Included in the formulation
Included in the list (Order of the Government of the Russian Federation No. 2782-r of 30.12.2014):VED
АТХ:N.01.A.X.13 Dinitrogen oxide
N.01.A.X Other drugs for general anesthesia
Pharmacodynamics:Anesthetic.
Nonspecifically interacts with neuronal membranes, depresses the synaptic transmission of excitation in the central nervous system, disrupts the transmission of afferent impulses, changes the cortical-subcortical relationships, the functions of the intermediate, middle and spinal cord.
Pharmacokinetics:Anesthesia develops using 94-95% of the content in the inspired air (which is unacceptable due to the development of hypoxia). Small concentrations cause a feeling of intoxication and mild drowsiness. Anesthesiology uses a mixture of 80% dinitrogen oxide and 20% oxygen, the effect reaches the initial level of the surgical anesthesia stage; usually used in combination with other more active means for anesthesia and muscle relaxants. Termination of inhalation leads to a rapid awakening without the phenomena of aftereffect. Has a high analgesic activity. Increases the heart rate, causes a narrowing of the peripheral vessels, can increase intracranial pressure, depressing breathing. Absorbed into the blood through the lungs.In the body is not metabolized, is in a dissolved state in the plasma. It is excreted completely unchanged in the form of light (10-15 minutes), a small amount - through the skin.
Indications:General anesthesia (introduction to anesthesia and maintenance of anesthesia); relief of pain syndrome in the postoperative period (prevention of traumatic shock), childbirth, unstable angina, myocardial infarction, acute pancreatitis; anesthesia in the performance of medical procedures requiring disconnection of consciousness.
XVIII.R50-R69.R52.0 Acute pain
XVIII.R50-R69.R52.1 Constant unrestrained pain
XX.Y83-Y84.Y83.8 Other Surgery
Contraindications:Hypersensitivity; at the relief of pain syndrome - severe diseases of the nervous system, chronic alcoholism, the state of alcoholic intoxication (excitement, hallucinations are possible).
Carefully:Inhalation of the mixture can be at an oxygen content of at least 30%, and after stopping inhalation, it is necessary to continue supplying oxygen for 5 minutes (prevention of hypoxia). To reduce emotional excitement, prevent nausea and vomiting, and potentiate the effect, a premedication is shown: intramuscular injection of 1-2 ml of a 0.5% solution of diazepam (5-10 mg), 2-3 ml of 0.25% solution of droperidol (5.0- 7.5 mg).It is necessary to control blood pressure, heart rate, heart rate, monitor breathing and gas exchange, body temperature. Care should be taken in the presence of air cysts in the lungs, kidneys or occlusion of the middle ear, air embolism, acute intestinal obstruction or pneumothorax, during pneumoencephalography or soon after it (increases the pressure inside the cavities or the volume of cavities containing air). They are used with caution in cases of craniocerebral trauma, increased intracranial pressure in the history, extensive intracranial lesion or tumor, pronounced hypoxia and violation of the diffusion of gases in the lungs. Patients with chronic alcoholism require higher concentrations.
Pregnancy and lactation:Contraindications to use during pregnancy and lactation.
Dosing and Administration:Used in a mixture with oxygen with the help of special apparatus for gas anesthesia. Concentration should be selected individually, depending on the patient's condition, type and amount of injected drugs.Usual dose for adults: introduction to anesthesia - 70% of dinitrogen oxide and 30% of oxygen, maintenance of anesthesia - 40-50% of dinitrogen oxide with oxygen. For the anesthetization of labor, the method of interrupted autoanalgesia (with the help of special anesthesia apparatus) is used - 40-75% mixture of the dinitrogen oxide with oxygen (the mother gives birth to inhaling the mixture at the appearance of harbingers of the fight and ends the inhalation at the height of the bout or to its end). To perform medical procedures that require disconnection of consciousness - inhalation of 25-50% of the mixture with oxygen. For children, doses are selected individually.
Side effects:During the introduction to anesthesia, supraventricular arrhythmias, bradycardia, circulatory failure; after coming out of anesthesia - diffuse hypoxia, postnarcosis delirium: sensation of anxiety, confusion, agitation, hallucinations, nervousness, motor anxiety; with prolonged use - leukopenia, CNS damage, respiratory depression, nausea, vomiting, malignant hyperthermic crisis, postoperative chills.
Overdose:Symptoms: bradycardia, arrhythmias, circulatory insufficiency, hypotension, hyperthermic crisis, respiratory depression, delirium.
Treatment: at a bradycardia - introduction of 0,3-0,6 mg atropine, arrhythmias - correction of the maintenance of gases in blood, insufficiency of a circulation and a hypotension - introduction of plasma or plazmozameshchajushchih agents, decrease of depth or the termination of anesthesia, at a hyperthermic crisis - the termination of inhalation, administration of antipyretics, correction of water-salt balance and metabolic acidosis, if necessary, administer dantrolene (1 mg / kg) intravenously drip and continue the injection until the symptoms of the crisis disappear (maximum amount dosed dose of 10 mg / kg). To prevent recurrence of the crisis within 1-3 days after the operation, dantrolen is administered cautiously or intravenously (4-8 mg / kg per day in 4 divided doses). Inhibition of respiration or inadequate postoperative ventilation of the lungs necessitates a reduction in the dose of anesthetic (if it is still used), airway patency and artificial ventilation. In the case of the development of delirium after leaving the anesthesia, small doses of the narcotic analgesic are administered.
Interaction:Clinically significant interactions have not been identified, since the drug is used for anesthesia in surgical interventions.
Special instructions:Medical personnel with prolonged exposure to dinitrogen oxide increases the risk of leukopenia. During use, periodic pumping of gas from the cuff of the endotracheal tube is recommended. Mixtures with ether, cyclopropane, chloroethyl at certain concentrations are explosive.