thuat vung bung, Cac phau thuat can gian co nhieu thi phai phdi hop vdi
thu6c gian co khac. Ngoai ra, thu6c ciing lam gian co tron t11cung va co
tron phe quan.
Ttic dung khongmong muon
Gi6ng nhu halothan, nhung do it chuyen hoa trong co th~ nen it d(k vdi tim, gan, than hen, pham vi an toan rong hen. Cac tac dung khong mong muon thuong gap la suy ho hap, co that khi quan, ha huyet ap,
Chong chi dinh
M&ncam thu6c.
Ti€n s11s6t cao ac tinh sau khi dung thu6c.
usa dung
Nong d9 gay me trung binh tit 1- 3% trong han hop oxy va nitrogen oxyd. 2.5. Cac d'n xuat halogen khac cua ether
- Methoxyfluran: tuong tl;lenfluran va isofluran, la thu6c gay me manh, tac dung giam dau va gian co t6t. Tuy nhien, methoxyfluran co thoi ky khdi me keo dai, gay suy ho hap, tu~n hoan n:';tngva chuy~n hoa nhi€u d gan t~o ra cac chat chuy~n hoa gay d9Cvoi gan va th~n nen it s11d\lng hon cac thu6c cung nhom.
- Sevofluran, desfluran ... tuong tl;lenfluran.
2.6.Nitrogen oxyd (nitd protoxyd, N20)
Dijc die"m
Chat khi khong mau, khong mui, tan nhi€u trong lipid, khong gay chay n6.
Tac dlfng
Thu6c co tac d\lng khdi me nhanh, tinh nhanh, khong gay kich thich, tac d\lng giam dau m~nh nhung ho~t tinh gay me ye'u va khong gay gian co, thu6c thich hqp cho cac ph&u thu~t ngiin. Do thu6c d~ gay thieu oxy cho mo nen khi dung thudng ph6i hqp voi oxy (n6ng d9 gay me thudng la 85% nitrogen oxyd va 15% oxy).Viho~t tinh gay me ye'u nen it dung rieng re ma thudng ph6i hqp voi cac thu6c gay me khac nhu halothan ho:';tcthu6c gay me tinh m~ch. Ngoai ra, thu6c con dUQcdung d~ giam dau trong nha khoa va giai do~n d~u cua thdi ky chuy~n d~.
Tac dlfng khong mong mu6n
Nitrogen oxyd co th~ uc che'tuy xuong gay thie'u mau, giam b~ch c~u, uc che t6ng hqp ADN va protein do tac d\lng oxy hoa coban trong vitamin B12.
3. THUnC GAY ME DUdNG TINH M4CH 3.1. D{lc di~m chung
Uu die'm: cac thuoc gay me duong tinh mach thuong khdi me nhanh va em diu, tinh nhanh, kh6ng c6 cac thoi ky nhu thuoc gay me h6 hap. Ky thuat gay me don gian.
NhltflC die'm: tac dung giam dau va gian co kern, thoi gian me ngan kh6ng thich hop cho cac ca phjiu thuat keo dai, d~ gay uc che h6 hap.
3.2. Thiopental
Duqc di}ng hoc
Thuoc gay me tinh mach, lien ket vdi protein huyet tuong khoang 85% nhung vftn nhanh chong qua hang rao mau nao. Sau khi tiem 10- 20 giay da c6 tac dung va duy tri tac dung 20- 30 phut neu tiem lieu duy nhat.
Trong co th~ chuyen h6a thanh hydroxy thiopental, thai tru chu yeu qua nude ti~u dang da chuyen h6a, mot phan nho d dang nguyen ven, thoi gian ban thai khoang 9 gid.
Ttic dung
- Gay me: thiopental la dftn xuat cua acid barbituric co thdi gian tac d\mg rfft ng~n. Tiem tinh m:;tch, thuo'c co tac d\mg gay me nhanh, m:;tnh va ng~n. Khdi me nhanh, sau 1 phut da me sau vi thuo'c nhanh d:;tt du<;Jc ngudng me d thlln kinh trung udng. Sau do thu5c phan pho'i l:;ti,Wi cac m6 nen n6ng dQ thuo'c d thlln kinh trung udng giam nhanh, vi v~y thdi gian tac d\mg ng~n. Tac d\mg gay me duy tri du<;Jc20- 30 phut.
- Tren tulln hoan: lic che tulln hoan lam giam nhip tim, giam nh~ huyet ap, c6 th~ gay ro'i lo:;tnnhip tim ho(lc suy tim.
- Tren h6 hffp: lic che h6 hffp, co th~t khi, phe quan.
- Tac d\mg khac: hllu nhu kh6ng co tac d\lng giam dau, tac d\mg gian cd kern nen hay dung pho'i h<;Jpvoi thuo'c gay me khac ho(lc cac thu5c giam dau va gian cd. Thu5c lam giam chuy~n hoa va sa d\mg oxy d nao, kh6ng gay tang ap h;lC SQnao, vi v~y dung du<;Jccho b~nh nhan bi phu nao.
Chi dinh
- Khdi me trong phftu thu~t thdi gian dai. - Gay me trong phftu thu~t thdi gian ng~n.
Tcicdung khong mong muon
- Suy h6 hffp.
- Suy tim, lo:;tnnhip tim, h:;thuyet ap. - Viem tlnh m:;tch.
Ch{/ng chi dinh.
- Roi loan chuyen hoa porphyrin. - Suy ho hap nang.