Intravenous Lidoca in anaesthetic surgery for liver cancer in 1 drug-using patient

The anaesthetic choice of drug-taking patients should not only ensure adequate analgesic, ensure the smoothness of surgery, but also try toprevent the occurrence ofperioperative withdrawal syndrome, so the appropriate anaesthetic selection is very importantThe application of 1 case of intravenous lidoca in the operation of anaesthetic in liver cancer in drug-using patients is reported, and the treatment scheme of this type of case is discussed1Information and Methods1.1 Basic Informationmale, 44 years old, weight 52kg, ASAI gradeThere have been 3 years of drug use history, the drug is heroin, has been drug treatment for 3 years; Check body: general situation can beHeart function rating I, physical examination did not see abnormalAuxiliary examination: admission special examination: hepatitis B small sanyang,hepatitis C(plus); MRI: (1) hepatitis right lobe upper swelling (S7/8), consider the possibility of primary liver cancer; Preoperativediagnosis: hepatic right lobe primary liver cancer, Child-pughA grade, proposed liver right loe liver cancer excision1.2 anaesthetic preoperative antibiotics prevention of infection , ethyl ether 1mg anticholinergic treatment Regularly monitor heart rate, blood pressure, pulse oxygen saturation, exhalation of end carbon dioxide, electroencephaly double spectrum index (BIS) after entering the operating room To the right metorciin 0.8ug/kg load dose intravenous pump injection plus flubiofcinest50 mg line advanced analgesic, in the hemp down the right side of the neck venous puncture tube, left artery puncture tube to monitor arterial blood pressure induction before the injection of disemison 10mg intravenous injection, anaesthetic induction: Lidoca in 2mg/kg-propofol 1.5-2mg/kg-phensulshun aqualku ammonium 0.4mg/kg rapid-induced anesthesia Anaesthetic maintenance: Lidoca in 2mg/kg/h- right metormiedd 0.2ug/kg/h-propofol 6-8mg/kg/h-phensul-seinazoln ammonium 0.2mg/kg/h continuous pump injection After abdominal liver right leaf liver cancer excision, gallbladder excision, large retina free transplantation, intestinal adhesion hemorrhage 600 ml, infusion 2600 ml, urine volume of 300 ml During surgery, the blood pressure heart rate was stable, the blood pressure fluctuated at 100-145/50-80mmHg, the heart rate was 70-90 times/min, and the BIS was maintained at 40-60 The operation went well and the operation lasted 245 minutes 50 minutes before the end of the operation to deactivate the right metamine and benzene shun aquoram, 30 minutes before the end of the operation to give flubiofenesters 50mg plus qumaldo 100mg intravenous injection, Lidoca because of maintenance until the end of surgery, postoperative to PACU resuscitation, 20 min after consciousness, muscle recovery, pull out trachea catheter, respiratory circulation is stable Postoperative analgesia is given to fluprofenesters 50mg, twice a day plus tummydo 100mg, three intravenous injections a day, and to tothean to prevent nausea and vomiting Postoperative analgesia effect was satisfactory, no withdrawal syndrome The patient recovered and was discharged from the hospital 7 days after the operation 2 Discussion increased sensitivity of drug users to narcotic drugs, especially opioids, and increased risk of withdrawal syndrome after surgery Open abdominal liver cancer excision surgery stress, high risk of bleeding, trachea intubation general anesthesia is the preferred method of anesthesia Combined with this case of intravenous Lidoca in drug users to perform liver cancer surgery anaesthetic application, there are the following experience 2.1 to clarify the particularity of anesthesia choice in drug-using patients
long-term drug users have different degrees of damage to the heart, liver and kidney, should choose the small impact on liver and kidney function of anaesthetic drugs This case of heroin use, belongs to opioids, drug users from the body ingest a large number of exogenous opioid-like compounds, inhibit the formation and release of normal endogenous opioid peptides in the body, while opioid receptors exogenous opioid-like compounds easy to produce tolerance When the supply of drugs is interrupted, the systems from the center to the outer circanas will be disrupted and patients will experience various symptoms and complications The patient has been drug treatment for 3 years, the current patient's general condition is relatively stable, should be actively prevented and treated 2.2 Full preoperative assessment to understand the type and dose of drugs used by drug users, the time of starting exposure to drugs, the time of drug treatment, the time of withdrawal symptoms, the symptoms At the same time, the patient's heart, lung, liver, kidney and other functions are evaluated, there are no complications Preoperative infectious diseases can not be ignored, such as hepatitis B, hepatitis C, HIV and so on 2.3 Intravenous anaesthetic use non-opioid general anaesthetic in this case Give right metamine a fixed load dose and fluoropolofenest earlier in the analgesia, reducing the patient's pain and stress response Fluorofen esters are nonsteroidal analgesics that reduce the synthesis of prostaglandins by inhibiting cyclooxidase, thereby reducing the pain allergy state caused by surgical trauma In anaesthetic induction and maintenance, analgesics are selected for intravenous pumping lidocain Lidocain intravenous injection inhibits peripheral and central sensitization, thus having analgesic effect At the same time, Lidoca in have a sedative effect, Wang Hongzhu and others found that intravenous lidocain can reduce BIS value and stress response intravenous lidocain can also reduce the demand for intraoperative drugs and postoperative analgesic demand, and reduce the postoperative pain score In addition, Lidocain can remove free radicals, inhibit endothelial cell adhesion molecular expression, anti-cell apoptosis, the heart, brain, lung and other important organs have a protective effect The choice of intravenous lidocain, can avoid the use of opioid analgesics in general anesthesia of drug users, reduce the incidence of induced addiction and withdrawal reaction, at the same time, Lidoca in the course of surgery, postoperative analgesic effect is significant, from this case, the hemodynamics in surgery smooth, smooth postoperative recovery, the perinatal period did not appear abstinence syndrome, patients are satisfied with the pain effect supplemented by right metorciin and propaean, right metoris is a alpha 2-adrenaline receptor agonist, effective, and has a calming, analgesic effect, no respiratory inhibition, can reduce stress response, reduce the amount of anesthesia in surgery Propofol has the characteristics of rapid action, rapid metabolism and rapid awakening, is widely used in general anesthesia, and many studies can be seen in anesthesia in drug-addicted patients 2.4 postoperative management postoperative analgesia program is: fluorolovinest 50mg, twice a day plus tramadol 100mg, three intravenous injections a day Qumado is a non-opioid central analgesic that can be used to treat moderate to severe pain and post-surgery and post-operative pain relief Studies have shown that tramadol can be used in the treatment of postoperative pain in drug addicts during drug addiction From this example, Tramado postoperative analgesic effect is satisfactory, but it is necessary to to the Toane Joan to prevent nausea and vomiting 3 Summary in the general anesthesia of drug users, the choice of non-opioid anesthesia can not only meet the needs of surgery, but also reduce the incidence of perinatal withdrawal syndrome, and intravenous Lidocain has been proved to be safe and effective