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1 regionaluri anestezia bavsvebsi n.cogovaze

2 regionaluri anestezia bavsvebsi bolo 30wlis ganmavlobasi regionaluri anesteziis gamoyeneba bavsvebsi ufro xsiria ganvitarda arwurviloba pediatriuli regionaluri anesteziistvis sonografiis ganvitareba

4 sonografiis upiratesobebi samizne nervis da Rrus vizualizacia inieqciebis raodenoba lokaluri anestetikebis doza lokaluri anestetikis gavrcelebis vizualicazia moqmedebis dawyeba swrafia gaxangzlivebulia mgrznobelobiti (sensitiuri) blokada

5 regionaluri anesteziis Cveneba bavsvebsi intraoperaciuli da postoperaciuli tkivilis prevencia da martva

6 regionaluri anestezia bavsvebsi bolo wlebsi periferiuli nervis blokadam Seanacvla neiroaqsialuri midgoma ris gamoc gverditma efeqtebma literaturasi ufro metad aris arwerili usafrtxoebaze da efeqturobaze

7 lokaluri anestetikebis toqsiuri efeqtebi bavsvebsi toqsiurobis riski maralia gulis wutmoculoba sistemuri atviseba wamlis umwifari hematoencefaluri barieri ZiriTadad Cvil bavsvebsi fermentuli umwifroba (naxevardaslis periodi ) qlirensi plazmasi cilis Semcveloba plazmasi wamlis Tavisufali fraqcia

8 regionaluri anestezia bavsvebsi toqsiuri efeqtis prevencia aucilebelia zustad iyos datvlili lokaluri anestetikis doza moculoba koncentracia

9 lokaluri anestetikebis sitemuri toqsiuri efeqti cnobiereba nateli anesteziis foni Tavis tkivili kuntebis rigidoba somnolencia auxsneli hipoqsemia perioraluri parestezia Tavbrusxveva tremori gulyra auxsneli taqikardia, disritmia gamtareblobiti blokada, QRS gafartoveba, T talris amplituda - 25% gulis kumsvadi funqcia gulsisxlzarrvta kolafsi, gulis gacereba

10 lokaluri anstetikebis toqsiurobis Sedareba Bupivacaine > Levobupivacaine > Ropivacaine Lidocaine

11 toqsiuri efeqtis martva oqsigenacia 100% O2 gulyris martva: benzodiazepini hiperkapniis prevencia, xelovnuri ventilacia CPR (epinephrine dabali dozebi 1mkg/kg) Intralipide 20% i.v (2009w) sawyisi doza 1 1.5ml/kg 20% 1wT ganmavlobasi ganmeorebiti doza yovel 3 5wT CPR dros 1 1.5ml/kg 20% 1wT ganmavlobasi. saerto doza 3ml/kg infuziis dawyeba 20% ml/kg/wT Cardipulmonary bypass

12 AMERICAN SOCIETY OF REGIONAL ANESTHES IA AND PAIN MEDICINE

13 kaudaluri anestesia usafrtxoa advilia gasaketeblad lokaluri anestetiki vrceldeba Torakalur donemde gamoiyeneba bavsvebsi < 8 w ertjeradi doza an kateteri

14 kaudaluri anestezia specifika bavsvebsi gavis naprali asaktan ertad mcirdeba nervebis gviani mielinizacia moqmdebis swrafi dawyeba, ganzavebuli lokaluri anestetiki Tanabarefeqturia ufro metad koncentrirebuli xsnaris mozrdilebsi epidurul cximsi sitxis gazrdili Semcveloba lokaluri anestetikebis gazrdili difuzia 6 7wlamde

15 Dermatoma distribution of different volumes of local anesthetic for singleshot caudal block.

16 Caudal block. Note that an equilateral triangle is formed with the fingertips from the posterior superior iliac spine(psis) to PSIS to needle insertion at the sacral hiatus (SH). SC, Sacral cornua; TC, tip of coccyx.

17 Caudal sonoanatomy.

18 kaudaluri anesteziis nemsi SedarebiT mokle 25 30mm Short beveled 45 stiletit arwurviloba

19 kaudaluri blokadis dozebi (bupivacaine, levobupivicaine, ropivicaine

20 kaudaluri anesteziis gartulebebi Zalian isviatia ZiriTadad ganpirobebulia arasatanado arwurvilobit subduruli an intravaskularuli inieqcia

Figure 42-11. Sites of misplacement of local anesthetic for caudal block anesthesia.

21 Figure Sites of misplacement of local anesthetic for caudal block anesthesia. Note that injection may be made into bone marrow (A), into subperiosteum (B), into posterior sacral ligaments (C), into a false decoy hiatus (D), into the anterior sacral wall and possibly out into the pelvis (E), or into a lateral foramen, producing a limited block (F). Coté C. J., Practice of Anesthesia for Infants and Children 4 th ed., 2009

22 kaudaluri anestezia magari garsis perforacia magari garsi mtavrdeba S3 doneze S3 donis zevit gaxvretis riski simpatikuri inervaciis umwifroba da qveda kidurebsi mcire sisxlzarrovani avzi hemodinamiuri stabiluroba neiroaqsialuri blokadis dros apnoe

Figure 42-4. Anatomic differences between adults and children that affect the performance of spinal and epidural anesthesia; an infant s sacrum (left) is flatter and narrower than an adult s (right).

23 Figure Anatomic differences between adults and children that affect the performance of spinal and epidural anesthesia; an infant s sacrum (left) is flatter and narrower than an adult s (right). Note that the tip of the spinal cord in a neonate ends at L3 and does not achieve the normal adult position (L1-2) until approximately 1 year of age. The relative location of the spinal cord with growth to adulthood is illustrated on the right as different shades of yellow with the darkest being the final adult configuration.

24 gamoyenebuli literatura Davis P.J, Cladis F.P, Motoyama E.K Smith s Anesthesia for Infants and Children 8 th ed., Ronald D., MS Miller s Anesthesia 8 th ed., Coté C. J., Practice of Anesthesia for Infants and Children 4 th ed., 2013 Gregory A. Gregory,.B.Andropoulos Gregory's Pediatric Anesthesia 5 th ed J. Ehrenwerth, J.B. Eisenkraft, J. M. Berry Anesthesia Equipment: Principles and Applications Morray JP, Geldusccheck JM, Ramamoorthy C et al: Anesthesia-related cardiac arrest in children: initial findings of the pediatric perioperative cardia arrest (POCA) Registry. Anesthesiology 2000 Morray JP, Bhananker SM: Recent Findings From the Pediatric Perioperative CardiacArrest (POCA) Registry. ASA Newsletter 69(6): 10-12, Uptodate version 21.2

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