Edema after surgery on the head
Neurological status: conscious, sluggish, inhibited; cranial nerves: the pupils are uniform, the photoreaction is sharply reduced,
corneal reflexes are absent, movements of eyeballs are limited. Semiptosis of both eyelids, paresis of the gaze upward, the face is symmetrical. Language by
middle line. Meningue syndrome of moderate severity. Tendon reflexes from the hands are low, with legs alive. Colonoids of the feet.
Pathological carpal and stop signs are positive. There are no obvious sensitive violations. Coordinated samples: arise from
For urgent indications, the following was performed:
1.The brain. Occulted: occlusal hydrocephalus, cerebral edema.
2. MRT. Revealed: Education of the third ventricle, with no exception of occlusive hydrocephalus.
02.02.2004 The patient under urgent indications performs the operation: Ventriculo-cystinal anastomosis according to Torkildsen from two sides.
Duration of the operation: Beginning-22.25, ending-1.00.
Condition after surgery. Swelling-swelling of the brain, compensated intracranial hypertension.
III. Justification of the methods of research, anesthesia, intensive care, which were used in the patient.
CT scan in addition to detecting intracranial hematomas and foci of bruises allows visualization of localization, prevalence and
the severity of edema and swelling of the brain, its dislocation, as well as evaluate the effect of therapeutic measures in repeated studies. Magnetic
- Resonance tomography (MRI) supplements CT, in particular, in the visualization of small structural changes in diffuse axonal
damage. MRI allows differentiating different types of cerebral edema, and therefore more appropriate to build therapeutic tactics
3. ECG-characterizes the condition, the work of the heart.
4.Monitoring: consciousness, BH, PS, AD, hourly diuresis, body temperature, electrolyte balance. Hb, hematocrit, clotting time,
rate of infusion therapy. All this allows us to conduct adequate therapy.
atropine 0.1% -0.5; promedol 2% -1.0.
Catheterization of peripheral and subclavian veins.
Intubation. IVL. To exclude all factors that can cause an increase in intracranial pressure.
The main anesthesia: NLA (fentanyl 8.0, droperidol 4.0).
Relaxants: Ditiline 5.0, Arduan 4 mg + 8 mg
Catheterization of peripheral and central veins. The catheterization of these two veins is performed for the purpose of simultaneous infusion
Infusion therapy in the operating room was: 1800 ml. fiz-ra and 450,0 ml. Hemochae.
It is aimed at preventing the development of cerebral edema, intracranial hypertension, improving the rheological properties of the blood,
1. Preparations of HES (Hemochaez) currently most fully meet the requirements for the ideal anti-shock
- minimizes the manifestations of hypoxia of the nervous tissue and thereby contributes to the normal water content in the tissues,
- quickly recover the lost BCC,
- restore hemodynamic equilibrium,
- a sufficiently long time are in the vascular bed,
- improve the rheology of blood and the delivery of oxygen to organs and tissues,
- contribute to the elimination of arteriolospasm,
- normalize the oncotic pressure of the plasma,
- do not accumulate in tissues,
- do not affect the immune system.
Prevents development of cerebral edema. Prevent the growth of intracranial hypertension due to stabilization of permeability
blood-brain barrier and reduce the transition of fluid into the brain tissue. (Prednisylone 150 mg)
3. Potassium chloride (3% -60.0) - since the patient is reduced the amount of K in the blood plasma (3.8 mmol / l), appointed for the purpose of correction and prevention
4. Magnesium sulphate (25% -10.0) - causes dilation of spasmodic cerebral vessels, improving perfusion of ischemic areas
5. In order to ensure sputum evacuation and "dilution", inhalation is used. solution.
Ph.D. during operation:
4: 2: 1 with body weight = 60 kg, duration of operation, 10 250.0
Blood loss about 100 ml, U the amount of infusion therapy = 3350,0
Hemochae is prescribed in the calculation of 20 ml / kg / MT (MAX dose). MT of our patient is 60 kg. Ю 20мл., * 60кг = 1200
(in the operating room of the physical department 400.0 * 3 = 1200.0 + Hemochae450.0 = 1650.0)
Introduction of AB during the operation: Cefazolin 1-2 g IV 15 min before surgery + IV 40-50 min after the first injection, then 1 g IV
Intensive therapy after surgery.
2. Combining infection. Prevention: introduction of AB during the operation: Cefazolin 1-2 g IV 15 min before surgery + iv in 40-50 min
after the first injection, then 1 g IV for every hour of the operation.
3. Possible hypo- or hyperventilation in 10 erroneous calculations.
4.Vozmozhna vomiting with subsequent aspiration with introductory anesthesia. To prevent this, complications should be emptied with
5. It is possible to raise ICP when switching to artificial ventilation, due to deterioration of venous outflow. Prevention - gentle ventilation, with minimal
intrathoracic pressure on inspiration. A slight rise of the head end on the operating table is possible.
7. Apnea (or hypopnea) during the initial anesthesia, followed by hypercapnia, increased ICP. To prevent these complications,
to carry out artificial ventilation of the lungs through a mask. The danger of this treatment is the injection of gas into the stomach followed by
regurgitation and aspiration of gastric contents.