INHOUD
definitie .................................................................................................................................................................................................................................................. 5
middelen ................................................................................................................................................................................................................................................ 5
pre-operatieve zorg ................................................................................................................................................................................................................................. 5
informeren en kiezen .......................................................................................................................................................................................................................... 5
informatie verzamelen ........................................................................................................................................................................................................................ 6
allergische reacties bij anesthesie .................................................................................................................................................................................................. 6
pre-operatieve vragenlijst .............................................................................................................................................................................................................. 6
info: surgery, anesthesia and outcome ....................................................................................................................................................................................... 6
info: perioperatieve mortaliteit .................................................................................................................................................................................................. 7
nuchterinstructies: ................................................................................................................................................................................................................... 7
verpleegkundige voorbereiding ................................................................................................................................................................................................................. 7
wassen-ontharing-desinfecteren ......................................................................................................................................................................................................... 8
technische voorbereiding ........................................................................................................................................................................................................................ 8
anesthesietechnieken ............................................................................................................................................................................................................................. 8
Pijlers van de algehele anesthesie: ......................................................................................................................................................................................................... 10
Stadia van de algehele anesthesie .......................................................................................................................................................................................................... 10
inductie ........................................................................................................................................................................................................................................... 10
kinderen ..................................................................................................................................................................................................................................... 10
IV inductie ............................................................................................................................................................................................................................. 10
inhalatie-inductie ................................................................................................................................................................................................................... 11
volwassenen medicatie ............................................................................................................................................................................................................... 11
hypnotica .............................................................................................................................................................................................................................. 11
overzicht 4 pijlers ........................................................................................................................................................................................................................ 11
onderhoud ....................................................................................................................................................................................................................................... 12
hypothermie ............................................................................................................................................................................................................................... 12
temperatuur homeostase bij kind ................................................................................................................................................................................................. 12
monitoring .................................................................................................................................................................................................................................. 13
uitleiding ......................................................................................................................................................................................................................................... 13
vochtbeleid ...................................................................................................................................................................................................................................... 14
bloedvolume ............................................................................................................................................................................................................................... 14
recovery – pacu ................................................................................................................................................................................................................................ 14
frequente problemen op PAZA (= post-anesthesie zorgafdeling) ........................................................................................................................................................... 15
organisatie operatiekwartier .................................................................................................................................................................................................................. 15
pijn ...................................................................................................................................................................................................................................................... 16
belang van pijncontrole .................................................................................................................................................................................................................... 16
probleem van “undermanagement”................................................................................................................................................................................................... 16
farmacologie ................................................................................................................................................................................................................................... 17
paracetamol ............................................................................................................................................................................................................................... 17
tramadol..................................................................................................................................................................................................................................... 18
sterke opioïden ........................................................................................................................................................................................................................... 18
oxycodone ............................................................................................................................................................................................................................. 18
de balans bij pijnbestrijding............................................................................................................................................................................................................... 18
Praktijk van de pijnmeting : VAS-schaal .............................................................................................................................................................................................. 19
nurse-control vs. patient-control ....................................................................................................................................................................................................... 19
patient-control ................................................................................................................................................................................................................................. 19
PCA = patient controled analyse ................................................................................................................................................................................................... 19
patient gecontroleerde technieken ............................................................................................................................................................................................... 20
patient-specifieke risicofactoren op PONV (= postoperatieve misselijkheid en braken) ..................................................................................................................... 20
postoperatieve controles ....................................................................................................................................................................................................................... 21
1
, postoperatief apnoe bij neonaat ........................................................................................................................................................................................................ 21
postoperatief apnoe na prematuriteit (niet vanbuiten kennen!!!) .......................................................................................................................................................... 21
het zenuwstelsel ................................................................................................................................................................................................................................... 22
schema neuronen perifere zenuwstelsel ............................................................................................................................................................................................ 22
neonataal zenuwstelsel .................................................................................................................................................................................................................... 23
neuronen ......................................................................................................................................................................................................................................... 23
locale anesthetica................................................................................................................................................................................................................................. 23
toxische reacties (infiltratie) .............................................................................................................................................................................................................. 23
anatomie ......................................................................................................................................................................................................................................... 24
topografie ........................................................................................................................................................................................................................................ 24
epidurale punctie: anatomie ............................................................................................................................................................................................................ 24
rachi-epiduraal ................................................................................................................................................................................................................................ 24
houding ...................................................................................................................................................................................................................................... 25
spinaal block/ rachi .......................................................................................................................................................................................................................... 26
anatomie .................................................................................................................................................................................................................................... 26
techniek ..................................................................................................................................................................................................................................... 26
eigenschappen: densiteit (= dichtheid van een massa) .................................................................................................................................................................. 27
complicaties rachi-anesthesie ..................................................................................................................................................................................................... 27
postdural puncture headache (PDPH) ...................................................................................................................................................................................... 28
epidurale anesthesie ........................................................................................................................................................................................................................ 29
techniek ..................................................................................................................................................................................................................................... 29
caudaal block ........................................................................................................................................................................................................................ 30
soort: combined spinale epidural (CSE) ........................................................................................................................................................................................ 30
algemene of locoregionale anesthesie? .................................................................................................................................................................................................. 30
locoregionale ................................................................................................................................................................................................................................... 30
algemene ........................................................................................................................................................................................................................................ 31
postoperative cognitive disorders = POCD .................................................................................................................................................................................... 31
maternal physiology = fysiologische veranderingen bij zwangerschap ...................................................................................................................................................... 33
pijn tijdens de baring: intensiteit ............................................................................................................................................................................................................ 34
tevredenheid over de baring .............................................................................................................................................................................................................. 34
pijnbanen gedurende de arbeid (belangrijk!!!) ..................................................................................................................................................................................... 35
gerefereerde pijn - hartinfarct ....................................................................................................................................................................................................... 36
gerefereerde pijn – laparoscopie (schouderpijn) ............................................................................................................................................................................ 36
effecten van pijn tijdens de arbeid ..................................................................................................................................................................................................... 36
Nadelinge effecten van inadequaat ‘behandelde’ pijn tijdens de arbeid: ........................................................................................................................................ 36
voordelen van pijn ...................................................................................................................................................................................................................... 37
Beïnvloedende factoren ............................................................................................................................................................................................................... 37
pijnbestrijding tijdens arbeid ............................................................................................................................................................................................................. 38
TENS .......................................................................................................................................................................................................................................... 39
chloroform.................................................................................................................................................................................................................................. 39
lachgas – N2O ............................................................................................................................................................................................................................. 39
Locoregionale zenuwblok ............................................................................................................................................................................................................ 40
Epidurale analgesie ................................................................................................................................................................................................................ 40
Mechanisme epidurale analgesie ............................................................................................................................................................................................ 40
Complicaties LRA (locoregionale anesthesie) ........................................................................................................................................................................... 41
effect epidurale anesthesie tijdens de arbeid ..................................................................................................................................................................................... 41
foetale bradycardie ..................................................................................................................................................................................................................... 41
Deze vragen kan de zwangere allemaal stellen: (kunnen op antwoorden!!!) ..................................................................................................................................... 41
studies naar effect epidurale anesthesie ............................................................................................................................................................................................ 42
maternal and neonatal outcomes ................................................................................................................................................................................................. 42
early vs. late epidural ................................................................................................................................................................................................................... 43
2
, effect van locoregionale anesthesie (LRA) .......................................................................................................................................................................................... 43
bijzondere indicaties voor LRA (redenen om wel epidurale te geven) ............................................................................................................................................... 44
effecten CSE = combined spinale epidural ......................................................................................................................................................................................... 45
besluit: ................................................................................................................................................................................................................................................. 45
informeren en kiezen ........................................................................................................................................................................................................................ 45
walking vs. ‘klassieke’ epidural .............................................................................................................................................................................................................. 46
voordelen ‘walking’ epidural .................................................................................................................................................................................................................. 46
praktijk ‘walking’ epidural ...................................................................................................................................................................................................................... 46
remifentanil in verloskunde ............................................................................................................................................................................................................... 48
tijdens partus .............................................................................................................................................................................................................................. 48
maternele bijwerkingen ............................................................................................................................................................................................................... 48
inleiding ............................................................................................................................................................................................................................................... 49
definities .............................................................................................................................................................................................................................................. 49
indicaties – foetaal/stuit ........................................................................................................................................................................................................................ 49
soorten anesthesie voor keizersnede ...................................................................................................................................................................................................... 49
locoregionale anesthesie .................................................................................................................................................................................................................. 50
spinale anesthesie ...................................................................................................................................................................................................................... 50
epidurale anesthesie ................................................................................................................................................................................................................... 50
algehele anesthesie (totale narcose) ................................................................................................................................................................................................. 51
complicaties ............................................................................................................................................................................................................................... 51
uteroplacentair transfert van medicatie ................................................................................................................................................................................... 52
Awareness ............................................................................................................................................................................................................................. 52
incidentie awareness bij sectio (AA) .................................................................................................................................................................................... 53
6 ‘direct’anaesthesia deaths ................................................................................................................................................................................................... 53
fatale complicaties...................................................................................................................................................................................................................... 53
Voorkomen van aspiratie bij spoedintubatie: ................................................................................................................................................................................. 53
techniek van de Sellick’s manoeuvre ....................................................................................................................................................................................... 54
voorbereiding spoedintubatie .................................................................................................................................................................................................. 54
Factoren die leiden tot een verhoogde kans op braken en aspiratie ................................................................................................................................................. 54
pros and cons of eating and drinking during labour .................................................................................................................................................................................. 55
isotonische dranken tijdens arbeid .................................................................................................................................................................................................... 55
conclusie......................................................................................................................................................................................................................................... 55
wat verwacht de baby bij sectio? ............................................................................................................................................................................................................ 56
vermijd hypotensie ........................................................................................................................................................................................................................... 56
aorto-cavale compressie .................................................................................................................................................................................................................. 56
conclusie......................................................................................................................................................................................................................................... 56
welke verdovingstechniek kiezen? .......................................................................................................................................................................................................... 57
dringende sectio .............................................................................................................................................................................................................................. 57
walking the baby out .............................................................................................................................................................................................................................. 57
praktisch .............................................................................................................................................................................................................................................. 58
de sectio .............................................................................................................................................................................................................................................. 58
Indicaties ............................................................................................................................................................................................................................................. 59
Tijdstip ................................................................................................................................................................................................................................................. 59
vermijd en behandel onmiddellijk ........................................................................................................................................................................................................... 59
Monitoring ............................................................................................................................................................................................................................................ 59
Vraag ................................................................................................................................................................................................................................................... 60
teratogeniciteit ..................................................................................................................................................................................................................................... 60
anesthetica: ......................................................................................................................................................................................................................................... 60
postoperatieve preterme arbeid ........................................................................................................................................................................................................ 60
besluit ............................................................................................................................................................................................................................................. 60
borstvoeding en anesthesie .............................................................................................................................................................................................................. 60
3
, oorzaken .............................................................................................................................................................................................................................................. 61
Physiologische veranderingen in de late zws met invloed op CPR .............................................................................................................................................................. 61
fetal outcome in cpr .............................................................................................................................................................................................................................. 62
Chain of survival ................................................................................................................................................................................................................................... 62
belangrijkste elementen ........................................................................................................................................................................................................................ 62
die zorgen voor kwaliteitsreanimatie (1) ............................................................................................................................................................................................. 62
die zorgen voor kwaliteitsreanimatie (2) ............................................................................................................................................................................................. 62
continue cpr ......................................................................................................................................................................................................................................... 62
4
definitie .................................................................................................................................................................................................................................................. 5
middelen ................................................................................................................................................................................................................................................ 5
pre-operatieve zorg ................................................................................................................................................................................................................................. 5
informeren en kiezen .......................................................................................................................................................................................................................... 5
informatie verzamelen ........................................................................................................................................................................................................................ 6
allergische reacties bij anesthesie .................................................................................................................................................................................................. 6
pre-operatieve vragenlijst .............................................................................................................................................................................................................. 6
info: surgery, anesthesia and outcome ....................................................................................................................................................................................... 6
info: perioperatieve mortaliteit .................................................................................................................................................................................................. 7
nuchterinstructies: ................................................................................................................................................................................................................... 7
verpleegkundige voorbereiding ................................................................................................................................................................................................................. 7
wassen-ontharing-desinfecteren ......................................................................................................................................................................................................... 8
technische voorbereiding ........................................................................................................................................................................................................................ 8
anesthesietechnieken ............................................................................................................................................................................................................................. 8
Pijlers van de algehele anesthesie: ......................................................................................................................................................................................................... 10
Stadia van de algehele anesthesie .......................................................................................................................................................................................................... 10
inductie ........................................................................................................................................................................................................................................... 10
kinderen ..................................................................................................................................................................................................................................... 10
IV inductie ............................................................................................................................................................................................................................. 10
inhalatie-inductie ................................................................................................................................................................................................................... 11
volwassenen medicatie ............................................................................................................................................................................................................... 11
hypnotica .............................................................................................................................................................................................................................. 11
overzicht 4 pijlers ........................................................................................................................................................................................................................ 11
onderhoud ....................................................................................................................................................................................................................................... 12
hypothermie ............................................................................................................................................................................................................................... 12
temperatuur homeostase bij kind ................................................................................................................................................................................................. 12
monitoring .................................................................................................................................................................................................................................. 13
uitleiding ......................................................................................................................................................................................................................................... 13
vochtbeleid ...................................................................................................................................................................................................................................... 14
bloedvolume ............................................................................................................................................................................................................................... 14
recovery – pacu ................................................................................................................................................................................................................................ 14
frequente problemen op PAZA (= post-anesthesie zorgafdeling) ........................................................................................................................................................... 15
organisatie operatiekwartier .................................................................................................................................................................................................................. 15
pijn ...................................................................................................................................................................................................................................................... 16
belang van pijncontrole .................................................................................................................................................................................................................... 16
probleem van “undermanagement”................................................................................................................................................................................................... 16
farmacologie ................................................................................................................................................................................................................................... 17
paracetamol ............................................................................................................................................................................................................................... 17
tramadol..................................................................................................................................................................................................................................... 18
sterke opioïden ........................................................................................................................................................................................................................... 18
oxycodone ............................................................................................................................................................................................................................. 18
de balans bij pijnbestrijding............................................................................................................................................................................................................... 18
Praktijk van de pijnmeting : VAS-schaal .............................................................................................................................................................................................. 19
nurse-control vs. patient-control ....................................................................................................................................................................................................... 19
patient-control ................................................................................................................................................................................................................................. 19
PCA = patient controled analyse ................................................................................................................................................................................................... 19
patient gecontroleerde technieken ............................................................................................................................................................................................... 20
patient-specifieke risicofactoren op PONV (= postoperatieve misselijkheid en braken) ..................................................................................................................... 20
postoperatieve controles ....................................................................................................................................................................................................................... 21
1
, postoperatief apnoe bij neonaat ........................................................................................................................................................................................................ 21
postoperatief apnoe na prematuriteit (niet vanbuiten kennen!!!) .......................................................................................................................................................... 21
het zenuwstelsel ................................................................................................................................................................................................................................... 22
schema neuronen perifere zenuwstelsel ............................................................................................................................................................................................ 22
neonataal zenuwstelsel .................................................................................................................................................................................................................... 23
neuronen ......................................................................................................................................................................................................................................... 23
locale anesthetica................................................................................................................................................................................................................................. 23
toxische reacties (infiltratie) .............................................................................................................................................................................................................. 23
anatomie ......................................................................................................................................................................................................................................... 24
topografie ........................................................................................................................................................................................................................................ 24
epidurale punctie: anatomie ............................................................................................................................................................................................................ 24
rachi-epiduraal ................................................................................................................................................................................................................................ 24
houding ...................................................................................................................................................................................................................................... 25
spinaal block/ rachi .......................................................................................................................................................................................................................... 26
anatomie .................................................................................................................................................................................................................................... 26
techniek ..................................................................................................................................................................................................................................... 26
eigenschappen: densiteit (= dichtheid van een massa) .................................................................................................................................................................. 27
complicaties rachi-anesthesie ..................................................................................................................................................................................................... 27
postdural puncture headache (PDPH) ...................................................................................................................................................................................... 28
epidurale anesthesie ........................................................................................................................................................................................................................ 29
techniek ..................................................................................................................................................................................................................................... 29
caudaal block ........................................................................................................................................................................................................................ 30
soort: combined spinale epidural (CSE) ........................................................................................................................................................................................ 30
algemene of locoregionale anesthesie? .................................................................................................................................................................................................. 30
locoregionale ................................................................................................................................................................................................................................... 30
algemene ........................................................................................................................................................................................................................................ 31
postoperative cognitive disorders = POCD .................................................................................................................................................................................... 31
maternal physiology = fysiologische veranderingen bij zwangerschap ...................................................................................................................................................... 33
pijn tijdens de baring: intensiteit ............................................................................................................................................................................................................ 34
tevredenheid over de baring .............................................................................................................................................................................................................. 34
pijnbanen gedurende de arbeid (belangrijk!!!) ..................................................................................................................................................................................... 35
gerefereerde pijn - hartinfarct ....................................................................................................................................................................................................... 36
gerefereerde pijn – laparoscopie (schouderpijn) ............................................................................................................................................................................ 36
effecten van pijn tijdens de arbeid ..................................................................................................................................................................................................... 36
Nadelinge effecten van inadequaat ‘behandelde’ pijn tijdens de arbeid: ........................................................................................................................................ 36
voordelen van pijn ...................................................................................................................................................................................................................... 37
Beïnvloedende factoren ............................................................................................................................................................................................................... 37
pijnbestrijding tijdens arbeid ............................................................................................................................................................................................................. 38
TENS .......................................................................................................................................................................................................................................... 39
chloroform.................................................................................................................................................................................................................................. 39
lachgas – N2O ............................................................................................................................................................................................................................. 39
Locoregionale zenuwblok ............................................................................................................................................................................................................ 40
Epidurale analgesie ................................................................................................................................................................................................................ 40
Mechanisme epidurale analgesie ............................................................................................................................................................................................ 40
Complicaties LRA (locoregionale anesthesie) ........................................................................................................................................................................... 41
effect epidurale anesthesie tijdens de arbeid ..................................................................................................................................................................................... 41
foetale bradycardie ..................................................................................................................................................................................................................... 41
Deze vragen kan de zwangere allemaal stellen: (kunnen op antwoorden!!!) ..................................................................................................................................... 41
studies naar effect epidurale anesthesie ............................................................................................................................................................................................ 42
maternal and neonatal outcomes ................................................................................................................................................................................................. 42
early vs. late epidural ................................................................................................................................................................................................................... 43
2
, effect van locoregionale anesthesie (LRA) .......................................................................................................................................................................................... 43
bijzondere indicaties voor LRA (redenen om wel epidurale te geven) ............................................................................................................................................... 44
effecten CSE = combined spinale epidural ......................................................................................................................................................................................... 45
besluit: ................................................................................................................................................................................................................................................. 45
informeren en kiezen ........................................................................................................................................................................................................................ 45
walking vs. ‘klassieke’ epidural .............................................................................................................................................................................................................. 46
voordelen ‘walking’ epidural .................................................................................................................................................................................................................. 46
praktijk ‘walking’ epidural ...................................................................................................................................................................................................................... 46
remifentanil in verloskunde ............................................................................................................................................................................................................... 48
tijdens partus .............................................................................................................................................................................................................................. 48
maternele bijwerkingen ............................................................................................................................................................................................................... 48
inleiding ............................................................................................................................................................................................................................................... 49
definities .............................................................................................................................................................................................................................................. 49
indicaties – foetaal/stuit ........................................................................................................................................................................................................................ 49
soorten anesthesie voor keizersnede ...................................................................................................................................................................................................... 49
locoregionale anesthesie .................................................................................................................................................................................................................. 50
spinale anesthesie ...................................................................................................................................................................................................................... 50
epidurale anesthesie ................................................................................................................................................................................................................... 50
algehele anesthesie (totale narcose) ................................................................................................................................................................................................. 51
complicaties ............................................................................................................................................................................................................................... 51
uteroplacentair transfert van medicatie ................................................................................................................................................................................... 52
Awareness ............................................................................................................................................................................................................................. 52
incidentie awareness bij sectio (AA) .................................................................................................................................................................................... 53
6 ‘direct’anaesthesia deaths ................................................................................................................................................................................................... 53
fatale complicaties...................................................................................................................................................................................................................... 53
Voorkomen van aspiratie bij spoedintubatie: ................................................................................................................................................................................. 53
techniek van de Sellick’s manoeuvre ....................................................................................................................................................................................... 54
voorbereiding spoedintubatie .................................................................................................................................................................................................. 54
Factoren die leiden tot een verhoogde kans op braken en aspiratie ................................................................................................................................................. 54
pros and cons of eating and drinking during labour .................................................................................................................................................................................. 55
isotonische dranken tijdens arbeid .................................................................................................................................................................................................... 55
conclusie......................................................................................................................................................................................................................................... 55
wat verwacht de baby bij sectio? ............................................................................................................................................................................................................ 56
vermijd hypotensie ........................................................................................................................................................................................................................... 56
aorto-cavale compressie .................................................................................................................................................................................................................. 56
conclusie......................................................................................................................................................................................................................................... 56
welke verdovingstechniek kiezen? .......................................................................................................................................................................................................... 57
dringende sectio .............................................................................................................................................................................................................................. 57
walking the baby out .............................................................................................................................................................................................................................. 57
praktisch .............................................................................................................................................................................................................................................. 58
de sectio .............................................................................................................................................................................................................................................. 58
Indicaties ............................................................................................................................................................................................................................................. 59
Tijdstip ................................................................................................................................................................................................................................................. 59
vermijd en behandel onmiddellijk ........................................................................................................................................................................................................... 59
Monitoring ............................................................................................................................................................................................................................................ 59
Vraag ................................................................................................................................................................................................................................................... 60
teratogeniciteit ..................................................................................................................................................................................................................................... 60
anesthetica: ......................................................................................................................................................................................................................................... 60
postoperatieve preterme arbeid ........................................................................................................................................................................................................ 60
besluit ............................................................................................................................................................................................................................................. 60
borstvoeding en anesthesie .............................................................................................................................................................................................................. 60
3
, oorzaken .............................................................................................................................................................................................................................................. 61
Physiologische veranderingen in de late zws met invloed op CPR .............................................................................................................................................................. 61
fetal outcome in cpr .............................................................................................................................................................................................................................. 62
Chain of survival ................................................................................................................................................................................................................................... 62
belangrijkste elementen ........................................................................................................................................................................................................................ 62
die zorgen voor kwaliteitsreanimatie (1) ............................................................................................................................................................................................. 62
die zorgen voor kwaliteitsreanimatie (2) ............................................................................................................................................................................................. 62
continue cpr ......................................................................................................................................................................................................................................... 62
4
