Chii chinonzi Remifentanil: Zvazvinoshandiswa, Madosi, Migumisiro Yakaipa nezvimwe

Remifentanil mushonga une simba wekurwadziwa weopioid unopiwa kuburikidza neIV panguva yekuvhiyiwa uye mamwe maitiro ekurapa. Inoshanda nekukurumidza uye inopera nekukurumidza, zvichiita kuti ive yakakwana mumamiriro ezvinhu apo vanachiremba vanoda kutonga kwakaringana pamusoro pekubatsira kurwadziwa. Funga nezvazvo sechishandiso chakanyanya kunyanya icho anesthesiologists vanoshandisa kuti vakuchengete wakasununguka panguva yekuvhiyiwa vachivimbisa kuti unomuka zvakanaka mushure.

Chii chinonzi Remifentanil?

Remifentanil ndeyeboka remishonga inonzi synthetic opioids, yakagadzirirwa zvakananga kushandiswa muzvipatara uye nzvimbo dzekuvhiya. Kusiyana nemimwe mishonga yekurwadziwa yaungatora kumba, iyi inopiwa chete kuburikidza neIV line nevashandi vehutano vakadzidziswa. Izvo zvatinoziva se ultra-short-acting opioid, zvinoreva kuti inotanga kushanda mukati memasekonzi uye inomira kushanda nekukurumidza kana infusion yapera.

Mishonga iyi ine simba zvekuti kunyange huwandu hudiki hunogona kupa rubatsiro rwakakura rwekurwadziwa. Simba iri, rakabatanidzwa nekutanga kwayo nekukurumidza uye offset, inoita kuti ive isingakosheki mukamuri yekuvhiya uko kutonga kwakaringana kwekurwadziwa kwakakosha. Hauzombosangana nemushonga uyu kunze kwenzvimbo yechipatara nekuti inoda kuongororwa nguva dzose uye midziyo yakakosha kuti itungamirirwe zvakachengeteka.

Chii chinonzi Remifentanil chinoshandiswa?

Remifentanil inonyanya kushandiswa panguva ye general anesthesia kubatsira kubata kurwadziwa paunenge usina kuziva panguva yekuvhiyiwa. Inoshandiswawo mumayuniti ekuchengetedza akanyanya kune varwere vari pa ventilators uye vanoda rubatsiro rwekurwadziwa rwuri kuenderera mberi. Mishonga iyi inobatsira kuona kuti unogara wakasununguka mukati memaitiro ekurapa uchibvumira vanachiremba kuti vagadzirise manejimendi ako ekurwadziwa munguva chaiyo.

Kunze kwekushanda, mushonga uyu unobatsira panguva yemamwe maitiro ekuongorora anogona kunge asinganzwisisike kana kurwadza. Mamwe maitiro emoyo, kuvhiya kweuropi, uye mamwe mashandiro akaomarara anonyanya kubatsirwa nezvinhu zvakasiyana zve remifentanil. Chinhu chikuru ndechokuti hachigari mumuviri wako mushure mekunge maitiro apera, izvo zvinokubatsira kupora nekukurumidza.

Remifentanil Inoshanda Sei?

Remifentanil inoshanda nekubatanidza kune opioid receptors muuropi hwako uye musana, zvichivharisa zviratidzo zverurwadzo kuti zvisasvike pakuziva kwako. Inoonekwa seopioid ine simba rakanyanya, zvinoreva kuti kunyange madhizaini madiki anogona kuburitsa mhedzisiro yakakosha. Zvisinei, kusiyana nemamwe maopioid, muviri wako unoiisa pasi nekukurumidza kuburikidza nema enzymes muropa rako uye matishu.

Kuparara uku nekukurumidza ndiko kunoita kuti remifentanil ive yakasiyana uye inobatsira mumamiriro ezvinhu ekurapa. Nepo mamwe maopioid angatora maawa kuti apera, mhedzisiro ye remifentanil inonyangarika mukati memaminitsi ekumisa infusion. Izvi zvinobvumira timu yako yekurapa kuti ipe rubatsiro rwakanyanya rwerurwadzo panguva yemaitiro uku ichiita kuti upore nekukurumidza mushure meizvozvo pasina kuneta kana matambudziko ekufema.

Ndingatora Sei Remifentanil?

Iwe hauzotori remifentanil iwe pachako - mushonga uyu unongotungamirirwa nevashandi vehutano vakadzidziswa kuburikidza neIV line. Anesthesiologist yako kana chiremba wekuchengetedza akanyanya achanyatsoverenga chiyero chakakodzera zvichienderana nehuremu hwako, mamiriro ako ekurapa, uye maitiro auri kuita. Mushonga unopihwa se infusion inoramba ichienderera mberi, zvinoreva kuti inoyerera zvishoma nezvishoma muropa rako pamwero unodzorwa.

Musati gamuchira remifentanil, timu yenyu yezvokurapa ichaisa catheter yeIV muruoko rwenyu kana ruwoko. Vachakutarisa nguva dzose panguva yekupinza vachishandisa michina yakakosha inotevera kumhanya kwemoyo wako, ropa, mazinga eokisijeni, uye kufema. Mushonga unogona kugadziriswa nguva nenguva zvichienderana nekupindura kwemuviri wako uye zvinodiwa zvechirongwa chako.

Hapana kugadzirira kwakakosha kunodiwa parutivi rwenyu maererano nechikafu kana chinwiwa, sezvo zvisarudzo izvi zvichaitwa sechikamu chechirongwa chenyu cheanesthesia. Timu yenyu yezvokurapa ichakupa mirairo chaiyo yekudya nekunwa pamberi pechirongwa chako zvichienderana nerudzi rwekuvhiyiwa kana kurapwa kwauri kugamuchira.

Ndingatora Remifentanil Kwenguva Yakareba Sei?

Kureba kwekurapa kwe remifentanil kunoenderana zvachose nechirongwa chako chekurapa uye zvaunoda. Panguva yekuvhiyiwa, iwe unowanzoigamuchira kwenguva yese yekuvhiya, iyo inogona kuva chero kupi zvako kubva pamaminitsi makumi matatu kusvika kumaawa akati wandei. Munzvimbo dzekuchengetwa kwakanyanya, nguva yacho inogona kuwedzera kumazuva kana uri pa ventilator uye uchida kurapwa kwerwadziwa kuri kuenderera mberi.

Timu yako yezvokurapa ichamisa kupinza kwe remifentanil kana isingachadiwi pakuchengetwa kwako. Nekuti mushonga unobviswa kubva muhurongwa hwako nekukurumidza, iwe unowanzo kutanga kunzwa mhedzisiro yayo ichipera mukati memaminitsi mashanu kusvika gumi mushure mekunge kupinza kwamira. Iyi rapid offset ndiyo imwe yezvakanakira zvikuru zve mushonga, sezvo ichibvumira shanduko yakatsetseka yekupora.

Ndezvipi Zvakaipa zveRemifentanil?

Kufanana nemishonga yese yeopioid, remifentanil inogona kukonzera mhedzisiro, kunyangwe vazhinji vachitungamirirwa proactively netimu yako yezvokurapa panguva yekutonga. Mhedzisiro yakajairika inosanganisira kufema kwakaderera, kuderedzwa kwemoyo, uye kudzvinyirirwa kweropa. Mhedzisiro iyi inotarisirwa uye inotariswa zvakanyanya, netimu yako yezvokurapa yakagadzirira kugadzirisa mushonga kana kupa rumwe rutsigiro kana zvichidikanwa.

Hezvino zvinogona kukonzera, zvakakamurwa zvichienderana nekuti zvakajairika sei:

Zvinokonzeresa zvakajairika zvinotarirwa uye zvinogadziriswa nechikwata chako chekurapa:

• Kufema kunonoka kana kusina kudzika (kuderera kwekufema)
• Kuderera kwemoyo (bradycardia)
• Kuderera kweropa (hypotension)
• Kusvotwa nekutsvuka mushure mekumuka
• Kuoma kwemhasuru kwenguva pfupi, kunyanya muchipfuva
• Kudedera sezvo mushonga uchipera

Zvisingawanzoitiki asi zvinokosha zvinokonzeresa:

• Kukwenya kwakanyanya (pruritus)
• Dizziness kana kunzwa lightheaded
• Kutukirwa kana flushing
• Kurwadziwa nemusoro panguva yekupora
• Kuvhiringidzika kwenguva pfupi sezvaunomuka

Zvisingawanzoitiki asi zvakakomba zvinokonzeresa:

• Zvakanyanya allergic reactions (anaphylaxis)
• Kukurumidza kwemoyo kunoda kupindira
• Kudonha kukuru kweropa
• Kufema kwenguva refu
• Moyo usinganzwisisike (arrhythmias)

Mashoko akanaka ndewekuti nekuti uri kugamuchira remifentanil munzvimbo yekurapa inodzorwa, chikwata chako chinogona kukurumidza kugadzirisa chero zvinokonzeresa zvingaitika. Vane mishonga nemidziyo inowanikwa kugadzirisa matambudziko uye kuona kuchengeteka kwako panguva yese yekuita.

Ndiani Asingafaniri Kutora Remifentanil?

Remifentanil haina kukodzera munhu wese, uye chikwata chako chekurapa chichanyatsoongorora nhoroondo yako yekurapa usati waishandisa. Vanhu vane mamwe marudzi ekurwara, mamiriro ekufema, kana matambudziko emoyo vangangoda dzimwe nzira dzekurapa kurwadziwa. Zvisinei, nzvimbo yekurapa inodzorwa inowanzoita kuti vanachiremba vashandise remifentanil zvakachengeteka kunyange mune dzimwe nzvimbo dzine njodzi.

Chiremba wako achanyatso chenjerera kana uine chero mamiriro aya:

Contraindications yakakwana (mamiriro apo remifentanil isingafaniri kushandiswa):

• Kuziva allergy ku remifentanil kana mamwe ma fentanyl-based mishonga
• Matambudziko akakomba ekufema pasina rutsigiro rwe mechanical ventilation
• Mhando dzakasiyana dze heart block pasina pacemaker
• Chirwere chakakomba chechiropa chinokanganisa metabolism yemishonga

Mamiriro anoda kungwarira kwakanyanya uye kuongorora:

• Chronic obstructive pulmonary disease (COPD) kana mamwe matambudziko ekufema
• Matambudziko e rhythm yemoyo kana kumhanya kwemoyo kwakaderera
• Chirwere cheitsvo chinokanganisa kubviswa kwemishonga
• Nhoroondo yekushandisa zvinodhaka zvisiri pamutemo kana kuvimba ne opioid
• Varwere vakuru vanogona kunge vachinyanya kunzwa kune mhedzisiro
• Kuzvitakura, kunyanya panguva yekushanda uye kubereka

Mamiriro asingawanzoitiki anoda kufunga kwakakosha:

• Myasthenia gravis kana mamwe matambudziko ekushaya simba kwemhasuru
• Kukuvara kwakakomba kwemusoro kana kuwedzera kumanikidzwa kwehuropi
• Mamwe mamiriro ejeneti anokanganisa metabolism yemishonga
• Maitiro asina kunaka ekare kune anesthesia

Kunyangwe uine imwe yemamiriro aya, usanetseka - chikwata chako chekurapa chine ruzivo rwekubata mamiriro akaoma uye ichagadzira chirongwa cheanesthesia chakachengeteka zvakanyanya zvezvido zvako chaizvo.

Mazita eRemifentanil Brand

Remifentanil inowanikwa pasi pemazita akati wandei emhando, neUltiva ndiyo inonyanya kuzivikanwa pasi rose. Muzvipatara, unogona zvakare kusangana nayo seRemifenta mune dzimwe nyika, kunyangwe iyo inoshanda ingredient uye mhedzisiro inoramba yakafanana zvisinei nezita remhando. Chikwata chako chekurapa chichaziva vhezheni ipi neipi inoshandiswa panzvimbo yavo.

Mishonga inouya seupfu hunofanirwa kusanganiswa nemvura yakachena kana saline isati yashandiswa. Kugadzirira uku kunogara kuchiitwa nevashandi ve pharmacy vakadzidziswa kana nyanzvi dzekurapa vachishandisa nzira dzakachena dzakanyanya. Haufanire kunetseka nezve rudzi rwaunogamuchira - ese mavhezheni anosangana neyakafanana kuchengeteka uye kushanda kwemaitiro.

Remifentanil Alternatives

Mishonga mimwe yakawanda yeopioid inogona kushandiswa kune zvinangwa zvakafanana panguva yekuvhiwa uye nzira dzekurapa. Fentanyl, sufentanil, uye alfentanil mishonga yese ine hukama inoshanda zvakafanana asi ine nguva dzakasiyana dzekutanga uye nguva dzekushanda. Chiremba wako weanesthesiologist achasarudza sarudzo yakanakisa zvichienderana nemaitiro ako chaiwo uye zvaunoda zvekurapa.

Kune dzimwe nzira, dzimwe nzira dzisiri dzeopioid dzinogona kufarirwa kana kushandiswa pamwe chete neopioids. Izvi zvinosanganisira mishonga yakaita sepropofol yekudzikamisa, nzira dzeanesthesia dzemudunhu dzinoshandisa anesthetics yemuno, kana nzira itsva dzekurapa marwadzo dzinoderedza kudiwa kweopioids zvachose. Chikwata chako chekurapa chichakurukura nzira yakanakisa yemamiriro ako ezvinhu.

Ko Remifentanil Ari Nani Pane Fentanyl?

Remifentanil na fentanyl vane zvakanakira zvakasiyana zvichienderana nemamiriro ezvinhu ekurapa. Chinhu chikuru chinobatsira remifentanil ndiyo nguva yayo pfupi - inopera mukati memaminitsi ekumisa infusion, ichibvumira kupora nekukurumidza uye kutonga kwakanyatsojeka panguva yenzira. Fentanyl, kune rumwe rutivi, inopa rubatsiro rwemarwadzo rwakareba asi rinotora nguva yakareba kuti ibude muhurongwa hwako.

Kune kuvhiwa kwaunoda kumuka nekukurumidza uye zvakajeka, remifentanil inowanzo kufarirwa. Zvisinei, kune nzira dzinodiwa rubatsiro rwemarwadzo mushure mekuvhiwa, fentanyl inogona kunge yakakodzera. Chiremba wako weanesthesiologist achasarudza zvichienderana nerudzi rwemaitiro, nguva yayo inotarisirwa, uye zvaunoda zvekurapa.

Hapana mushonga wakanyanya

Remifentanil inogona kushandiswa zvakachengeteka muvanhu vane chirwere chemoyo, asi zvinoda kunyatsoongororwa uye kugadziriswa kwemishonga. Mushonga uyu unogona kuderedza kumhanya kwemoyo wako uye kuderedza ropa, izvo zvingave zvinonetesa kana iwe uine matambudziko emoyo. Zvisinei, vanachiremba vanoita anesthesia vakadzidziswa zvakanyanya kuti vakwanise kubata nemigumisiro iyi uye vane mishonga inowanikwa kuti vatsigire basa remoyo wako kana zvichidikanwa.

Mamiriro ako emoyo achanyatsoongororwa vasati vaitwa kuvhiyiwa, uye chikwata chako chekurapa chichagadzirisa chirongwa cheanesthesia kune hutano hwako hwemoyo. Vanogona kushandisa madosi madiki, kupa imwe monitoring yemoyo, kana kuva nemishonga yemoyo yakagadzirirwa. Varwere vazhinji vane matambudziko emoyo vanogamuchira remifentanil zvakachengeteka zuva rega rega muzvipatara pasi rose.

Mubvunzo 2. Ndingaita Sei Kana Ndikashandisa Remifentanil Yakawandisa Netsaona?

Haugoni kuwandisa remifentanil netsaona nekuti inongopiwa chete nenyanzvi dzekurapa dzakadzidziswa kuburikidza neIV infusions inodzorwa zvakanyanya. Mushonga haumbopihwi kuti ushandiswe kumba, uye kutarisirwa kwese kunoitika pasi pekutariswa kwechiremba nguva dzose nekutarisa nguva dzose zviratidzo zvako zvakakosha.

Kana vashandi vezvokurapa vakaona chero zviratidzo zvehuwandu hwemishonga - senge kufema kunonoka kana kudzikira kweropa - vanogona pakarepo kumisa infusion uye kupa mishonga yekudzosa yakaita se naloxone kana zvichidikanwa. Iyo ultra-short duration ye remifentanil zvinoreva kuti migumisiro yakawanda yekuwandisa inogadziriswa nekukurumidza kana infusion yamira.

Mubvunzo 3. Ndingaita Sei Kana Ndikakanganwa Dosi yeRemifentanil?

Mubvunzo uyu haushande kune remifentanil sezvo ichipiwa sekuenderera mberi kwe infusion panguva yezvirongwa zvekurapa, kwete semadosi akarongeka. Chikwata chako chekurapa chinodzora maitiro ese ekutarisira, kugadzirisa chiyero zvichienderana nezvido zvako zvinoramba zvichiitika panguva yechirongwa.

Kana paine chero kukanganiswa mukudururwa kwemishonga nekuda kwenyaya dzekushanda, chikwata chako chekurapa chichakurumidza kuchigadzirisa uye chichava nechokwadi chekuti unogara wakasununguka. Vane masisitimu ekutsigira uye mishonga imwe inowanikwa kuti vachengetedze kutonga kwakakodzera kurwadziwa panguva yese yebasa rako.

Q4. Ndingamira Rini Kutora Remifentanil?

Iwe hauiti chisarudzo chekumisa remifentanil - chikwata chako chekurapa chinotema kana chisingachadiwi zvichienderana nebasa rako uye kufambira mberi kwekupora. Panguva yekuvhiyiwa, vanowanzo kumisa kudiridzwa sezvo kuvhiyiwa kunopera. Munzvimbo dzekutarisira zvakanyanya, vachamisa kana usisadi kufema kwemuchina kana kutarisirwa kwakanyanya kwekurwadziwa.

Nekuti remifentanil inobviswa kubva muhurongwa hwako nekukurumidza, hapana maitiro ekumira zvishoma nezvishoma semamwe maopioids. Kana kudiridzwa kwamira, mhedzisiro inopera mukati memaminitsi, zvichikubvumira kuti uchinje zvakanaka kune dzimwe nzira dzekutarisira kurwadziwa kana kupora zvakasikwa.

Q5. Remifentanil Inogona Kukonzera Kuwora Mwoyo Here?

Nepo remifentanil iri opioid ine simba, kuwora mwoyo hakuiti zvakanyanya kana tichiona mashandisirwo ayo munzvimbo dzekurapa. Iwe unongoburitswa kwairi usina kuziva panguva yemabasa kana uchirwara zvakanyanya mukutarisirwa zvakanyanya, uye inogumiswa pakarepo sezvo isingachadiwi zvakanyanya. Kushandiswa kwekurapa kunodzorwa, kwenguva pfupi hakugadziri mamiriro anowanzoenderana nekukura kwekuwora mwoyo.

Zvisinei, kana uine nhoroondo yekushandisa zvinodhaka zvisina kufanira, zvakakosha kuti ukurukure izvi nechikwata chako chekurapa usati waita chero basa. Vanogona kutora matanho ekuwedzera uye vanogona kusarudza mamwe maitiro ekutarisira kurwadziwa kuti vave nechokwadi chekuchengeteka kwako uye kupora kwako kubva pakuwora mwoyo.