Yini i-Remifentanil: Ukusetshenziswa, Umthamo, Imiphumela Eceleni nokuningi

I-Remifentanil iyikhambi elinamandla lokwelapha ubuhlungu le-opioid elinikezwa nge-IV ngesikhathi sokuhlinzwa nezinye izinqubo zezokwelapha. Isebenza ngokushesha okukhulu futhi iyaphela ngokushesha, okuyenza ilungele izimo lapho odokotela bedinga khona ukulawula okunembile ekwelapheni ubuhlungu. Cabanga ngayo njengethuluzi elikhethekile kakhulu elisetshenziswa ngabadokotela bezokwelapha ukukugcina ukhululekile ngesikhathi sokuhlinzwa ngenkathi uqinisekisa ukuthi uvuka kahle ngemva kwalokho.

Yini i-Remifentanil?

I-Remifentanil ingeyeqembu lemithi ebizwa ngokuthi ama-opioid okwenziwa, aklanyelwe ngqo ukusetshenziswa ezibhedlela nasemitholampilo yokuhlinzwa. Ngokungafani neminye imithi yokwelapha ubuhlungu ongayithatha ekhaya, le nto inikezwa kuphela nge-IV line ngabasebenzi bezokwelapha abaqeqeshiwe. Yilokho esikubiza ngokuthi i-ultra-short-acting opioid, okusho ukuthi iqala ukusebenza ngemizuzwana futhi iyeka ukusebenza ngokushesha lapho ukumnika kuphela.

Umuthi unamandla kangangokuthi ngisho namanani amancane angahlinzeka ngokuqeda ubuhlungu okukhulu. Lawa mandla, ahambisana nokuqala kwayo okusheshayo nokucisha, kuyenza ibe yigugu emagumbini okusebenza lapho ukulawulwa kobuhlungu okunembile kubalulekile. Ngeke uyithole le mithi ngaphandle kwendawo yesibhedlela ngoba idinga ukuqapha okuqhubekayo nemishini ekhethekile ukuze inikezwe ngokuphepha.

Yini i-Remifentanil Esetshenziselwa Yona?

I-Remifentanil isetshenziswa ikakhulukazi ngesikhathi sokuhlinzwa okujwayelekile ukusiza ukuphatha ubuhlungu ngenkathi ungalwazi ngesikhathi sokuhlinzwa. Iphinde isetshenziswe eminyangweni yokunakekelwa okukhulu ezigulini ezisebenzisa ama-ventilator futhi zidinga ukwelashwa ubuhlungu okuqhubekayo. Umuthi usiza ukuqinisekisa ukuthi uhlala ukhululekile kuyo yonke imikhuba yezokwelapha ngenkathi uvumela odokotela ukuthi balungise ukuphathwa kwakho ubuhlungu ngesikhathi sangempela.

Ngaphandle kokuhlinzwa, lo muthi uyasiza ngesikhathi sezinqubo ezithile zokuxilonga ezingase zingakhululeki noma zibuhlungu. Ezinye izinqubo zenhliziyo, ukuhlinzwa kobuchopho, neminye imisebenzi eyinkimbinkimbi ikakhulukazi izuza ezintweni eziyingqayizivele ze-remifentanil. Inzuzo enkulu ukuthi ayihlali emzimbeni wakho ngemuva kokuphela kwenqubo, okukusiza ukuthi ululame ngokushesha.

Isebenza Kanjani I-Remifentanil?

I-Remifentanil isebenza ngokubopha kuma-opioid receptors ebuchosheni bakho nasemgogodleni, ivimba ngempumelelo izimpawu zobuhlungu ekufinyeleleni ukuqwashisa kwakho. Ithathwa njenge-opioid enamandla kakhulu, okusho ukuthi ngisho nemithamo emincane ingaveza imiphumela ebalulekile. Kodwa-ke, ngokungafani namanye ama-opioids, umzimba wakho uyayihlukanisa ngokushesha okukhulu ngama-enzyme egazini lakho nezicubu.

Lokhu kuhlukaniswa okusheshayo yikho okwenza i-remifentanil ihluke kangaka futhi isetshenziswe ezindaweni zezokwelapha. Ngenkathi amanye ama-opioids angathatha amahora ukuthi aphele, imiphumela ye-remifentanil inyamalala ngemizuzu ngemuva kokumisa ukumnika. Lokhu kuvumela ithimba lakho lezokwelapha ukuthi linikeze ukukhululeka okukhulu kobuhlungu ngesikhathi sezinqubo ngenkathi liqinisekisa ukuthi ungalulama ngokushesha ngemuva kwalokho ngaphandle kokulala noma izinkinga zokuphefumula.

Ngingayithatha Kanjani I-Remifentanil?

Ngeke uzithathele wena i-remifentanil - lo muthi unikezwa kuphela ochwepheshe bezokwelapha abaqeqeshiwe ngomugqa we-IV. Udokotela wakho we-anesthesiologist noma udokotela wokunakekelwa okukhulu uzobala ngokucophelela umthamo ofanele ngokuya ngesisindo sakho, isimo sezokwelapha, kanye nenqubo oyenzayo. Umuthi unikezwa njengokumnika okuqhubekayo, okusho ukuthi ugeleza ngokuqhubekayo emsingeni wakho ngesilinganiso esilawulwayo.

Ngaphambi kokuthola i-remifentanil, ithimba lakho lezokwelapha lizofaka i-IV catheter engalweni yakho noma esandleni sakho. Bazokuqapha ngokuqhubekayo ngesikhathi sokufakwa ngemishini ekhethekile elandela izinga lokushaya kwenhliziyo yakho, umfutho wegazi, amazinga omoya-mpilo, nokuphefumula. Umthamo ungalungiswa umzuzu ngomzuzu ngokuya ngempendulo yomzimba wakho kanye nezidingo zenqubo yakho.

Akukho ukulungiselela okukhethekile okudingekayo ngakho mayelana nokudla noma isiphuzo, njengoba lezi zinqumo zizokwenziwa njengengxenye yohlelo lwakho olujwayelekile lokubeletha. Ithimba lakho lezokwelapha lizokunikeza imiyalelo ethile mayelana nokudla nokuphuza ngaphambi kwenqubo yakho ngokuya ngohlobo lokuhlinzwa noma ukwelashwa okutholayo.

Kufanele Ngiyithathe Isikhathi Esingakanani I-Remifentanil?

Ubude bokwelashwa nge-remifentanil buqondene ngokuphelele nenqubo yakho yezokwelapha nezidingo zomuntu ngamunye. Ngesikhathi sokuhlinzwa, ngokuvamile uzoyithola ngesikhathi sonke sokuhlinzwa, okungaba noma yikuphi kusuka kumaminithi angu-30 kuya emahoreni amaningana. Ezindaweni zokunakekelwa okukhulu, ubude bungase bufinyelele ezinsukwini uma usebenzisa i-ventilator futhi udinga ukuphathwa kobuhlungu okuqhubekayo.

Ithimba lakho lezokwelapha lizoyeka ukufakwa kwe-remifentanil lapho lingasadingeki ekunakekelweni kwakho. Ngenxa yokuthi umuthi usuka ngokushesha emzimbeni wakho, ngokuvamile uzoqala ukuzwa imiphumela yawo iphela phakathi kwemizuzu emi-5 kuya kweli-10 ngemuva kokuthi ukufakwa kuyeke. Lokhu kuqeda okusheshayo kungenye yezinzuzo ezinkulu zomuthi, njengoba kuvumela ukuguquka okubushelelezi ekululameni.

Yiziphi Imiphumela Eceleni Ye-Remifentanil?

Njengayo yonke imithi ye-opioid, i-remifentanil ingabangela imiphumela emibi, nakuba eminingi iphathwa ngokuqhubekayo yithimba lakho lezokwelapha ngesikhathi sokulawulwa. Imiphumela emibi evame kakhulu ihlanganisa ukuphefumula okuhamba kancane, ukwehla kwenhliziyo, nomfutho wegazi ophansi. Le miphumela empeleni ilindelekile futhi iqashwe eduze, nethimba lakho lezokwelapha lilungele ukulungisa umthamo noma linikeze ukwesekwa okwengeziwe uma kudingeka.

Nawa amanye amaphutha ongase uhlangabezane nawo, ahlukaniswe ngokuthi avamile kangakanani:

Imiphumela evamile eqashwe futhi iphathwe ithimba lakho lezokwelapha:

• Ukuphefumula okuhamba kancane noma okungashoni (ukucindezeleka kokuphefumula)
• Ukwehla kwesilinganiso senhliziyo (i-bradycardia)
• Umfutho wegazi ophansi (i-hypotension)
• Isicanucanu nokuhlanza ngemva kokuvuka
• Ukuqina kwemisipha okwesikhashana, ikakhulukazi esifubeni
• Ukuqhaqhazela njengoba umuthi uphela

Imiphumela engavamile kodwa ebalulekile:

• Ukulunywa okukhulu (pruritus)
• Isiyezi noma ukuzizwa unovalo
• Ukujuluka noma ukubomvu
• Ikhanda ngesikhathi sokululama
• Ukudideka okwesikhashana njengoba uvuka

Imiphumela engavamile kodwa ebucayi:

• Ukungezwani komzimba okukhulu (i-anaphylaxis)
• Isilinganiso senhliziyo esihamba kancane kakhulu esidinga ukungenelela
• Ukwehla okukhulu komfutho wegazi
• Ubunzima bokuphefumula obude
• Ukushaya kwenhliziyo okungavamile (ama-arrhythmias)

Izindaba ezinhle ukuthi ngenxa yokuthi uthola i-remifentanil endaweni yezokwelapha elawulwayo, ithimba lakho lingakwazi ukubhekana ngokushesha nanoma yimiphumela emibi eyenzekayo. Banemithi nemishini etholakalayo ukuze balwe nezinkinga futhi baqinisekise ukuphepha kwakho kuyo yonke inqubo.

Ubani Ongafanele Athole I-Remifentanil?

I-Remifentanil ayifanele wonke umuntu, futhi ithimba lakho lezokwelapha lizobuyekeza ngokucophelela umlando wakho wezokwelapha ngaphambi kokuyisebenzisa. Abantu abanezifo ezithile zokungezwani komzimba, izimo zokuphefumula, noma izinkinga zenhliziyo bangase badinge ezinye izindlela zokuphatha ubuhlungu. Kodwa-ke, indawo yesibhedlela elawulwayo ivame ukuvumela odokotela ukuthi basebenzise i-remifentanil ngokuphepha ngisho nasezimweni ezinobungozi obukhulu.

Udokotela wakho uzoba nokuqapha okukhethekile uma unezimo ezilandelayo:

Izimo ezingavumelekile ngokuphelele (izimo lapho i-remifentanil ingafanele isetshenziswe khona):

• Ukungezwani okwaziwayo ne-remifentanil noma eminye imithi esekelwe ku-fentanyl
• Izinkinga ezinkulu zokuphefumula ngaphandle kokusekelwa komoya ngomshini
• Izinhlobo ezithile zokuvaleka kwenhliziyo ngaphandle kwe-pacemaker
• Isifo sesibindi esibi esithinta ukumuncwa kwemithi

Izimo ezidinga ukuqapha nokuqapha okwengeziwe:

• Isifo sokuphefumula esingapheli (COPD) noma ezinye izifo zokuphefumula
• Izinkinga zesigqi senhliziyo noma izinga lenhliziyo elihamba kancane
• Isifo sezinso esithinta ukususwa kwemithi
• Umlando wokusebenzisa izidakamizwa noma ukuncika kuma-opioid
• Iziguli ezigugile ezingase zizwele kakhulu imiphumela
• Ukukhulelwa, ikakhulukazi ngesikhathi sokubeletha

Izimo ezingavamile ezidinga ukucatshangelwa okukhethekile:

• I-Myasthenia gravis noma ezinye izifo zokukhathala kwemisipha
• Ukwelashwa kwekhanda elibi noma ukwanda kwengcindezi ebuchosheni
• Izimo ezithile zofuzo ezithinta ukumuncwa kwemithi
• Ukuphendula okungalungile ngaphambilini ku-anesthesia

Noma ngabe unesinye salezi zimo, ungakhathazeki - ithimba lakho lezokwelapha linolwazi lokuphatha izimo eziyinkimbinkimbi futhi lizokwenza uhlelo oliphephe kakhulu lwe-anesthesia oludingayo.

Amagama e-Brand ye-Remifentanil

I-Remifentanil itholakala ngaphansi kwamagama amaningana e-brand, i-Ultiva iyona eyaziwa kakhulu emhlabeni wonke. Eziphathini, ungase futhi uhlangane nayo njenge-Remifenta emazweni athile, nakuba isithako esisebenzayo nemiphumela ihlala ifana kungakhathaliseki igama le-brand. Ithimba lakho lezokwelapha lizojwayelana nanoma iyiphi inguqulo esetshenziswa endaweni yabo.

Umuthi uza njengempushana okumele ixutshwe ngamanzi ahlanzekile noma i-saline ngaphambi kokusetshenziswa. Lokhu kulungiswa kwenziwa njalo ngabasebenzi be-pharmacy abaqeqeshiwe noma ochwepheshe bezokwelapha besebenzisa izindlela eziqinile zokuhlanzeka. Akudingeki ukhathazeke ngokuthi iyiphi i-brand oyitholayo - zonke izinguqulo zihlangabezana namazinga afanayo okuphepha nokusebenza kahle.

Ezinye izindlela ze-Remifentanil

Eminye imithi ye-opioid ingasetshenziswa ngezinhloso ezifanayo ngesikhathi sokuhlinzwa nezinqubo zezokwelapha. I-Fentanyl, i-sufentanil, ne-alfentanil yonke imithi ehlobene esebenza ngendlela efanayo kodwa inezikhathi ezihlukene zokuqala nobude besenzo. Udokotela wakho we-anesthesiologist uzokhetha inketho engcono kakhulu ngokusekelwe ezinqubweni zakho ezithile nezidingo zezokwelapha.

Kwezinye izinqubo, ezinye izindlela ezingezona ze-opioid zingase zithandwe noma zisetshenziswe ngokuhlangana nama-opioid. Lokhu kufaka phakathi imithi efana ne-propofol yokuthulisa, izindlela ze-anesthesia zesifunda ezisebenzisa ama-anesthetics endawo, noma izindlela ezintsha zokuphatha ubuhlungu ezinciphisa isidingo sama-opioid ngokuphelele. Ithimba lakho lezokwelapha lizoxoxa ngendlela engcono kakhulu yesimo sakho.

Ingabe i-Remifentanil Ingcono Kune-Fentanyl?

I-Remifentanil ne-fentanyl ngalinye linobuhle obuhlukile ngokuya ngesimo sezokwelapha. Inzuzo enkulu ye-Remifentanil ubude bayo obufushane kakhulu - iyaphela ngemizuzu embalwa ngemuva kokumisa ukumnika, okuvumela ukululama okusheshayo nokulawula okunembile ngesikhathi sezinqubo. I-Fentanyl, ngakolunye uhlangothi, inikeza ukukhululeka kobuhlungu obuhlala isikhathi eside kodwa kuthatha isikhathi eside ukuthi isuswe ohlelweni lwakho.

Ngokuhlinzwa lapho udinga ukuvuka ngokushesha nangokucacile, i-remifentanil ivame ukukhethwa. Kodwa-ke, ezinqubweni lapho kudingeka khona ukukhululeka kobuhlungu okuqhubekayo ngemuva kokuhlinzwa, i-fentanyl ingase ifaneleke kakhulu. Udokotela wakho we-anesthesiologist uzokhetha ngokusekelwe ohlotsheni lwenqubo, ubude bayo obulindelekile, nezidingo zakho zezokwelapha.

Akukho muthi ongcono ngokwemvelo - bayithuluzi elihlukile lezimo ezihlukene. Okubaluleke kakhulu ukuthi ithimba lakho lezokwelapha likhetha umuthi ofanele izimo zakho ezithile ukuqinisekisa ukuphepha kwakho nokunethezeka kuyo yonke inqubo yakho.

Imibuzo Evame Ukubuzwa Nge-Remifentanil

Q1. Ingabe i-Remifentanil Iphephile Ezigulini Zezifo Zenhliziyo?

I-Remifentanil ingasetshenziswa ngokuphepha kubantu abanezifo zenhliziyo, kodwa idinga ukuqashwa ngokucophelela nokulungiswa kwemithamo. Lo muthi unganciphisa izinga lokushaya kwenhliziyo yakho futhi wehlise umfutho wegazi, okungase kukhathaze uma usuvele unezinkinga zenhliziyo. Kodwa-ke, odokotela abaqeqeshwe ngokukhethekile ekuhlinzeni banokuqeqeshwa okukhethekile ukuphatha le miphumela futhi banemithi etholakalayo kalula yokusekela ukusebenza kwenhliziyo yakho uma kudingeka.

Isimo sakho senhliziyo sizohlolwa ngokucophelela ngaphambi kokuhlinzwa, futhi ithimba lakho lezokwelapha lizolungisa uhlelo lokuhlinzwa ngokuvumelana nempilo yakho yenhliziyo ethile. Bangase basebenzise imithamo ephansi, banikeze ukuqashwa okwengeziwe kwenhliziyo, noma babe nemithi yenhliziyo elungisiwe. Iziguli eziningi zenhliziyo zithola i-remifentanil ngokuphepha nsuku zonke ezibhedlela emhlabeni jikelele.

Q2. Kufanele Ngenzeni Uma Ngisebenzisa I-Remifentanil Engakanani Ngengozi?

Awukwazi ukweqisa i-remifentanil ngengozi ngoba inikezwa kuphela ochwepheshe bezokwelapha abaqeqeshiwe ngama-infusion e-IV alawulwa ngokucophelela. Lo muthi awukaze unikezwe ukusetshenziswa ekhaya, futhi konke ukuphathwa kwenzeka ngaphansi kokuqashwa kwezokwelapha okuqhubekayo nokuqashwa okuqhubekayo kwezimpawu zakho ezibalulekile.

Uma abasebenzi bezokwelapha beqaphela noma yiziphi izimpawu zomuthi omningi - njengokuphefumula okuhamba kancane kakhulu noma umfutho wegazi ophansi ngendlela eyingozi - bangakwazi ukumisa ngokushesha ukufakwa futhi banikeze imithi yokuguqula njenge-naloxone uma kudingeka. Ubude obufushane kakhulu be-remifentanil busho ukuthi imiphumela eminingi yokweqisa ixazululwa ngokushesha uma ukufakwa kuyeka.

Q3. Kufanele Ngenzeni Uma Ngiphuthelwa Umthamo We-Remifentanil?

Lo mbuzo awusebenzi ku-remifentanil njengoba inikezwa njenge-infusion eqhubekayo ngesikhathi senqubo yezokwelapha, hhayi njengemithamo ehleliwe. Ithimba lakho lezokwelapha lilawula yonke inqubo yokuphatha, lilungisa izinga ngokusekelwe ezidingweni zakho eziqhubekayo kuyo yonke inqubo.

Uma kukhona ukuphazamiseka ekufakweni ngenxa yezinkinga zobuchwepheshe, ithimba lakho lezokwelapha lizolungisa ngokushesha futhi liqinisekise ukuthi uhlala ukhululekile. Banamasistimu okusekela kanye nemithi ehlukile etholakalayo ukuze bagcine ukulawulwa kobuhlungu obufanele ngesikhathi senqubo yakho.

Q4. Ngingayeka nini ukuthatha i-Remifentanil?

Awuthathi isinqumo sokuyeka i-remifentanil - ithimba lakho lezokwelapha linquma ukuthi lingasadingeki nini ngokusekelwe enqubweni yakho nentuthuko yokululama. Ngesikhathi sokuhlinzwa, ngokuvamile bazoyeka ukufakwa njengoba ukuhlinzwa kuphela. Ezindaweni zokunakekelwa okukhulu, bazoyeka uma ungasadingi ukungeniswa komoya ngomshini noma ukuphathwa kobuhlungu obukhulu.

Ngenxa yokuthi i-remifentanil isuka ngokushesha emzimbeni wakho, akukho inqubo yokuyeka kancane njengakwamanye ama-opioids. Uma ukufakwa kuyeka, imiphumela iyaphela ngemizuzu, ikuvumela ukuthi ushintshe ngokushelela kwezinye izinhlobo zokuphathwa kobuhlungu noma ululame ngokwemvelo.

Q5. Ingabe i-Remifentanil ingabangela ukulutheka?

Ngenkathi i-remifentanil iyi-opioid enamandla, ukulutheka akunakwenzeka kakhulu uma kubhekwa indlela esetshenziswa ngayo ezindaweni zezokwelapha. Uvelelwa yiyo kuphela ngenkathi ungenalwazi ngesikhathi sezinqubo noma ngenkathi ugula kakhulu ekunakekelweni okukhulu, futhi iyekiswa ngokushesha nje lapho ingasadingeki ngokwezokwelapha. Ukusetshenziswa kwezokwelapha okulawulwayo, kwesikhashana akudali izimo ezivame ukuhlotshaniswa nokuthuthukiswa kokulutheka.

Kodwa-ke, uma unomlando wokusebenzisa izidakamizwa, kubalulekile ukuxoxa ngalokhu nethimba lakho lezokwelapha ngaphambi kwanoma iyiphi inqubo. Bangathatha izinyathelo zokuphepha ezengeziwe futhi bangase bakhethe amasu okuphatha ubuhlungu ahlukile ukuze baqinisekise ukuphepha kwakho nokululama okuqhubekayo ekuluthekeni.