Kudzora Upfu Pashure Kokuvhiya Ndiko Kunokosha
Mishonga inowanzoshandiswa kare, panguva, uye mushure mokuvhiya inoparadzaniswa zvakanyanya kubva kune murwere kusvika kune murwere. Izvi ndezvokuti mishonga chaiyo yaunogamuchira inobva pane rudzi rwekuvhiya iwe uripo, anesthesia iwe uchange uchitarisana, uye chero dambudziko rehutano huripo.
Pre-Operative kana Kupera Mishonga
Usati wambovhiyiwa, uchasangana neanesthesiologist yako.
Panokushanyira, iwe uchaongorora matambudziko ako ose ezvechiremba uye mazino uye maronda, pamwe nemishonga ipi yaunotora, kusanganisira mishonga inowedzera, mavhithamini, uye chero zvinodhaka-zvinodhaka semishonga seApirin.
Mukuwedzera, iva nechokwadi chekuudza anesthesiologist yako kana iwe ukatora mishonga isina kutenderwa, utsi, kana kunwa doro, sezvo zvose izvi zvinogona kukukanganisa kuti unoporesa sei kubva pakuvhiyiwa kwako uye kuti anesthesia zvinodhaka zvakadini zvinoshanda.
Pano rumwe rutivi, zvakakosha kuziva kuti kurega kusvuta kunotangira mushure mekuvhiyiwa sezvo kuchaderedza ngozi yako yemapapu matambudziko mushure mekuvhiyiwa, kunyanya chirwere chepineumonia . Anesthesiologist wako achabvunzawo kana iwe kana nhengo yemhuri wakamboita zvakaipa kana usati wamboita anesthesia.
Maererano nemishonga, vasati vavhiyiwa, mishonga inorwisa mabhakitiriya inogona kupiwa kudzivirira zvirwere panzvimbo yekuvhiya. Mishonga inorwisa mabhakitiriya inhengo yezvinodhaka zvinoshandiswa kurwisa mabhakitiriya, uye zvinowanzopiwa nomuromo (mupiritsi yepiritsi), kana kuti intravenously (kuburikidza ne IV).
Kusarudzwa kwemishonga inorwisa mabhakitiriya kunoenderana nerudzi rwekuvhiya munhu aripo, uye chinangwa chayo ndechekudzivirira utachiona panzvimbo yekuvhiya. Semuenzaniso, munhu anotarisana nechirwere chechironi chinonzi chirwere chinogona kupiwa antibiotic inonzi Ancef (cefazolin) mukati meawa imwe isati yasvika (incision cut) iri kuitwa.
Ancef inopiwa kuburikidza nemuviri (IV), uye chizvarwa chekutanga cephalosporin ine shanduko yakafanana ku penicillin.
Mishonga Inopiwa Pakuvhiya
Kune matatu matatu akasiyana eesesthesia:
- Nharaunda yeAnesthesia: Iwe wakamuka, uye mushonga unorohwa mukati meganda kuvhara kana kubvisa marwadzo mune imwe nzvimbo yemuviri (somuenzaniso, kubviswa kwemosi pamusana wemunhu).
- Regional Anesthesia: Iwe wakamuka, uye mishonga inorohwa munzvimbo yemazimbe kuti ivhare chikamu chemuviri uri kuitirwa chirwere (somuenzaniso, chirwere chemuviri panguva yekubata nekubereka mwana).
- Gara Anesthesia: Iwe wakarara, uye mishonga inopiwa kuti urege kurwadziwa kubva pakunzwika chero kupi mumuviri (somuenzaniso, kuvhiyiwa kubvisa nyota yemunhu kana appendikisi).
Zvizhinji zvekuvhiya kukuru zvinoda hurumende anesthesia. Neine anesthhesia yakawanda, mushonga unonzi anesthetic unoshandiswa kuita kuti urege kuziva uye uone kuti haunzwi kurwadziwa. Inogona kupiwa kuburikidza nemuviri (intravenously) kana kuburikidza nekuputika kufema kana tube. Muenzaniso wekushongedza kunowanzoshandiswa kujekesa anesthesia ndiyo propofol .
Dzimwe nguva, kufema kufema kunoiswa mumhepo yemunhu nemunhu anesthesiologist kuti ave nechokwadi chokuti munhu anofema zvakakodzera panguva yokuvhiyiwa.
Mukuwedzera, mushonga unonzi munhu akaoma rutivi rwomuviri unogona kushandiswa pamwe chete nekunyepedzera kuti unyatsozorodza mitsipa yemuviri womunhu panguva yekuvhiyiwa.
Bharbiturates uye benzodiazepines , zvinowanzozivikanwa se "vanononoka" kana kuti sedatives, ndiwo mapoka maviri akabatanidzwa emishonga yemishonga inoshandiswa kukonzera hutano hwepamusoro. Iko dzimwe nguva inoshandiswa ne anesthesia kunodzora murwere pasi pangangotanga kuvhiyiwa panguva yekudzoka kwavo.
Mienzaniso mitatu ye benzodiazepines dzimwe nguva inoshandiswa sedation inosanganisira:
- Ativan (lorazepam)
- Valium (diazepam)
- Versed (midazolam)
Mishonga Mushure mekuvhiya Post-Operative
Mushure mekunge munhu apedza kuvhiyiwa muimba yekuvhiya, achaenda kunzvimbo yekudzivirira iyo vanamukoti vachanyatsocherechedza mavheti (somuenzaniso, kutengesa kwemwoyo, kufema kwemhepo, uye kuwedzerwa kweropa), uye kurongedza kukwana kwakakwana kutarisa apo munhu anotanga kuzadza zvakakwana simuka kubva kune anesthesia.
Kana ukagara usiku humwe, munhu achazoenda kuchipatara kuitira kuti arambe achizorora, kuzorora, nekurwadziwa. Pane imwe nguva muimba yechipatara, vanachiremba uye vanachiremba vacharamba vachicherechedza mavhisi pamwe chete nemuguta uye zvichienderana nehuwandu hwemvura.
Vanachiremba vanogonawo kunge vane mirayiridzo yakananga yekuchengetedza nzvimbo yekuvhiya, saiyo yekupa kurapa kwakanaka kwemaonda, uye kuronga kuongorora ropa kuti uone zviratidzo zvekubuda ropa kana utachiona.
Mukuwedzera kune mirayiridzo iyi yekuchengetedza, mishonga sekutambudzika kunononoka ichapiwa kuitira kuchengetedza marwadzo panguva apo muviri unoporesa.
Analgesics
Analgesics, kana kurwadziwa kunorwadza, kunoshandiswa kudzora marwadzo mushure mekuvhiyiwa. Iyo inowanikwa mune marudzi akasiyana-siyana uye inogona kupiwa nenzira dzakasiyana-siyana seyo kuburikidza nehuwandu hwe IV, mapiritsi, lozenge, suppository, mvura, uye kunyange sechikwata, apo mushonga unoshandiswa kuburikidza neganda.
Simba remishonga inorwadza mumwe nomumwe yakasiyana-siyana, sezvinonzi dhiyo inorayirwa nachiremba inogona kunge yakasiyana nemumwe murwere kune imwe. Nokuda kwechikonzero ichi, mishonga inorayirwa ichaenderana zvikuru nemamiriro ayo inorayirwa.
Mazhinji emagetsi anotevera-operative ane opioid, zvichida kana kuti pamwe chete neacetaminophen kana NSAIDs.
Kazhinji inorayirwa marwadzo-kutambisa mishonga inowanikwa muchipatara mushure mekuvhiyiwa kuburikidza nemuviri wemunhu kunosanganisira Duramorph (morphine) uye Dilaudid (hydromorphone) inonzi opioids .
Paanorapwa kubva pakuvhiyiwa, marwadzo epipiyasi anopiwa nenzira yeLortab kana Vicodin (acetaminophen / hydrocodone) uye Percocet (acetaminophen / oxycodone) .
Mamwe mapepa ekurapa-kurapa mishonga iyo chiremba wako angakurudzira inosanganisira:
- Ultram (tramadol)
- NSAIDs (somuenzaniso, ibuprofen)
- Tylenol (acetaminophen)
Anticoagulants
Imwe mishonga inokosha zvikuru inowanzopiwa mushure mekuvhiyiwa ianticoagulant, iyo imishonga inononoka kuvhara ropa. Izvi zvakakosha seimwe yezvipingamupinyi zvekuvhiyiwa iropa rinoputika, kunyanya yakadzika yepine thrombosis , iyo inowanzoitika mumakumbo.
Kuchengetedza ropa revhapiti kubva pakuumba uye kukonzera matambudziko akadai sitiroko kana mapurmonary embolus (clot mumapapu), anticoagulants inopiwa kuburikidza neI, injection, kana mupepa yemapiritsi.
Mienzaniso yeanticoagulants inosanganisira:
- Argatroban
- Coumadin (Warfarin)
- Heparin
- Lovenox (Enoxaparin)
Chiratidzo-Kuderedza Mishonga
Pakupedzisira, chiremba wako anokwanisa kupa imwe zviratidzo-kuderedza mishonga yekudzikisa chero kushungurudzika kwaungave kwakabatanidzwa nekuvhiyiwa kana nemishonga inorwadza iwe uri kutora (kusuruvara uye kubatwa kwemavara zvinowanikwa neopioids). Mienzaniso ingasanganisira:
- Acid reducers seH-2 Blocker Pepcid (famotidine)
- Chigaro chevadziviriri uye zvinokonzera kukuvadza sePeri-Colace (docusate sodium / sennosides)
- Mishonga inorambidza kushungurudza seZofran (ondansetron)
Shoko Rinobva
Kana zvasvika pakuvhiyiwa, ichokwadi chisingaoneki kuti mishonga inogadzira nzira inorerukirwa, kukurumidza kupora uye kurwadziwa kuduku. Izvozvo hazvirevi kuti mishonga inogona kutarisira zvinhu zvose, nokuti zvinodhaka zvinongogona kuita zvakanyanya kuita kuti kupora kuri nani.
Murwere ane chido chokumuka uye kufamba mushure mekuvhiyiwa ichava nemukana wakanaka wekudzivirira pneumonia kupfuura murwere asingagoni kubva pabhedha. Murwere anoshanda nesimba pakugadzirisa hurumende achanyanya kusimba uye ave nekudzoka zviri nani kumabasa anowanzoitwa kunze kweiye anofanirwa kubhadharwa uye kuputirwa kuita maitiro avo.
> Sources:
> Anderson DJ, Sexton DJ. (2017). Antimicrobial Prophylaxis Yokudzivirira Kuvhiyiwa Site Infection muVakuru. Mu: UpToDate, Harris A (Ed), UpToDate, Waltham, MA
> Johns Hopkins Mushonga. Mhando dzeAnesthesia uye Anesthesiologist Yenyu.
> Mohabir PK, Gurney J. (May 2015). Merck Manual: Professional Version: Nheyo yekutarisira Mushandi Anoporesa.
> Salkind AR. Antibiotic Prophylaxis Kudzivirira Kuchengetedzwa Kwemawere Utachiona. Ndiye Chiremba weNzara . 2011 Mar 1; 83 (5): 585-90.