Ngaba nawe uziva uloyiko xa unikwa i-anesthetic yendawo? Makhe sithethe nge-LAST (Local Anesthetic Systemic Toxicity)!

Ngaba wakha wathatha i-anesthetic yendawo ukuze ukhuphe izinyo, uthunge inxeba, okanye wenze utyando oluncinci? Uze uzive ungenamsebenzi kwaye akukho nto yenzekayo? Kusenokuvakala kungaqhelekanga, kodwa le anesthetic ibaluleke kakhulu kwezonyango. Nangona kunjalo, kunqabile kakhulu, oko kukuthi, kunqabile kakhulu, le anesthetic inokubangela ingxaki encinci emzimbeni wethu. Yiloo nto siyibiza ngokuba yiLocal Anesthetic Systemic Toxicity , okanye i-LAST . Ungakhathazeki, oku kunqabile kakhulu. Kodwa kulungile ukwazi okuncinci ngale nto.

Ngoko ke yintoni i-LAST (iLocal Anesthetic Systemic Toxicity)?

Ngamafutshane, OKUGQIBELA yimpembelelo yokuba xa iyeza lityiwa, libe nayo kwiinkqubo zomzimba wethu, ingakumbi iCentral Nervous System (CNS), ebuchotsheni nasemqolo, kunye neCardiovascular System, eyintliziyo nemithambo yegazi.

Cinga ngendlela ezisebenza ngayo iintlungu. Zivala okwethutyana imithambo-luvo (imithambo-luvo ejikeleze umzimba) kwindawo ethile yomzimba wethu. Emva koko loo mithambo-luvo ayisayi kuthumela iimvakalelo ezifana neentlungu kunye nokuchukumisa engqondweni. Yiyo loo nto siziva ngathi sixinezelekile kuloo ndawo. Ezi ntlungu ziza ngohlobo lweenaliti, iijeli, kunye nezitshizi.

Ngoko ke, i-LAST iyenzeka kwimizuzu embalwa emva kokuthatha i-painkiller. Kodwa eyona nto ilungileyo kukuba, kukho unyango lwale nto. Ukuba ugqirha wakho ubona ezi mpawu, uza kuthatha amanyathelo ngokukhawuleza.

Zithini iimpawu ze-LAST? Sizibona njani?

I-LAST ichaphazela kakhulu inkqubo yethu yemithambo-luvo (CNS). Iimpawu zokuqala zinokuba zezi:

Iimpawu ezinxulumene nenkqubo ye-nervous system (CNS):

• Ukuxhuzula: Olu lolona phawu luqhelekileyo. Kukho ukuxhuzula ngequbuliso kunye nokulahlekelwa zingqondo.
• Ukudideka okanye ukudideka: Ukungakwazi ukuhlala ungashukumi, ukungakwazi ukugxila, nokungaqondi okwenzekayo.
• Utshintsho lweendlebe: Ukukhala okungapheliyo ezindlebeni (i-Tinnitus) .
• Ukungaziva ngqindilili emlonyeni wakho: Ukungaziva ngqindilili emlonyeni wakho, njengaxa ugqirha wamazinyo efaka iyeza.
• Incasa yesinyithi emlonyeni wakho: Inencasa efana nentsimbi emlonyeni wakho.
• Intetho engacacanga (Dysarthria): Amagama ayaxakaxaka kwaye kuba nzima ukuthetha ngokucacileyo.
• Izinto ezingabonakaliyo: Ukubona okanye ukuva izinto ezingekhoyo ngokwenene.
• Ukungahambi kakuhle kwentshukumo yamehlo: Amehlo ahamba ngokungalawulekiyo, ebonakala ngathi ahamba ukusuka kwelinye icala ukuya kwelinye.

Iimpawu ezinxulumene nenkqubo yentliziyo:

Imeko YOKUGQIBELA inokuchaphazela intliziyo yethu. Emva koko iimpawu ezinje ngezi zinokuvela:

• Uxinzelelo lwegazi oluphantsi:Uxinzelelo luyancipha.
• Utshintsho kwisantya sentliziyo: Isantya sentliziyo sinokuba sicotha kakhulu (iBradycardia) , sikhawuleze kakhulu (iTachycardia) , okanye izingqisho zentliziyo ezingaqhelekanga (iArrhythmias) .
• Ukuphefumla kancinci (Dyspnea): Ubunzima bokuphefumla, ukuphefumla kancinci.
• Ukuma kwentliziyo: Ukuyeka ngequbuliso ukusebenza kombane kwentliziyo. Oku kunokubangelwa kukulahlekelwa ngokupheleleyo komsebenzi wombane entliziyweni (i-asystole) , okanye ziiseli zentliziyo ezibetha ngokukhawuleza nangokungaqhelekanga (i-ventricular fibrillation) .

Kubalulekile: Ukuba ayinyangwa ngokukhawuleza, i-LAST ingakhokelela ekumisweni kokuphefumla okanye kwi-coma .

Ezi mpawu zihlala zibonakala kwimizuzu emihlanu emva kokuthatha i-painkiller. Ngamanye amaxesha ezi mpawu zinokuqala kancinci kakhulu zize zikhule kancinci kancinci, okanye zinokuba nzima ngequbuliso. Yiyo loo nto oogqirha beya kukujonga ngokusondeleyo emva kokukunika i-painkiller, ingakumbi ukuba usemngciphekweni omkhulu wokufumana isifo SOKUGQIBELA.

Kutheni oku kwenzeka okokugqibela? Zithini izizathu?

Eyona nto ibangela i-LAST kukufakwa ngengozi kwe-painkiller kwimithambo yegazi. Cinga ngayo, i-painkiller kufuneka ifakwe kufutshane nomthambo. Kodwa ngamanye amaxesha ukuba ingena kwimithambo yegazi, iyeza linokusasaza ngokukhawuleza emzimbeni wonke lize libangele le meko.

Kubikwa ukuba umngcipheko wokwenzeka kwe-LAST xa kusenziwa ii-nerve blocks ezithintela amalungu ukuba angasebenzi kakuhle umalunga nama-20%. Nangona kunjalo, oku akupheleli apho:

• I-LAST ikwaphuhliswe njengeyeza elisetyenziswa eluswini ngendlela yejeli .
• I-LAST ikwabangelwa ngamayeza acaphukisa i-mucous membranes yomlomo, umphimbo, kunye neendlela zomoya .

Oku kuthetha ukuba i-LAST inokwenzeka nokuba uyisebenzisa njani na i-painkiller. Nangona kunjalo, kukho izinto eziyandisa le ngozi.

Ngubani osengozini enkulu yokufumana isifo sokuGqibela? (Izinto Ezinobungozi)

Izinto ezithile ezinxulumene nempilo yakho zinokunyusa umngcipheko wokuba ube nomhlaza WOKUGQIBELA.

Izinto ezinobungozi ezinxulumene nempilo yakho:

• I-Metabolic acidosis: Xa ibhalansi yeekhemikhali emzimbeni itshintsha kwaye i-asidi iyanda.
• Amanqanaba aphantsi eoksijini emzimbeni (Hypoxia): Xa ubungakanani beoksijini egazini buncipha.
• Isifo sentliziyo esele sikhona: Ingakumbi abo baneemeko ezifana ne -ischemia , i-arrhythmias , i-conduction error , kunye ne -low ejection fraction .
• Abantu abangaphezu kweminyaka engama-65 ubudala:Kwakhona, iintsana ezingaphantsi kweenyanga ezi-4 ubudala zisengozini enkulu yokukhula NGOKUGQIBELA.
• Isifo sesibindi okanye sezintso: Abantu abanezi meko banokukhula ixesha elide KUDALA kuba kuthatha ixesha elide ukuba iyeza liphume emzimbeni.
• Ukukhulelwa.
• Izifo zeMitochondrial: Ezi zizifo ezichaphazela iindawo ezivelisa amandla kwiiseli zethu ezibizwa ngokuba yi-mitochondria.

Izinto ezinobungozi ezinxulumene namayeza eHiri:

Ezinye ii-anesthetics, ezifana ne -bupivacaine , zinokubangela i-LAST kunezinye. Kwakhona, umngcipheko uyanda xa ii-anesthetics zinikwa ngeedosi eziphezulu .

Izinto ezinobungozi ezinxulumene nendlela yonyango oluselwayo:

Ezinye iindlela zokusebenzisa amayeza okudambisa iintlungu zinokunyusa umngcipheko we-LAST. Uphononongo olwenziwe kwiimeko ezili-125 ze-LAST lufumanise oku:

• Iindlela zokungena emzimbeni ziindlela apho amayeza efakwa phantsi kolusu. Oku kwenza malunga nama-20% eemeko ZOKUGQIBELA.
• Iibhloko ze-nervaxial eziphakathi, njengeebhloko ze -epidural kunye ne-caudal, zinikwa umqolo. Zimalunga ne-15% yazo zonke iimeko ezixeliweyo.
• Malunga ne-13% ziye zaxelwa ngenxa yokufakwa rhoqo kwamayeza eentlungu, njenge-saline .

Okokugqibela, i-LAST inokwenzeka ngakumbi xa kufakwa amayeza okubulala iintlungu kwiindawo ezinemithambo yegazi ephezulu . Umzekelo, iimeko ze-LAST zixhaphake kakhulu xa kusenziwa iibhloko zemithambo-luvo yepenile .

Oogqirha bayixilonga njani i-LAST? (Ukuxilongwa)

Oogqirha baxilonga i-LAST ngokuyintloko ngokusekelwe kwiimpawu zakho. Ngenxa yokuba i-LAST yimeko engxamisekileyo efuna unyango olukhawulezileyo, uxilongo alunakulibaziseka. Kunqabile kakhulu, ugqirha wakho unokuyalela i-EKG (i-electrocardiogram) ukuqinisekisa oku.

Ziziphi iindlela zonyango ze-LAST?

I-Local Anesthetic Systemic Toxicity yingxaki yezonyango. Ke ngoko, oogqirha baza kuqala unyango ngokukhawuleza. Unyango oluqhelekileyo lulandelayo:

• Ulawulo lomoya: Unyango lweoksijini lunikwa ngoko nangoko ukuze ugcine ukuphefumla kwakho, kwaye umoya uyanikwa ukuba kuyimfuneko.
• Ukuthintela okanye unyango lokuxhuzula: Oku kuquka ukunika amayeza anjenge -benzodiazepines .
• Ukufakwa kwe-lipid emulsion nge-IV: Eli liyeza elikhethekileyo elinikwa umthambo . Lisebenza ngokufunxa iintlungu egazini nakwizicwili. Oku kunciphisa uxinano lweentlungu ezifikelela kwingqondo nakwintliziyo.
• I-CPR (Ukuvuselelwa kweCardiopulmonary):Ukuba i-LAST ichaphazela ukusebenza kwentliziyo, oogqirha benza i-CPR baze basebenzise ezinye iindlela zokuzinzisa intliziyo.

Emva konyango, uza kugcinwa phantsi koqwalaselo lwezonyango ubuncinane iiyure ezintandathu ukuze kujongwe ukuba unyango luphumelele na kwaye kukho naziphi na ezinye iingxaki.

Kuza kwenzeka ntoni kumntu onesifo sokuGqibela? (Ingqikelelo)

Abo baxilongwa baze banyangwe kwangethuba badla ngokuba neziphumo ezingcono. Unyango lunokuguqula imeko ye-LAST kakhulu.

Nangona kunjalo, ukuba i-LAST enzima ayinyangwa ngokukhawuleza, inokukhokelela kwi-coma okanye ekufeni. Nangona kunjalo, oku kunqabile kakhulu. Umzekelo, ngokwedatha evela kumaziko okulawula ityhefu e-United States, bekukho abantu abane kuphela ababhubha ngenxa yeentlungu zokuphelisa iintlungu ngo-2016.

Ngaba i-LAST ingathintelwa?

I-LAST ayinakuthintelwa rhoqo, kodwa oogqirha basebenzisa iindlela ezithile kunye nezikhokelo zokunciphisa le ngozi.

Umzekelo, ugqirha wakho uza kusebenzisa idosi ephantsi kakhulu yamayeza entlungu afunekayo . Kwakhona, ngamanye amaxesha baya kusebenzisa umfanekiso we-ultrasound ukuze banike inaliti, ukuqinisekisa ukuba ayingeni ngengozi emthanjeni wegazi.

Ukuba unezinto ezinokubangela ukuba ube nesifo sokuGqibela, ugqirha wakho uya kuqwalasela ngononophelo amayeza eentlungu akhuselekileyo, idosi, kunye nendlela yokusetyenziswa.

Xa usiya kufumana i-painkiller, mhlawumbi awucingi kakhulu nge-LAST. Mhlawumbi uxhalabile ngakumbi malunga nokuba inaliti iza kubuhlungu okanye ukuba uza kuziva ungenamdla kakhulu. Yinto eqhelekileyo leyo, kuba i-LAST ayiqhelekanga. Kodwa khumbula, ugqirha wakho uza kukunyamekela kakuhle emva kokukunika i-painkiller. Ukuba ubonakalisa iimpawu ze-LAST, ziya kusebenza ngokukhawuleza.

Okokugqibela, umyalezo oya ekhaya:

Ukuba unemibuzo, iinkxalabo, okanye amathandabuzo malunga ne-anesthetic yakho, ungathandabuzi ukubuza ugqirha wakho. Bakho ukuze bakuncede. I-Local Anesthetic Systemic Toxicity (LAST) ayisiyonto yokoyika, kuba ayiqhelekanga kwaye inonyango oluhle. Eyona nto ibalulekileyo kukwazi oku kwaye uthethe ngokukhululekileyo nogqirha wakho. Emva koko unokujongana nalo naluphi na unyango ngoxolo lwengqondo.

` I-Anesthetic Yasekuhlaleni Ubuthi Benkqubo, I-LAST, ubuthi be-anesthetic, iziphumo ebezingalindelekanga ze-anesthetic, inkqubo yemithambo-luvo, inkqubo yentliziyo, iimpawu, unyango