through a needle (or catheter) ako pacijent complains snaan bol. Moe da izazove oteenje nerava ili kimene modine. Test dose.Give 4 ml of 1.5% lidocaine with epinephrine through the catheter, observing the maternal heart rate in between contractions (from the pulse oximeter or EG!. Watch for signs of intravascular(. "ovecan#e srcane fre$venci#e %a &' (") na$on #edne minute mo%e da u$a%e na intravascular in#ection. palpitations, jumpy heart and hypetension! or subarachnoid injection Raise the level with 3 ml boluses to achieve a !" level (usual dose #$% ml). Never give more than 3 ml in one minute. AVOID HYOT!"#IO" $$ DO%&'!"T$ (intervals* + 1. ,ital signs, -. .ualit/ and level of the bloc$, and, &. 012. (lood pressure and patient status should be followed b/ the anesthesiologist for the first &' minutes after an/ bolus in#ection. 2emember that a high bloc$ from a subdural in#ection, and resulting h/potension and respirator/ depression, can occur up to 1.5 hours after an epidural in#ection or top+up.! Stage Description Spinal Dermatomes Stage I pocetak labor do 10 cm cervical dilation T10 !1 "Sympathetic #ibers$ Stage II 10 cm cervical dilatation do rodjenja bebe S %& S' "(udendal nerves, somatic$ Stage III Delivery o# the (lacenta T10 !1 "Sympathetic #ibers$ Kompletan anestezioloki pribor mora da bude dostupan. Poslednjih 4 sta bez davanja opioida---petidin Pre stavljanja katetera mora da se ustanovi faza porodjaja,srana radnja fetusa i arterijski pritisak porodilje Anesteziolo mora da bude prethodno upoznat sa kompletnom medi!inskom istorijom majke,da objasni detalje anestezije Anesteziolo mora tano a odredi volumen,kon!entra!iju i tip anestetika pre zapoinjanja anestezije ". #$ infusion %) Insertion o# epidural as above *) %irst dose iven b& anaesthetist - The standard dose is 1+ml o# 0)1, -upivicaine "*ml 0)+, -upivicaine made up to 1+ml .ith /ormal saline$ 0 1entanyl +0ug) This does act as both initial dose and test dose) 2nalgesia should be apparent .ithin 1 & %0 minutes, although the sensation o# contraction should still be present) ') The mid.i#e measures maternal -( and pulse every #ive minutes #or t.enty minutes and monitors the #oetal heart continuously #or thirty minutes) The anaesthetist stays .ith the mother during this time and is available to administer #luid 03& 4phedrine * & 5 mg boluses as re6uired should systolic -( #all belo. 100m7g or by greater than %0,) +) 2#ter t'ent& minutes, the anaesthetist assesses the components o# the block8 1) s&mpatheti! tople noge %) motor & ability to raise legs o## the bed against resistance *) sensor& redukovana osetljivost na ethyl chloride) 2n upper level o# T9&10 is usually ade6uate) (ei der 3osierung rechnet man %wischen 1 + 1,5 ml pro %u bloc$ierendes 4egment, wobei die 5usbreitung relativ gleichm67ig ober+ und unterhalb der atheterspit%e erfolgt. 8bri%gani anesteti$ i%a%va9e privremenu,rever%ibilnu si()ati*+u,sen-ornu i (otornu blo$adu. (lo$ada sprovo:en#a impulsa prvo nasta#e u tan#im,a %atim u debl#im nervnim vla$nima,pa su ta$o prvo %ahva9ena simpati;$a,%atim sen%orna i na $ra#u motorna vla$na. 2astvori lo$alnog anesteti$a man#e $oncentraci#e dovode do sen%orne blo$ade,$o#a se po#a;ava i produ<ava pove9an#em do%e,do$ rastvori ve9e $oncentraci#e br<e ispol#ava#u de#stvo i uspostavl#a#u i motornu blo$adu ,e9 posle . do / (in od davan#a anesteti$a,nasta#e lagano ubla<avan#e poro:a#nih bolova,u% prate9u simpati;$u blo$adu sa gubit$om ose9a#a %a te()eraturu i hi)oalge-ijo(. "rogresivno dola%i do gubit$a ose9a#a %a bol i lagani dodir,a a$o se $oncentraci#a anesteti$a pove9a,ra%vi#a se gubita$ ose9a#a %a grub dodir i motorna blo$ada.
prela%i lini#a $o#a spa#a obe crista+e iliaca+e superior,i odgovara#u9eg me:upr>l#ens$og prostora(?-+?& i ?&+?4!,$o<a i pot$o<no t$ivo infiltru#u se lo$alnim anesteti$om,$a$o bi intervenci#a prote$la be%bolno 8vesti @uoh/ iglu sa vrhom o$renutim $rani#alno do ligamentum flavum,i%vaditi mandren i sa n#om spo#iti bri%galicu sa fi%iolo>$um rastvorom 8 to$u latentne fa-e )rvog )oro1ajnog doba ra%vi#a se tipi;an visceralni bol umerene #a;ine u obli$u neprestanih gr;eva,$o#i dose<e do @+11 i @+1- dermatoma.a$o porod#a# napredu#e do a$tivne fa%e prvog poro:a#nog doba(dilataci#a cervi$sa &+4 cm!,uterusne $ontra$ci#e posta#u sve #a;e,pa samim tim i bol,$o#i ve9ina porodil#a opisu#e $ao o>tar i gr;evit.An ta$o:e obuhvata dermatome @+11 i@+1-,ali se >iri i na dermatome @+1' i?1."ro#e$ci#a ovih dermatoma u le:nom delu, anatoms$i se po$lapa sa gorn#om polovinom sa$ralne $osti i posledn#a tri lumbalna pr>l#ena(?+5,?+4,?&!. "ri +raju )rvog )oro1ajnog doba i u drugo( )oro1ajno( dobu bol posta#e o>tri#i i >iri se $a perineumu,don#im delovima sa$ruma,anusu,a ;esto i butinama.ao i drugi bolovi i%a%vani stimulaci#om povr>nih somats$ih stru$tura,perinealni bol #e o>tar,dobro lo$ali%ovan,a prenose ga nervi plecsus+a pudendus+a.,e9ina porodil#a se tada <ali na nepre$idne Dati inicijalnu do-u 2 bupivacain ',-5% 5+B ml fra$cionirano, Inter(itentna +ontinuirana(!A32 bupivacain ',-5% 5+B ml, ponoviti do%e posle C' do D' min Visina sen-ornog blo+a $o#a treba da bude do @1' pr>l#ena,procen#u#e se neosetl#ivo>9u pup$a na hladno ili boc$an#e insulins$om iglom,a stepen motornog blo$a (romage+ s$alom o (rthostati! h&potension )anaement :be;bediti adekvatnu hidrataciju i nadoknadu te<nosti Zabeleiti svaku promenu veu za 20% od bazalne H4)oten-ija& smanjenje po<etne vrednosti srednjeg arterijskog pritiska ;a *0,,;ahteva terapijski tretman) %O'5I%ATIO"#2 6. Decreased fetal heart rate. 782 @urn the patient on her side. A- b/ mas$. (olus with E, lactated ringerFs solution (use caution if the patient is h/pertensive!. Ephedrine 5+1' mg. =otif/ A( team, notif/ anesthesia fellow or attending. 9. H4)otension 4/stolic (" G1''mm 1g s/stolic or a decrease of -'%, whichever results in the higher (". 782 E, 2ingers bolus. Ephedrine 5+1'mg E,. Greater left uterine displacement. ?eg elevation if needed. Ef 12 slows ma/ need gl/cop/rollate or atropine. :. High s)inal. 4/mptoms* Hea$ arms, wea$ head+lift, difficult/ swallowing, shortness of breath, decreasing A- 4at 782 Ax/gen b/ mas$, control the airwa/ + intubate if necessar/ using thiopental 1'' mg and succin/lcholine 1-' mg. Ionfirm the position of the endotracheal tube b/ auscultation of the chest and epigastrium, b/ pulse oximetr/, and b/ capnograph/. )onitor vital signs. 4upport ("+fluids, ephedrine, gl/cop/rollate. (eware of the increased li$elihood of h/potension and brad/cardia if general anesthesia is administered in the presence of a high spinal bloc$. .. Intravascular injection. 3iagnosis* 2inging in the ears. 3i%%iness Iircum+oral numbness. 2estlessness, anxiet/. @ach/cardia (if epinephrine used!. 4ei%ures 7;2 4@A" in#ectingJ .Get help statJ .1ave nurse set up suction and '-. .Apen bottom drawer of epidural cart + have resuscitation eKuipment read/J Ef the patient sei%es, protect the airwa/, appl/ additional left uterine displacement, ventilate, and rapidl/ administer thiopental 1'' mg. and succin/lcholine 1-' mg, with cricoid pressure, and intubate. @urn the patient into the left lateral position. )easure vital signsL if the patient is h/potensive, avoid additional thiopental. Don<t )rocrastinate. Alwa4s err on the side of treating too earl4. Ef in doubt, give pressors, paral/%e, intubate, and maintain ox/genation. 2emember that a h/poxic, acidotic patient is more difficult to rescuscitate. (egin 5I?4 immediatel/ M /ou can alwa/s discontinue it if the patient recovers Kuic$l/. N %entral=nervous2 + Excitation* O Iircumoral numbness +++u$ocenost lica O @ongue paresthesia+++pareste%i#a #e%i$a O 3i%%iness++++vrtoglavica O (lurred vision++++%amagl#en pogled O @innitus+++%u#an#e O 2estlessness+++nemir O IonfusionP5gitation+++++ O )uscular twitchings+++podrhtavan#e misica O 4ei%ures tonic clonic++++ tonic clonicni napadi + 3epression* O ?oss of conscience O 2espirator/ arrest O 3eath N %ardio=vascular2 + Earl/Pmild* O 1/pertension O @ach/cardia + 4evere* O 5,+3issociation O (rad/cardia O )/ocardial ischemia O 1/potension O Iardiac arrest (lood concentration
Evaluating The Adjuvant Effect of Dexamethasone To Ropivacaine in Transversus Abdominis Plane Block For Inguinal Hernia Repair and Spermatocelectomy: A Randomized Controlled Trial