INHOUDSTAFEL
INHOUDSTAFEL .......................................................................................................................................................................... 1
ALGEMEEN PIJN & ANESTHESIOLOGIE ........................................................................................................................................ 3
DEFINITIE ALGEMENE ANESTHESIE ........................................................................................................................................................... 3
ELEMENTEN ANESTHESIE........................................................................................................................................................................ 4
FARMACOLOGIE VAN IV ANESTHETICA....................................................................................................................................... 7
HYPNOTICA......................................................................................................................................................................................... 7
FARMACOLOGIE VAN INHALATIE ANESTHETICA ....................................................................................................................... 11
WERKING ......................................................................................................................................................................................... 11
SOORTEN INHALATIE ANESTHETICA ......................................................................................................................................................... 12
FARMACOLOGIE VAN DE SPIERVERSLAPPERS ........................................................................................................................... 15
NEUROMUSCULAIRE JUNCTIE ................................................................................................................................................................ 15
SOORTEN SPIERVERSLAPPERS ................................................................................................................................................................ 16
MONITORING .................................................................................................................................................................................... 17
MONITORING ........................................................................................................................................................................... 21
DOEL: MONITORING ........................................................................................................................................................................... 21
KLINISCHE MONITORING ...................................................................................................................................................................... 21
MONITORING CIRCULATIE: ................................................................................................................................................................... 21
MONITORING ADEMHALING ................................................................................................................................................................. 23
MONITORING ANESTHESIEDIEPTE .......................................................................................................................................................... 24
NEUROLOGISCHE MONITOR.................................................................................................................................................................. 25
NEUROMUSCULAIRE MONITORING......................................................................................................................................................... 25
MONITORING LICHAAMSTEMPERATUUR ................................................................................................................................................. 26
MONITORING URINEDEBIET ................................................................................................................................................................. 26
MONITORING CONCLUSIES .................................................................................................................................................................. 26
PREOPERATIEVE OPPUNTSTELLNG ........................................................................................................................................... 27
PREOPERATIEVE CONSULTATIE .............................................................................................................................................................. 27
WAT WIL JE TE WETEN KOMEN? ............................................................................................................................................................ 27
LOCALE ANESTHETICA (LA) ....................................................................................................................................................... 31
SOORTEN ......................................................................................................................................................................................... 31
ZENUWGELEIDING .............................................................................................................................................................................. 31
FARMACOLOGISCHE BEGRIPPEN ............................................................................................................................................................ 32
METABOLISME .................................................................................................................................................................................. 32
CASUS ............................................................................................................................................................................................. 33
LOCOREGIONALE ANESTHESIETECHNIEKEN .............................................................................................................................. 35
REGIONALE TECHNIEKEN ...................................................................................................................................................................... 35
NEURAXIAAL ..................................................................................................................................................................................... 35
SPECIFIEKE ZENUWEN/ PLEXUS.............................................................................................................................................................. 38
IN VLAK WAAR ZENUWEN DOORLOPEN LA INJECTEREN .............................................................................................................................. 41
COMPLICATIES VAN LOCOREGIONALE ANESTHESIE .................................................................................................................. 43
VEEL VOORKOMENDE COMPLICATIES ...................................................................................................................................................... 43
1
, CONTRA-INDICATIES NEURAXIALE TECHNIEKEN ......................................................................................................................................... 46
LUCHTWEG, OXYGENATIE EN VENTILATIE ................................................................................................................................ 47
MOEILIJKE LUCHTWEG ........................................................................................................................................................................ 47
ADEMHALING .................................................................................................................................................................................... 50
VASCULAIRE ACCES .................................................................................................................................................................. 53
INLEIDING ......................................................................................................................................................................................... 53
BESLISBOOM ..................................................................................................................................................................................... 53
SOORTEN IV KATHETERS ...................................................................................................................................................................... 54
MEEST VOORKOMENDE COMPLICATIES ................................................................................................................................................... 56
CASUSSEN : WELKE LIJN VOORSTELLEN? .................................................................................................................................................. 57
TAKE HOME MESSAGE IV ACCES ............................................................................................................................................................ 57
HOMEOSTASE ........................................................................................................................................................................... 59
VOCHTBELEID .................................................................................................................................................................................... 59
ELEKTROLYTEN .................................................................................................................................................................................. 60
BLOED EN STOLLING............................................................................................................................................................................ 60
LICHAAMSTEMPERATUUR .................................................................................................................................................................... 61
ZUUR BASE EVENWICHT ....................................................................................................................................................................... 62
GLYCEMIE......................................................................................................................................................................................... 63
BESLUIT ........................................................................................................................................................................................... 63
PERI-OPERATIEVE COMPLICATIES ............................................................................................................................................. 65
VOORNAAMSTE COMPLICATIES (<24H) .................................................................................................................................................. 65
PIJNSTILLING BIJ DE PARTUS..................................................................................................................................................... 73
FYSIOLOGISCHE VERANDERINGEN TIJDENS ZWANGERSCHAP ........................................................................................................................ 73
PIJNSTILLING BIJ DE PARTUS.................................................................................................................................................................. 74
BORSTVOEDING ................................................................................................................................................................................. 78
2
, ALGEMEEN PIJN & ANESTHESIOLOGIE
DEFINITIE ALGEMENE ANESTHESIE
- Medicamenteus geïnduceerde
- Omkeerbare
- Onderdrukking van het centraal zenuwstelsel
- Veranderingen in gedrag en/of perceptie op schadelijke stimuli
ELEMENTEN ALGEMENE ANESTHESIE
- Bewusteloosheid en/of sedatie
o Amnesie; kunnen zich achteraf niets herinneren
- Pijnstilling
- Spierverslapping
- Protectie tegen autonome reflexen
o Vagale reactie, bradycardie OCR, salivatie, stress respons
- Peroperatieve stabilisatie
o Hemodynamisch
o Respiratoir (oxygenatie, ventilatie)
o Vochtbeleid
o Stolling
o Glycemiecontrole
o Zuur-base
- Antagonisatie
PREMEDICATIE
- Doel
o Anxiolyse
o Pijnbestrijding
o Voorkomen complicaties
- Minder toegepast dan vroeger want patient moet zich kunnen identificeren op de operatietafel + moet de juiste kant
kunnen aanduiden
- Ouders mogen altijd bij kinderen meegaan
- Bij zware ingrepen zoals bv cardio of thoraco-abdominale nog wel
- Welke ?
o Enkel sedativen/ anxiolytica bij patienten die extreem angstig zijn
o Parasympaticolyticum: ter preventie van bradycardie
o Chronische medicatie: medicatie die de pt al gebruikt
o Anti-aspiratie: vooral bij zwangere
o PONV profylaxe (post operative nausea & vomiting)
o Anti-thrombotische profylaxe
o Anti-allergie
TYPES ANESTHESIE
- Algemene anesthesie
- Locale en regionale anesthesie
Worden vaak gecombineerd
INDUCTIE VAN SLAAP, HOE ?
- Meestal bij volwassenen IV en IV onderhouden worden
- IV induceren en dan overschakelen op inhalatie onderhoud
- Bij kinderen vnl. inh alatie inductie en onderhoud
- Inhalatie inductie en IV odnerhoud: bij patienten die moeilijk aan te prikken zijn want inhalatie geeft vasodilatatie
- Inhalatie inductie en onderhoud met een ander volatiel
INHALATIE ANESTHATICA
- Zeer frequent toegepast onderhoud anesthesie
- Vooral bij kinderen (vasodilatatie, EMLA)
3
INHOUDSTAFEL .......................................................................................................................................................................... 1
ALGEMEEN PIJN & ANESTHESIOLOGIE ........................................................................................................................................ 3
DEFINITIE ALGEMENE ANESTHESIE ........................................................................................................................................................... 3
ELEMENTEN ANESTHESIE........................................................................................................................................................................ 4
FARMACOLOGIE VAN IV ANESTHETICA....................................................................................................................................... 7
HYPNOTICA......................................................................................................................................................................................... 7
FARMACOLOGIE VAN INHALATIE ANESTHETICA ....................................................................................................................... 11
WERKING ......................................................................................................................................................................................... 11
SOORTEN INHALATIE ANESTHETICA ......................................................................................................................................................... 12
FARMACOLOGIE VAN DE SPIERVERSLAPPERS ........................................................................................................................... 15
NEUROMUSCULAIRE JUNCTIE ................................................................................................................................................................ 15
SOORTEN SPIERVERSLAPPERS ................................................................................................................................................................ 16
MONITORING .................................................................................................................................................................................... 17
MONITORING ........................................................................................................................................................................... 21
DOEL: MONITORING ........................................................................................................................................................................... 21
KLINISCHE MONITORING ...................................................................................................................................................................... 21
MONITORING CIRCULATIE: ................................................................................................................................................................... 21
MONITORING ADEMHALING ................................................................................................................................................................. 23
MONITORING ANESTHESIEDIEPTE .......................................................................................................................................................... 24
NEUROLOGISCHE MONITOR.................................................................................................................................................................. 25
NEUROMUSCULAIRE MONITORING......................................................................................................................................................... 25
MONITORING LICHAAMSTEMPERATUUR ................................................................................................................................................. 26
MONITORING URINEDEBIET ................................................................................................................................................................. 26
MONITORING CONCLUSIES .................................................................................................................................................................. 26
PREOPERATIEVE OPPUNTSTELLNG ........................................................................................................................................... 27
PREOPERATIEVE CONSULTATIE .............................................................................................................................................................. 27
WAT WIL JE TE WETEN KOMEN? ............................................................................................................................................................ 27
LOCALE ANESTHETICA (LA) ....................................................................................................................................................... 31
SOORTEN ......................................................................................................................................................................................... 31
ZENUWGELEIDING .............................................................................................................................................................................. 31
FARMACOLOGISCHE BEGRIPPEN ............................................................................................................................................................ 32
METABOLISME .................................................................................................................................................................................. 32
CASUS ............................................................................................................................................................................................. 33
LOCOREGIONALE ANESTHESIETECHNIEKEN .............................................................................................................................. 35
REGIONALE TECHNIEKEN ...................................................................................................................................................................... 35
NEURAXIAAL ..................................................................................................................................................................................... 35
SPECIFIEKE ZENUWEN/ PLEXUS.............................................................................................................................................................. 38
IN VLAK WAAR ZENUWEN DOORLOPEN LA INJECTEREN .............................................................................................................................. 41
COMPLICATIES VAN LOCOREGIONALE ANESTHESIE .................................................................................................................. 43
VEEL VOORKOMENDE COMPLICATIES ...................................................................................................................................................... 43
1
, CONTRA-INDICATIES NEURAXIALE TECHNIEKEN ......................................................................................................................................... 46
LUCHTWEG, OXYGENATIE EN VENTILATIE ................................................................................................................................ 47
MOEILIJKE LUCHTWEG ........................................................................................................................................................................ 47
ADEMHALING .................................................................................................................................................................................... 50
VASCULAIRE ACCES .................................................................................................................................................................. 53
INLEIDING ......................................................................................................................................................................................... 53
BESLISBOOM ..................................................................................................................................................................................... 53
SOORTEN IV KATHETERS ...................................................................................................................................................................... 54
MEEST VOORKOMENDE COMPLICATIES ................................................................................................................................................... 56
CASUSSEN : WELKE LIJN VOORSTELLEN? .................................................................................................................................................. 57
TAKE HOME MESSAGE IV ACCES ............................................................................................................................................................ 57
HOMEOSTASE ........................................................................................................................................................................... 59
VOCHTBELEID .................................................................................................................................................................................... 59
ELEKTROLYTEN .................................................................................................................................................................................. 60
BLOED EN STOLLING............................................................................................................................................................................ 60
LICHAAMSTEMPERATUUR .................................................................................................................................................................... 61
ZUUR BASE EVENWICHT ....................................................................................................................................................................... 62
GLYCEMIE......................................................................................................................................................................................... 63
BESLUIT ........................................................................................................................................................................................... 63
PERI-OPERATIEVE COMPLICATIES ............................................................................................................................................. 65
VOORNAAMSTE COMPLICATIES (<24H) .................................................................................................................................................. 65
PIJNSTILLING BIJ DE PARTUS..................................................................................................................................................... 73
FYSIOLOGISCHE VERANDERINGEN TIJDENS ZWANGERSCHAP ........................................................................................................................ 73
PIJNSTILLING BIJ DE PARTUS.................................................................................................................................................................. 74
BORSTVOEDING ................................................................................................................................................................................. 78
2
, ALGEMEEN PIJN & ANESTHESIOLOGIE
DEFINITIE ALGEMENE ANESTHESIE
- Medicamenteus geïnduceerde
- Omkeerbare
- Onderdrukking van het centraal zenuwstelsel
- Veranderingen in gedrag en/of perceptie op schadelijke stimuli
ELEMENTEN ALGEMENE ANESTHESIE
- Bewusteloosheid en/of sedatie
o Amnesie; kunnen zich achteraf niets herinneren
- Pijnstilling
- Spierverslapping
- Protectie tegen autonome reflexen
o Vagale reactie, bradycardie OCR, salivatie, stress respons
- Peroperatieve stabilisatie
o Hemodynamisch
o Respiratoir (oxygenatie, ventilatie)
o Vochtbeleid
o Stolling
o Glycemiecontrole
o Zuur-base
- Antagonisatie
PREMEDICATIE
- Doel
o Anxiolyse
o Pijnbestrijding
o Voorkomen complicaties
- Minder toegepast dan vroeger want patient moet zich kunnen identificeren op de operatietafel + moet de juiste kant
kunnen aanduiden
- Ouders mogen altijd bij kinderen meegaan
- Bij zware ingrepen zoals bv cardio of thoraco-abdominale nog wel
- Welke ?
o Enkel sedativen/ anxiolytica bij patienten die extreem angstig zijn
o Parasympaticolyticum: ter preventie van bradycardie
o Chronische medicatie: medicatie die de pt al gebruikt
o Anti-aspiratie: vooral bij zwangere
o PONV profylaxe (post operative nausea & vomiting)
o Anti-thrombotische profylaxe
o Anti-allergie
TYPES ANESTHESIE
- Algemene anesthesie
- Locale en regionale anesthesie
Worden vaak gecombineerd
INDUCTIE VAN SLAAP, HOE ?
- Meestal bij volwassenen IV en IV onderhouden worden
- IV induceren en dan overschakelen op inhalatie onderhoud
- Bij kinderen vnl. inh alatie inductie en onderhoud
- Inhalatie inductie en IV odnerhoud: bij patienten die moeilijk aan te prikken zijn want inhalatie geeft vasodilatatie
- Inhalatie inductie en onderhoud met een ander volatiel
INHALATIE ANESTHATICA
- Zeer frequent toegepast onderhoud anesthesie
- Vooral bij kinderen (vasodilatatie, EMLA)
3
