pediatric anesthesia , hand surgery & orthopedic procedures скачать в хорошем качестве

pediatric anesthesia , hand surgery & orthopedic procedures

pediatric anesthesia hand surgery & orthopedic procedures 🩺 General Anesthesia in Hand Surgery 🔹 Indications Complex or prolonged procedures Microsurgical replantation, tendon/nerve grafting, free flaps. Patient factors Children (uncooperative for blocks). Severe anxiety or inability to tolerate awake/ regional anesthesia. Contraindication to regional (coagulopathy, infection at injection site, nerve injury risk). Surgeon preference when absolute immobility is critical. 🔹 Techniques Airway Management: Endotracheal intubation or laryngeal mask airway (LMA). Induction: IV agents (e.g., propofol, thiopental, etomidate). Maintenance: Inhalational agents (sevoflurane, desflurane) ± IV agents (propofol infusion). Adjuncts: Opioids (fentanyl, remifentanil) for analgesia. Muscle relaxants if needed. Regional block can be added post-op for pain control (“combined technique”). 🔹 Advantages Provides immobility and comfort during long/complex surgery. Useful when a tourniquet must be applied for long periods. Airway secured → better control in patients at risk. Good choice in children or non-cooperative adults. 🔹 Disadvantages Systemic risks: Airway complications, nausea/vomiting, hemodynamic instability. Higher resource use (OR time, monitoring, recovery room). Post-op pain may be worse compared to regional unless nerve block is added. 🔹 Postoperative Considerations Pain control → often better with a regional block (e.g., brachial plexus) given at the end of GA. PONV prophylaxis may be required. Early mobilization/physiotherapy → important for functional outcome. ✅ In summary: General anesthesia for hand surgery is usually reserved for long, complex, or pediatric cases, or when regional anesthesia is not feasible. It provides immobility and airway control, but at the cost of higher systemic risks and less effective postoperative analgesia unless combined with a block.