vigilance in an anaesthetist is a function of self-motivation. The novice anaesthetist should acquire rigorous monitoring habits. Tracheal intubation must be confirmed every time and the equipment the anaesthetic machine and circuitry checked as a routine. Postoperative visits to assess a patient s progress are salutary and give an opportunity to improve aspects of care such as postoperative analgesia nausea and vomiting. Checking and monitoring equipment Checking and monitoring the function of anaesthetic equipment has already been discussed in preceding chapters. The means of maintaining airway control intravenous fluids and infusion devices must be understood the anaesthetic machine circuits and ventilators must be checked. Two key features must be emphasised - the oxygen supply and the breathing systems. Oxygen supply The gas supply to the oxygen flowmeter must contain a low pressure warning device and have an audible alarm. If hypoxic mixtures can be delivered most old machines then a device which monitors continuously the concentration of oxygen delivered to the patient must be fitted and have an audible alarm. Breathing system If faults exist in the circuit these are best detected by monitoring the expired volume the end-tidal carbon dioxide concentration and by 47 emedicina How to Survive in Anaesthesia measuring the airway pressure