Kulamulira Ululu Pambuyo Opaleshoni Ndizofunikira
Mankhwala omwe amagwiritsidwa ntchito kale, nthawi, komanso pambuyo pochita opaleshoni amasiyanasiyana kwambiri kuchokera kwa odwala mpaka opirira. Ichi ndi chifukwa chakuti mankhwala omwe mumalandira amachokera ku mtundu wa opaleshoni yomwe muli nayo, matenda a anesthesia omwe mudzakhala mukukumana nawo, ndi mavuto omwe mukudwala nawo omwe muli nawo.
Pre-Operative kapena Asanayambe Mankhwala Opaleshoni
Musanachite opaleshoni, mudzakumana ndi munthu wodwala matenda opatsirana pogonana.
Paulendo umenewu, mudzawongolera mavuto anu onse a zachipatala ndi a mano ndi matenda omwe mumalandira, kuphatikizapo mankhwala owonjezera, mavitamini, ndi mankhwala ena monga aspirin.
Kuwonjezera apo, onetsetsani kuti mumauza munthu yemwe akudwala mankhwala osokoneza bongo ngati mumamwa mankhwala osokoneza bongo, kusuta, kapena kumwa mowa, chifukwa zonsezi zingakhudze momwe mukuchiritsira kuchokera ku opaleshoni yanu komanso momwe mankhwala a anesthesia amagwirira ntchito.
Pazolemba, ndizofunikira kuzindikira kuti kusiya kusuta kuli koyenera musanachite opaleshoni chifukwa kumachepetsa vuto lanu la matenda a mapapo pambuyo pa opaleshoni, makamaka chibayo . Katswiri wanu wamagetsi adzafunsanso ngati inu kapena wachibale wanu mwachitapo kanthu choipa musanayambe kumverera.
Malinga ndi mankhwala, asanayambe opaleshoni, antibiotic ikhoza kuperekedwa kuti iteteze matenda pa malo opaleshoni. Maantibayotiki ndi gulu la mankhwala ogwiritsidwa ntchito polimbana ndi mabakiteriya, ndipo amaperekedwa pamlomo (mwa mapiritsi), kapena mwachindunji (kupyolera mu IV).
Kusankhidwa kwa ma antibiotic kumadalira mtundu wa opaleshoni yomwe munthu ali nayo, ndipo cholinga chake ndikuteteza matenda pa malo opaleshoni. Mwachitsanzo, munthu amene ali ndi mitsempha yothandizira opaleshoni akhoza kulandira antibiotic yotchedwa Ancef (cefazolin) mkati mwa ora limodzi isanayambe kugwiritsidwa ntchito.
Nyerere imaperekedwa kudzera mu mitsempha (IV), ndipo ndi cephalosporin yoyamba yomwe imakhala ndi penicillin yofanana.
Mankhwala Operekedwa Pa Opaleshoni
Pali mitundu itatu yosiyanasiyana ya anesthesia:
- Anesthesia wamba: Ndiwe wogalamuka, ndipo mankhwala amamwa katemera pakhungu kapena kutsekereza ululu pamalo ena a thupi (mwachitsanzo, kuchotsa mole pamsana).
- Chigawo cha Anesthesia: Mumakhala odwala, ndipo mumayikidwa mankhwala m'thupi la mitsempha kuti asokoneze mbali ya thupi lomwe likuchitidwa opaleshoni (mwachitsanzo, matenda opatsirana pogonana ndi kubereka).
- General Anesthesia: Mukugona, ndipo mankhwala amaperekedwa kuti musiye kupweteka kuti musamveke kulikonse m'thupi (mwachitsanzo, opaleshoni kuchotsa ndulu ya munthu kapena zowonjezereka).
Njira zambiri zothandizira opaleshoni zimafuna anesthhesia wamba. Ndi antiesthesia wambiri, mankhwala omwe amachititsa kuti munthu asamamveke bwino amagwiritsidwa ntchito pofuna kupangitsa kuti asadziwe bwino komanso kuti asamve ululu. Ikhoza kuperekedwa kudzera mu mitsempha (intravenously) kapena pogwiritsa ntchito maski kapena kapu. Chitsanzo cha mankhwala osokoneza bongo omwe amagwiritsidwa ntchito popangitsa anesthesia ndi propofol .
Nthawi zina, mpweya wopuma umayikidwa mu mphepo ya munthu ndi wodwalayo wamwamuna kuti atsimikizire kuti munthu amapuma bwino pa opaleshoni.
Kuwonjezera apo, mankhwala omwe amatchedwa wodwala manjenje angagwiritsidwe ntchito pamodzi ndi kupweteka kwa thupi kuti athetsetu minofu ya thupi la munthu panthawi ya opaleshoni.
Mabala a barbiturates ndi benzodiazepines , omwe amadziwika kuti "downers" kapena sedatives, ndi magulu awiri okhudzana ndi mankhwala omwe amagwiritsidwa ntchito pofuna kuchepetsa dongosolo la mitsempha. Nthaŵi zina amagwiritsidwa ntchito ndi anesthesia kuti amuthandize wodwalayo atangotsala pang'ono kuchitidwa opaleshoni.
Zitsanzo zitatu za benzodiazepines zomwe nthawi zina zimagwiritsidwa ntchito kuti zikhale zowonjezereka zikuphatikizapo:
- Ativan (lorazepam)
- Valium (diazepam)
- Kulimbana (midazolam)
Mankhwala Pambuyo Opaleshoni Ntchito Yogwira Ntchito
Munthu akamaliza opaleshoni m'chipinda chochita opaleshoni, amapita kuchipatala komwe anamwino amayang'anitsitsa mavitamini (mwachitsanzo, kuthamanga kwa mtima, kupuma kwa magazi, ndi kuthamanga kwa magazi), komanso kuonetsetsa kuti kupweteka koyenera kumayamba pamene munthuyo ayamba kukwanira dzuka kuchokera ku anesthesia.
Ngati atagona usiku, munthu amatha kupita kuchipatala kukapuma, kupumula, ndi kupweteka kwambiri. Nthaŵi ina m'chipinda cha chipatala, anamwino ndi madokotala adzapitiriza kuyang'ana mavitamini komanso mkodzo ndi mlingo wa madzi omwe amatuluka m'mimba.
Ochita opaleshoni angakhalenso ndi malangizo enieni a malo opangira opaleshoni, monga momwe angaperekerere chilonda choyenera, ndi kuyitanitsa mayeso a magazi kuti ayang'ane zizindikiro za magazi kapena matenda.
Kuphatikiza pa malangizo awa osamalidwa, mankhwala monga kupweteka kwapweteka amaperekedwa kuti asunge ululu pamene thupi limachiza.
Analgesics
Mankhwala ovuta, kapena mankhwala opweteka, amagwiritsidwa ntchito kuti athetse ululu pambuyo pa opaleshoni. Amapezeka m'njira zosiyanasiyana ndipo angaperekedwe m'njira zosiyanasiyana monga kudzera mu mawonekedwe a piritsi, mapiritsi, lozenge, suppository, madzi, komanso ngati chigamba, kumene mankhwala amachotsedwa kudzera pakhungu.
Mphamvu ya mankhwala opweteka amodzi amasiyana kwambiri, monga momwe mlingo woperekedwa ndi dokotala ukhoza kukhala wosiyana ndi wodwala mpaka wina. Pachifukwachi, mankhwala omwe adayenera adzadalira kwambiri momwe akufunira.
Mankhwala amtunduwu amatha kukhala ndi opioids, mwina mwachangu kapena osakaniza ndi acetaminophen kapena NSAIDs.
Mankhwala opatsa ululu omwe amaperekedwa kuchipatala atatha opaleshoni kudzera mu mitsempha ya munthu ndi Duramorph (morphine) ndi Dilaudid (hydromorphone) omwe ali opioid .
Pakutha kwa opaleshoni, mankhwala opweteka opioid amaperekedwa ngati Lortab kapena Vicodin (acetaminophen / hydrocodone) ndi Percocet (acetaminophen / oxycodone) .
Mankhwala ena opatsirana opweteka omwe dokotala angakulimbikitseni ndi awa:
- Ultram (tramadol)
- NSAIDs (mwachitsanzo, ibuprofen)
- Tylenol (acetaminophen)
Anticoagulants
Chinthu china chofunika kwambiri mankhwala omwe amaperekedwa pambuyo pochita opaleshoni ndi anticoagulant, yomwe ndi mankhwala omwe amachepetsetsa kutseka magazi. Izi ndizofunika kwambiri ngati chimodzi mwa zoopsa za opaleshoni ndi magazi, makamaka mitsempha ya thrombosis , yomwe imachitika miyendo nthawi zambiri.
Pofuna kuteteza magazi kuti asapangidwe ndi kupanga mavuto monga stroke kapena pulmonary embolus (clot m'mapapo), antiticoagulants amaperekedwa kudzera mu IV, jekeseni, kapena piritsi.
Zitsanzo za antiticoagulants zikuphatikizapo:
- Argatroban
- Coumadin (Warfarin)
- Heparin
- Lovenox (Enoxaparin)
Mankhwala Ochepetsa Chizindikiro
Pomalizira, dokotala wanu angapereke mankhwala ena-kuchepetsa mankhwala kuti achepetse vuto lililonse lomwe mwakhala mukukumana nalo ndi opaleshoni kapena mankhwala opweteka omwe mukukumana nawo (kusungunuka ndi kudzimbidwa kumapezeka ndi opioids). Zitsanzo zingaphatikizepo:
- Othandizira amadzi monga H-2 Blocker Pepcid (famotidine)
- Zosakaniza zowonongeka ndi mankhwala opatsa mphamvu monga Peri-Colace (docusate sodium / sennosides)
- Mankhwala osokoneza bongo monga Zofran (ondansetron)
Mawu Ochokera
Pankhani ya opaleshoni, ndizosatsutsika kuti mankhwala amachititsa kuti pakhale njira yolekerera, kupuma msanga komanso kupweteka pang'ono. Izi sizikutanthauza kuti mankhwala akhoza kusamalira chirichonse, chifukwa mankhwala amatha kuchita zambiri kuti apulumuke bwino.
Wodwala wokonzeka kudzuka ndi kusamuka atatha opaleshoni adzakhala ndi mwayi wabwino wopewa chibayo kuposa wodwalayo amene sangadzutse. Wodwala amene amachita nawo mwakhama kukonzanso nthawi zambiri amakhala amphamvu ndipo amabwereranso kuzinthu zachizolowezi kusiyana ndi amene ayenera kukakamizidwa kuti apange zochitika zawo.
> Zotsatira:
> Anderson DJ, Sexton DJ. (2017). Antimicrobial Prophylaxis pofuna Kuteteza Opaleshoni Malo Opatsirana M'magulu Achikulire. Mu: UpToDate, Harris A (Ed), UpToDate, Waltham, MA
> Johns Hopkins Mankhwala. Mitundu ya Anesthesia ndi Anesthesiologist Wanu.
> Mohabir PK, Gurney J. (May 2015). Merck Manual: Professional Version: Chiyambi cha Kusamalira Odwala Opaleshoni.
> Salkind AR. Antibiotic Prophylaxis Kuletsa Kuteteza Matenda Akumalo. Am Phys Physician . 2011 Mar 1; 83 (5): 585-90.