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Dr.

Pii Bogdan

INDUCIA ANESTEZIC N URGEN


1. Strile de OC
a) Hipovolemic deshidratare trauma fr T.C.C.A septic hemoragic dormicum 5mg i.v ketamina 2 mg/kg i.v lystenon 100 mg i.v norcuron 4 mg i.v (dup I.O.T) Meninere: ketamina 5 10 mg/kg traum + T.C.C.A atropin 0.5 mg i.v xilin 100 mg i.v fentanyl 3g/kg i.v dormicum 5 mg i.v etomidat 20 mg i.v lystenon 100 mg (+/-) Meninere: norcuron 4mg + fentanyl 3 g/ kg i.v *ketamina la pacienii cu T.A nemsurabil anafilactic I.O.T dificil = se efectueaz minitraheostomie b) ocul Cardiogen I.M.A T.E.P E.P.A, Disecie de Ao dormicum 5 mg i.v fentanyl 3 g/kg i.v etomidat 20 mg. i.v lystenon 100 mg i.v norcuron 4 mg. i.v (dup IOT) Meninere: norcuron 4 mg i.v + propofol in p.e.v continu + fentanyl 50-100 g i.v la 2030 min

2. E.P.A sever cu T.A crescut


dormicum 5 mg i.v
1

Premed.

Dr. Pii Bogdan

etomidat 20 mg i.v morfin 4 mg i.v (repetat la nevoie dup 5-10 min) Meninere: morfin + propofol 200 mg (p.e.v) +/- norcuron 4 mg iv

3. H.I.C A.V.C/T.U cu T.A normal sau crescut


premed

xilin 1-1,5 mg/kg i.v fentanyl 1-3 g/kg i.v dormicum 5 mg. i.v thiopental (diluie 25mg/ml) 2-4 mg/kg i.v lystenon 100 mg i.v norcuron 4 mg i.v (dup I.O.T) Meninere: thiopental n p.e.v continua + fentanyl 50-100 g la 2030

4. T.C.C cu T.A normal, fr alte leziuni toracoabdominale


premed.

atropin 0.5 mg i.v xilin 1-1,5 mg/kg i.v fentanyl 1-3 g/kg i.v dormicum 5 mg i.v thiopental (diluie 25mg/ml) 2-4 mg/kg i.v lystenon 100 mg i.v Meninere: norcuron 4 mg i.v + fentanyl 50-100 g i.v (la 2030)+ thiopental p.e.v continua

5. Status convulsiv
xilin 1- 1,5 mg/kg i.v diazepam 10 mg i.v thiopental (diluie 25 mg/ml) 4 mg/kg i.v

6. Astm bronic / BPOC


dormicum 5 mg i.v ketamin 2-5 mg/kg i.v +/- lystenon 100 mg i.v Meninere: ketamin 1-2 mg/kg i.v (repetat la 10 min)

7. Cardioversie
etomidat 20 mg i.v propofol 150-200 mg i.v fentanyl 1-2 g/kg (2-3 ml) i.v

I.O.T
premed

Atropin 0.02 mg/kg (minim 0.1mg)


2

Dr. Pii Bogdan

Agent Tiopental

Xilin 1-1,5 mg/kg Midazolam 0.1-0.2 mg/kg Etomidat 0.03 mg/kg = T.A prbuit, boli cardiace congenitale, trauma Thiopental 4-6 mg/kg = T.C.C cu T.A normal, status convulsiv, sdr. H.I.C Ketamina 2 mg/kg , 5-10 mg/kg n astm bronic, T.C.C cu T.A nemsurabil Doz
3-5 mg/kg iv 1 mg/kg iv

Inducia
30-60 s < 60 s

Durat
10 - 30 min 5 - 7 min

Beneficii
PIC PIC bronho dilatator amnezie disociativ TA PIC TIO neutru pe PIC antiemetic anticonvulsi vant

Atenie special
TA TA laringospasm convulsii secreiile PIC

Metohexital

Ketamina

1-2 mg/kg iv

60 s

5 min

Etomidat

0,3 mg/kg iv

< 60 s

10 - 20 min

Propofol

0,5 3 mg/kg (2 !)

20 40 s

8 -15 min

Fentanyl

3 8 g/kg 1 g/kg copii

1 2 min

20 - 30 min

analgezie revers. neutru pe TA sedare amnezie reversibil

Midazolam

0,1 mg/kg

1 2 min

5 10 min

conv. mioclonic vrsatur far analgezie apnee TA fr analgezie rigid.peret. toracic PIC ef. variabile doz foarte variabil fr analgezie apnee
Inducia rapid

Agent Lystenon (succinilcolina ) Norcuron

Doza iv pt adult
1 1,5 mg/kg 0,08 0,15 mg/kg

Debut
45 60s 24 3

Durat
5 9 min 25 40 min

Complicaii
bradiaritmii, vrsturi PIO, PIC, K, toC SCR, oc anafilactic timpul de recuperare la

(vecuroniu) Tracrium (actracurium) Esmeron (rocuroniu) Pavulon (pancuroniu) Nuromax (doxacurium)

0,15 0,28 mg/kg (dz ridicat) 0,4-0,5 mg/kg 0,6 mg/kg (apoi din doz) 0,05-0,1 mg/kg iv (4-6 mg) 0,01 mg/kg repet. La nevoie 0,05 0,08 mg/kg

min 23 min 13 min 30 35 s 35 min

60 120 min 25 45 min 30 45min 60 min 80 100 min

Dr. Pii Bogdan obezi, btrni, insuf. Hepatic sau renal hTA, bronhospasm, eliberare de histamin FC FC, TA, bronhospasm sialoree, bloc prelungit
Relaxante neuromusculare