Machame Anaesthesia Notebook for Medical Auxiliaries: With Special Emphasis on the Developing Countries

ISBN-13: 9783540090557 / Angielski / Miękka / 1982 / 154 str.

G. Kamm; T. Graf-Baumann

Opis

The advances in the field of anaesthesiology and reanimation have contributed in all developed countries to the decrease in deaths occurring on the operating table (exitus in tabula), from the ratio 1: 100 (in the nineteenth century) down to approximately 1: 1000 (in the first half of the twentieth century) and finally to approxi mately 1: 10 000 (nowadays). Numerous human lives were saved not only through the intro duction of new medicine and methods but even more so by better training for the doctors and nurses who apply these new techni ques. I am happy about the splendid initiative of my student and friend Georg Kamm, which has now made these advances acces sible to the developing countries. He knows very well how to make his colleagues understand the theory and the practical side of modern anaesthesiology, under the most difficult conditions and in a completely different world, to such an extent that to day in his country all of his patients are given the benefit of the advances of medicine. There is nothing more rewarding for an academic teacher than to see how his students continue developing his ideas and spread them far and wide. I am therefore happy and proud to write this foreword for Georg Kamm, one of the pioneers of anaesthesiology in Africa."

Spis treści

1. A Short Review of the Anatomy and Physiology of the Respiratory System.- 1.1 Anatomy.- 1.2 Physiology.- 1.2.1 Upper Respiratory System.- 1.2.2 Lower Respiratory System.- 1.2.2.1 Larynx.- 1.2.2.2 Trachea.- 1.2.2.3 Bronchi.- 1.2.2.4 Lungs.- 1.2.3 Mechanism of Ventilation.- 1.2.4 Regulation of Respiration.- 1.2.5 Normal Respiratory Rate.- 1.2.5.1 Ventilation.- 1.2.5.2 Diffusion.- 1.2.5.3 Perfusion.- 1.3 Oxygen.- 1.4 Anatomy and Physiology of the Autonomic Nerve System.- 2. Pharmacology of General Anaesthesia.- 2.1 Inhalation Anaesthesia.- 2.1.1 Ether.- 2.1.1.1 Effects on the Central Respiratory System (CRS).- 2.1.1.2 Effect on the Cardio-Vascular System (CVS).- 2.1.1.3 Muscle Relaxation.- 2.1.1.4 Disadvantages of Ether.- 2.1.1.5 Advantages of Ether.- 2.1.1.6 Dosage of Ether.- 2.1.2 Halothane.- 2.1.2.1 Effect on the CRS.- 2.1.2.2 Effect on the CVS.- 2.1.2.3 Excretion and Fate.- 2.1.2.4 Disadvantages of Halothane.- 2.1.2.5 Advantages of Halothane.- 2.1.2.6 Clinical Use.- 2.1.2.7 Dosage.- 2.1.3 Trilene.- 2.1.4 Gas.- 2.1.4.1 Use.- 2.2 Intravenous Anaesthesia.- 2.2.1 Barbiturates.- 2.2.1.1 The Effect on the CNS.- 2.2.1.2 Effects on the CRS.- 2.2.1.3 Effect on the CVS.- 2.2.1.4 Metabolisation.- 2.2.1.5 Advantages of Barbiturates.- 2.2.1.6 Disadvantages of Barbiturates.- 2.2.1.7 Contraindications.- 2.2.2 Ketalar.- 2.2.2.1 Effects on the CVS.- 2.2.2.2 Effects on the CRS.- 2.2.2.3 Reflexes and Muscle Tonus.- 2.2.2.4 Laboratory Analysis.- 2.2.2.5 Dosage and Duration of Action.- 2.2.2.6 Clinical Use of Ketalar.- 2.2.2.7 Disadvantages of Ketalar.- 2.2.2.8 Contraindications.- 2.2.3 Propanidid (Epontol).- 2.3 Neuromuscular Blocking Drugs.- 2.3.1 Non-depolarising Muscle Relaxant.- 2.3.1.1 Dosage and Duration of Action.- 2.3.2 Depolarising Relaxant (Succinyl bicholine).- 2.4 Other Drugs Used in Anaesthesia.- 2.4.1 Atropine.- 2.4.2 Analgetica.- 2.4.2.1 Mechanism of Action.- 2.4.2.2 Effects of Analgetics.- 2.4.2.3 Dosages of the Different Agents.- 2.4.3 Narcotic Antagonists.- 2.4.4 Neuroleptica.- 2.4.5 Diazepam (Valium).- 2.4.6 Tranquilisers (Promethazine).- 2.5 List of Drugs Commonly Used in Anaesthesia.- 3. Pre-operative Examination.- 3.1 History of the Patient.- 3.2 Clinical Examination.- 3.3 Laboratory Investigations.- 3.4 Summary.- 3.5 Comments.- 3.6.1 Cyanosis.- 3.6.2 Tumours, etc.- 3.6.3 Lung Disease.- 3.6.4 Circulation Problems.- 3.6.5 Hypotension.- 3.6.6 Hypertension.- 3.6.7 Arrhythmia.- 3.6.8 Tachycardia.- 3.6.9 Bradycardia.- 3.6.10 Hepatomegaly and Ascites.- 3.6.11 Temperature.- 3.6.12 History of Drug Taking.- 3.7 Laboratory Investigation.- 3.8 Remember.- 4. Premedication.- 4.1 Lowering of Reflex Activity.- 4.2 Sedation and Reduction of Anxiety.- 4.2.1 Neuroleptics.- 4.2.2 Sedative Analgetics.- 4.2.3 Tranquiliser.- 4.3 Premedication for Children and Infants.- 4.4 Summary.- 5. Maintenance of the Airway.- 5.1 Causes of Respiratory Obstruction in the Patient.- 5.1.1 Loose Teeth.- 5.1.2 Tumours.- 5.1.3 Stenosis.- 5.1.4 Pharynx.- 5.1.5 Vomiting.- 5.1.6 Spasm.- 5.1.7 Obstruction of the Trachea and Bronchi.- 5.2 Intubation.- 5.2.1 Indications and Contraindications.- 5.2.1.1 Poor-Risk Patients.- 5.2.1.2 Operations on Certain Parts of the Body.- 5.2.1.3 Position of the Patient.- 5.2.1.4 Severity and Length of the Operation.- 5.2.1.5 Contraindication.- 5.2.2 Technical Equipment.- 5.2.2.1 Endotracheal Tubes.- 5.2.2.2 Laryngoscope.- 5.2.3 Methods of Intubation.- 5.2.4 Oral Intubation Under Light Anaesthesia with Muscular Relaxation.- 5.2.5 Nasal Intubation.- 5.2.6 Oral Intubation Under Local Anaesthesia with a Sedated Patient.- 5.2.7 Difficulties and Complications.- 5.2.7.1 Anatomical Problems.- 5.2.7.2 Insufficient Relaxation.- 5.2.7.3 Complications.- 5.2.7.4 Late Complications.- 5.3 Artificial Ventilation of the Lungs.- 5.3.1 Controlled Respiration.- 5.3.2 Assisted Respiration.- 6. Anaesthesia Techniques and Equipment.- 6.1 Open Method.- 6.2 Half-Open Method or Semi-Open System.- 6.2.1 The Choice of Ether.- 6.2.2 The Choice of Air.- 6.2.3 The Choice of the Non-Return System.- 6.3 Half-Closed System.- 6.4 Closed System.- 6.5 PEEP Respiration.- 7. General Anaesthesia Techniques.- 7.1 Barbiturate — Ether — Air.- 7.2 Ketalar — Ether — Air.- 7.3 Neuroleptica — Ether — Air.- 7.4 Induction Followed by 02+N20+Halothane.- 7.5 Maintenance of Anaesthesia.- 7.6 Monitoring.- 7.6.1 Respiration.- 7.6.2 Circulation.- 7.6.3 O2 Substitute.- 7.7 Recovery.- 7.8 Relaxation and Artificial Ventilation.- 7.8.1 Technique.- 7.8.2 Maintenance.- 7.8.3 Recovery Period.- 8. Anaesthesia in Obstetrics.- 8.1 Drugs.- 8.2 Adequate O2 Tension.- 8.3 General Anaesthesia for Caesarean Section.- 8.4 Care and Resuscitation of the Neonatal.- 9. Paediatric Anaesthesia.- 9.1 Equipment.- 9.2 Technique of Anaesthesia.- 9.2.1 Premedication and Induction.- 9.2.2 Intubation.- 9.2.3 Continuous Anaesthesia and Relaxation.- 9.2.4 Monitoring.- 9.2.5 Recovery and Extubation.- 9.2.6 Prevention of Cooling.- 10. Ketalar-Mono Anaesthesia.- 10.1 Short-Acting Anaesthesia.- 10.2 Anaesthesia for Longer than 20 Minutes.- 10.3 Indication and Technique.- 10.4 Scoline-drip as Muscle Relaxant.- 11. Anaesthesia for Ophthalmic Surgery.- 12. Anaesthesia and Associated Medical Problems.- 12.1 Anaemia.- 12.2 Sickle Cell Anaemia.- 12.3 Heart Disease.- 12.4 Hypertension.- 12.5 Chest Disease.- 12.6 Chronic Chest Disease.- 12.7 Liver Disease.- 12.8 Renal Disease.- 12.9 Diabetes.- 13. Local Anaesthesia.- 13.1 Pharmacology.- 13.1.1 Addition of Vasoconstriction.- 13.1.2 Toxicity.- 13.1.3 Metabolisation.- 13.2 Indications of Local Anaesthesia.- 13.3 Complications.- 13.4 Types of Local Anaesthesia.- 13.4.1 Topical or Surface Anaesthesia.- 13.4.2 Infiltration Anaesthesia.- 13.4.3 Regional Anaesthesia.- 13.5 Technique.- 13.5.1 Surface Anaesthesia.- 13.5.2 Infiltration Anaesthesia.- 13.5.3 Regional Anaesthesia.- 13.5.3.1 Digital Nerve Block.- 13.5.3.2 Intravenous Forearm Block.- 13.5.3.3 Plexus Block.- 13.6 Spinal Anaesthesia.- 13.6.1 Anaesthetic Anatomy.- 13.6.2 Drugs and Instruments.- 13.6.3 Method.- 13.6.4 Care and Monitoring.- 13.6.5 Complications with Spinal Analgesia.- 13.6.6 Indications and Contraindications.- 13.7 Epidural Anaesthesia.- 13.7.1 Complications.- 14. Management of Emergency Situations.- 14.1 Cardiac Arrest.- 14.1.1 Summary.- 14.2 Shock.- 14.3 Poisoning.- 15. Fluids and Electrolytes.- 15.1 Acidosis and Alkalosis.- 15.2 Electrolytes.- 15.2.1 Pre-Operative.- 15.2.2 Intra-Operative.- 15.2.2.1 Blood Transfusion.- 15.2.3 Post-Operative.- 15.2.3.1 Acidosis.- 16. Intensive Care Unit (I.C.U.).- 16.1 Trained Personnel.- 16.2 Special Establishment.- 16.3 Equipment.- 17. Fear and Confidence.- References.