Dinitrogen oxide

Chemical name

Nitrous oxide

Gross

N2-O

Characteristics

Colorless gas is heavier than air (relative density 1.527), the characteristic smell. Rat in water (1:2). In ^ 0 C and a pressure of 30 atm. (or 20 ^ C and a pressure of 40 atm.) Move in a colorless liquid. Do not ignite, but the fire.

Of drugs

The drugs-publeanestezirutee. Nespecificski interacts with the cell membrane, oppressing sinapticescuu transmission in the case of central nervous system violates transfer MUP impulses alter korkov-podcorkove relationship as an interim, secondary and spinal cord. Anaesthesia dispensed with the use of 94-95% in the wdahaemom air (which is not acceptable in connection with the development of hypoxia). Small concentrations of a drunken state and lighter clothes. In anesthesiology mixture using 80% dinitrogen oxide and 20% oxygen, the effect is the primary stage surgical narcosis; Usually used in combination with other more active means to narcosis and miorelaxanthami. The inhalation leads to a rapid awakening without phenomena aftereffect. There is a high analgezirutuyu activity. Increases choose is a matter of narrowing peripheral vessels may increase intracranial pressure oppressing breath. Absorbed in the blood through the lungs. The body is not metabolised is dissolved in the plasma. Return to unchanged to the light (in 10-15 min), a small quantity through the skin.

Indications

General anaesthesia (introduction to anaesthesia and maintenance narcosis); Mild pain syndrome in the aftercare period (prevention of traumatic shock), childbirth, unstable strokes, myocardial infarct, acute pankreatite, etc.; Pain in the performance of medical procedures requiring off consciousness.

Contraindications

Hypersensitivity; Kupirovanii in controlling pain critically diseases of the nervous system, chronic alcoholism, the state of drunkenness (possible prosecution, hallucinations).

Side-Effects

At the time of its introduction in anaesthesia - najeludockove adults, aetiology, circulatory insufficiency; When leaving the narcosis - diffused hypoxia, postnarkozny deliri : a sense of anxiety, sputannosti consciousness, arousal, hallucinations, nervousness, dwigatelnoe concern; In the long-lakopenia, lesion of central nervous system, respiratory depression, nausea, vomiting, malignant gipertermiceski kriz, posleoperazionny shivers.

Specific guidance

Medical personnel in the long-term with dinitrogene oxide increases the risk of radiation. At the time of application that periodically pumping gas from mangetki endotrahealna tube. Mixtures with ether, ziklopropanom, hloretilom in certain concentrations dangerous.

Patient interaction

Do antigipertenziveh effects (especially diazoksida, ganglioblokatorov, hlorpromazina, dioretikov) antikoagulih (coumarin derivatives and indandiona), oppressive central and breathing funds. City increases the risk bradikardii (not kupiruema atropinom) and hypotonia, xantina - arrhythmias. Fentanyl and its derivatives increasing influence on the cardiovascular system (reduction curves and minutes of cardiac arrest). Metildofa contributes to the development of general anesthesia.

Overdosing

Symptoms : aetiology, adults, circulatory insufficiency, gipotenzia, gipertermiceski kriz, respiratory depression, Deliri.lechenie : when bradikardii Introduction 0.3-0.6 mg atropine, aritmiah-correction of gases in the blood, circulatory failure and hypotonia, a plasma or plazmozameshchath funds, reducing the depth or termination narcosis, and gipertermicescom krize-termination inhalation, the increased supply of oxygen antipiretikov a correction of water balance and metabolic azidoza, if necessary impose dantrolen (1 mg / kg) in / in drip and continue until the symptoms are gone kriza (maximum total dose of 10 mg / kg). To prevent recurrence kriza within 1-3 days after the operation carefully appoint dantrolen inside or / in (4-8 mg / kg / day in four divided doses). Oppression respiratory or inadequate postoperative ventilation require lower doses anestetika (if it still existed), the respiratory passage ways and IVL. In the case of deliria aftermath of narcosis introduce small doses of narcotic painkiller.

Precautions

Ingalirovti mixture is the oxygen content of at least 30%, and after inhalation to the continuation of oxygen within 5 minutes (prevention hypoxia). To reduce the emotional state, preventing nausea and vomiting and potenzirovania actions shown holding Then : in / m a 1-2 ml of 0.5% solution of diazepam (5-10 mg), 2-3 ml of 0.25% solution droperidola (5,0-7,5 mg). There is a need to control the AD HR, heart rhythm, to monitor respiration and gas, the temperature of his body. A caution in the air cyst in the lungs, kidneys or occluzii middle ear, air embolism, acute bowel obstruction or pneumothorax, during pnevmoengjefalografii or shortly thereafter (increases pressure in the cavities or volume cavities containing air). Be wary when using skull trauma, raising vnutricerepnogo pressure in history, the vast vnutricerepnom damage or tumors expressed significant hypoxia and the violation of diffusion of gases in the lungs. Patients alcoholics require higher concentrations.

Dosing and Administration

Is mixed with oxygen with the aid of special equipment for gas narcosis. Concentration must be collected individually, depending on the condition of the patient, the type and quantity imposed aids. The normal dose for adults : Introduction to anaesthesia-70% dinitrogen oxide and 30% кислорода,поддержани�� narcosis - 40-50% dinitrogen oxide with oxygen. For anesthesia delivery employ broken autoanalgesia (with the aid of special anaesthesia machines), 40-75% mixture dinitrogen oxide with oxygen (woman is a mixture of sleeping when the fire warning and ends inhalation at an altitude of battle or the end). In order to carry out medical procedures requiring off-consciousness inhalation 25-50% mixture with oxygen. For children doses selected individually.

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