Chohan Amandeep S
Department of Veterinary Clinical Sciences, College of Veterinary Medicine, Washington State University, Pullman, WA 99164-6610, USA.
Top Companion Anim Med. 2010 May;25(2):107-19. doi: 10.1053/j.tcam.2010.01.002.
Anesthetic management of orthopedic patients could vary from normal routine management to more challenging critical management depending on the state in which the patient is presented. Multimodal pain management strategies incorporating opioids, which are the mainstay drugs for pain management, along with adjunctive drugs like local anesthetics (eg, lidocaine), dissociative anesthetics (eg, ketamine), and alpha-2 agonists (eg, dexmedetomidine), could improve overall patient comfort and help prevent establishment of chronic pain pathways. Also, use of local nerve blocks can prevent nociception right at the point of origin. Orthopedic patients with multiple organ traumas like head injuries, spinal injuries, pulmonary fat embolism, compartment syndrome, or thoracic injuries are high-risk patients in which any life-threatening organ pathology should be addressed before the patient is put under general anesthesia. Interactions of various drugs like antibiotics and neuromuscular blocking agents used in the perioperative period in orthopedic patients should warrant a careful consideration with respect to their interactions with each other and other anesthetic drugs used.
根据患者的病情，骨科患者的麻醉管理可能从常规管理到更具挑战性的危重症管理不等。多模式疼痛管理策略包括作为疼痛管理主要药物的阿片类药物，以及局部麻醉药（如利多卡因）、解离麻醉药（如氯胺酮）和α-2激动剂（如右美托咪定）等辅助药物，可提高患者的整体舒适度，并有助于防止慢性疼痛通路的形成。此外，使用局部神经阻滞可在疼痛起源点预防伤害性感受。患有多种器官创伤（如头部损伤、脊柱损伤、肺脂肪栓塞、骨筋膜室综合征或胸部损伤）的骨科患者属于高危患者，在对其实施全身麻醉前，应先处理任何危及生命的器官病变。骨科患者围手术期使用的各种药物（如抗生素和神经肌肉阻滞剂）之间的相互作用，应仔细考虑它们彼此之间以及与其他麻醉药物的相互作用。
