FacultateadeMedicinVeterinarClujNapoca

DisciplinadeAnesteziologieiReanimare

LP9Principiidemonitorizareapacientuluiaflatsubanestezie

"Echipamentele scumpe i complexe nu reprezint un substitut pentru o monitorizare clinic

atent i o interpretare corect a datelor obinute!"
Sistemulnervoscentral
Reflexulpalpebraldiminuatdispare
Poziiaglobuluiocularventromedialcentral
Reflexulcorneanunindicatormaipuinimportant
Lacrimaiainversproporionalcuprofunzimeaanesteziei
Reflexulpupilarprezent
Midriazsaumioznfunciedeprotocoluldeanestezieutilizat
Tonusulmuscular(maseteri,musculaturalingual)importantpentruintubareaET
Tonusulfaringianilaringianscadeodatcunivelulprofundalanesteziei
Reflexulderetragereamembruluilastimulidureroidisparenanesteziaprofund
Electroencefalograma(EEG)cercetare

Sistemulcardiovascular
Cord
Frecveniritmpalpaie
ascultaiestetoscop
stetoscopesofagian
Electrocardiografie(ECG)

Bradicardia
Supradozareanestezice
Hiperkalemie
Stimularevagal
Hipoxieavansat
Hipoglicemie
Sincopcardiac

Tahicardia
Anesteziesauanalgezieinsuficient
Hipoxie
Hipercapnie
Hipotensiune
Medicaiaparasimpaticolitic
Hipotermia
Hipertermia

Presiuneaarterial
Palpaieartereperiferice
Monitorizaredirect(invaziv)
Monitorizareindirect(neinvaziv)

Metodaoscilometric

Doppler

Hipotensiuneascdereacirculaieivenoasedentoarcere
scderearezisteneivasculare

Aritmii
Traumecardiace
Hipoxiecardiac
Hipercapnie
Dezechilibreelectrolitice

DebitulcardiaccateterSwanGanz(cercetare)
Perfuziatisulartimpdereumplerecapilar
aspectulmucoaselor
aspectulfocaruluichirurgical
debitulurinar
diferenadetemperaturcentralperiferic

Sistemulrespirator
Monitorizareaventilaieirespirometre
monitorpentruapnee
capnograf

mmHgCO2
35
3545
45

kPaCO2
4.6
4.66.0
6.0

Interpretare
hipocapnie
normocapnie
hipercapnie

hiperventilaie
Anesteziesuperficial
Durere

hipoventilaie
Supradozareanestezie
Anestezicecaredepreseazrespiraia
(opioide)
Anesteziaprofund

apnee
Anestezicepropofol
Neuroblocantemusculare

Stimularechirurgical
Hipoxie
Hipotensiune
Pirexie/hipertermie

Stopcardiorespirator
Presiunecrescutncircuit

Monitorizareaschimburilorgazoase
pulsoximetrie
analizagazelorsanguine

Temperatura
Scdereatemperaturiicorporaleevaporare
conducie
convecie
radiaie
Prevenireascderiitemperaturiicorporalereducereadurateianesteziei
meninereauneitemperaturiambientaleridicate
evitareaantisepticeloralcoolice
nclzireagazelorinspirate
nclzirealichidelorperfuzabile

Monitorizareaactuluichirurgicaliafluidoterapiei
Monitorizareaglicemiei
Monitorizareablocajuluineuromuscular
Monitorizareaechipamentuluifolositnanestezie

FI DE ANESTEZIE

USAMV CLUJ-NAPOCA
Disciplina de Anesteziologie i Reanimare

Data:

Nr. Registru:

PACIENT

Medic Curant:

Manopera:
Medic Chirurg:
START

STOP

ANESTEZIE
MANOPERA
EVALUARE PACIENT

APARATUR I MONITORIZARE

TEHNICA ANESTEZIEI

MANAGEMENTUL CILOR AERIENE

Inducie anestezie general

Identificare pacient
Brar
Accept semnat

Inclzire fluide/snge

Pre-O2

IM

IV

Meninerea anesteziei generale

Tensiune arterial ne-invaziv

Diet alimentar de la ____
Doppler

ECG continuu

Pulsoximetru

Nivel CO2 n aer expirat

Inhalatoriu

Inhalatoriu/IV

Regional i general

Stomac plin
Evaluare pre-anestezie
Agitat

Monitorizare O2 sau FiO2

Necooperant

Temperatur

Calm

Umidificator oxigen

Contient

Tub nasogastric/orogastric

Sedat

Linie arterial ____________________________

Funciile vitale
Puls:______ Respiraie:______
Temperatura:______________
Timp reumplere capilar:______
Aspect mucoase:____________
Evaluare risc anesteziologic

Analizor gaze ET

nclzire corporal extern

Presiune intracranian
Cateter Foley

Presiune venoas central _________________

Linie arterial pulmonar ___________________
Linie venoas ___________________________
Stimulare a nervilor
Ulnar

Facial

Inhalatorie

Tibial

TIVA

IM

Sedare & Analgezie/monitorizare

Toracic

Lombar

Femural

Brahial

Blocaj inelar

Sond ET laser

Sond ET nazal

Masc laringian

Sond ET ranforsat

Anestezie regional
Epidural

Sond ET oral

Combitub

Caudal

Dimensiune sond: ________

Sond ET blocant pulmonar

Numr de ncercri X ________

Regional intravenos

Spinal

Anestezic local / nebulizare

Alt metod

CO2 la sfritul respiraiei

Tehnica anesteziei regionale

Vezi observaii

Pregtiri _______________

Anestezie local _______

Locul de elecie _________

Ac __________

Expansiune pulmonar bilateral

Balon umflat - presiune min. de ocluzionare _________

Anestezic local _________________

Narcotic ___________

Aditiv __________________

Doza test X __________

Nr. ncercri X ___________

Cateter _______

Amplasare _________

_________________

LCR
Hem

+
+

Sond fr balon scurgeri _________ cm H2O

Circuit:
Sistem circuit

Sistem Bain

Masc facial cu rezervor O2

Canul nazal

1 2 3 4 5 U

Masc
Cutie inducie

Masc simpl cu O2

PREMEDICAIE
Ora

Produs

Doz

Cale de administrare

Observaii

_____

_________________________________________________________________________________________________________

________________________________________________

_____

_________________________________________________________________________________________________________

________________________________________________

_____

_________________________________________________________________________________________________________

________________________________________________

_____

_________________________________________________________________________________________________________

________________________________________________

INDUCIE
Ora

Produs

Doz

Cale de administrare

Observaii

_____

_________________________________________________________________________________________________________

________________________________________________

_____

_________________________________________________________________________________________________________

________________________________________________

_____

_________________________________________________________________________________________________________

________________________________________________

_____

_________________________________________________________________________________________________________

________________________________________________

_____

_________________________________________________________________________________________________________

________________________________________________

Observaii:

NGRIJIRE POST-ANESTEZIE
Contient

Detubat

ANALGEZIE POST-OPERATORIE
Ora _____________________

Managementul durerii pe perioada post-operatorie a fost discutat cu medicul curant / de la terapie

intensiv

Somnolent

Tensiunea arterial _________

Incontient

Saturaie O2 % ____________

Stabil

Puls ____________________

AINS _____________________ mg/kg ____X zi

Ketamin _______________ mg/kg _____ X zi

Instabil

Respiraie _______________

Opioide ___________________ mg/kg ____ X zi

Medetomidin ___________ mg/kg _____ X zi

Suplimentare O2

Temperatura _____________

Anestezice locale ___________ mg/kg ____ X zi

Altele __________________ mg/kg _____ X zi

Protocolul de ngrijire a fost complectat

Intraoperator nu s-au nregistrat reacii adverse la anestezie

Anestezist:

Cateter epidural

Dren toracic

___________________________

Timp:
Des

Iso

Sev

N2O

Aer

(L/min.)
(L/min.)
(
)
(

Fluide

Agent anestezic

Oxigen

Total:

Hal (%)

Urin eliminat

(ml.)

ECG

Simbol

% oxigen inspirat (FiO2)

V

Monitorizare

Sat. n O2 a sngelui arterial (SaO2)

Nivel CO2 n aerul expirat

TA

Temperatura C
Sat. n O2 a hemoglobinei (SpO2)
Reflex palpebral

TA
Invaziv

X
Medic. preoperatorie

PA medie
MAP

Ora
200

Puls
180

180

180

180

180

180

Ventilaie

160

O/SV
Spontan

140

/AV
Asistat

120

120

120

120

120

120

X /CV
O
Controlat

60

60

60

60

60

Garou

100
80
60

locaie
40
mmHg
20
pus:
Ventilaie

Volumul respiraiei (ml)

Frecvena respiraiei
Presiunea maxim
PEEP

(bpm)
(cm H2O)

CPAP (cm H2O)

Poziia:
Semne pentru observaii:

scos:
Timp
total: