Laringo cardiac reflex. Compensatory mechanisms in heart failure. Humoral effects on the heart

Cardiovascular reflexes

Reflex mechanisms of regulation of cardiac activity.

Innervation of the heart.

The parasympathetic centers of cardiac activity are located in the medulla oblongata - these are the dorsal nuclei. From them, the vagus nerves begin, going to the myocardium and to the conduction system.

Sympathetic centers located in the lateral horns of the gray matter of the 5 upper thoracic segments of the spinal cord. Sympathetic nerves from them go to the heart.

When the PNS is excited, ACh is released in the vagus nerve endings, when it interacts with M-ChR, it reduces the excitability of the heart muscle, the conduction of excitation slows down, heart contractions slow down and their amplitude decreases.

The influence of the SNS is associated with the effect of the norepinephrine mediator on β-AR. At the same time, the heart rate and their strength increase, the excitability of the heart increases and the conduction of excitation improves.

Reflex changes in the work of the heart occur when different receptors are stimulated, located in different places: vessels, internal organs, in the heart itself. In this regard, there are:

1) vascular-cardiac reflexes

2) cardio-cardiac reflexes

3) viscero-cardiac reflexes

Of particular importance in the regulation of the work of the heart are receptors located in some parts of the vascular system. These areas are called vascular reflexogenic zones (SRZ). They are in the aortic arch - the aortic zone and in the branching of the carotid artery - the carotid sinus zone. The receptors found here respond to changes in blood pressure in the vessels - baroreceptors and changes in the chemical composition of the blood - chemoreceptors. From these receptors, afferent nerves begin - aortic and carotid sinus, which conduct excitation to the medulla oblongata.

With an increase in blood pressure, SRH receptors are excited, as a result, the flow of nerve impulses to the medulla oblongata increases and the tone of the nuclei of the vagus nerves increases, along the vagus nerves, excitation goes to the heart and its contractions weaken, their rhythm slows down, which means that the initial level of blood pressure is restored.

If the blood pressure in the vessels decreases, the flow of afferent impulses from the receptors to the medulla oblongata decreases, which means that the tone of the nuclei of the vagus nerve decreases, as a result of which the influence of the sympathetic nervous system on the heart increases: the heart rate, their strength increase and blood pressure returns to normal.

Cardiac activity also changes with the excitation of receptors present in the heart itself. In the right atrium there are mechanoreceptors that respond to stretching. With an increase in blood flow to the heart, these receptors are excited, along the sensitive fibers of the vagus nerve, nerve impulses go to the medulla oblongata, the activity of the centers of the vagus nerves decreases and the tone of the sympathetic nervous system increases. In this regard, the heart rate increases and the heart throws excess blood into the arterial system. This reflex is called the Bainbridge reflex, or unloading reflex.

Tracheal intubation during general anesthesia involves the introduction of a tube into the trachea for the purpose of mechanical ventilation (artificial ventilation of the lungs). Intubation is the main method of providing temporary free airway patency during anesthesia and resuscitation.

Indications for tracheal intubation are multicomponent endotracheal anesthesia and the need for prolonged mechanical ventilation.

Tools

It is possible to distinguish a certain set of tools used for tracheal intubation and artificial ventilation of the lungs:

Set of endotracheal tubes. There are several types of tubes: according to the size of the outer diameter (from 0 to 10 mm), along the length, with a cuff and without a cuff, one and two lumen type Carlens for special intubation methods. In adult patients, women are more often used No. 7 - 8, for men No. 8 - 10. For younger patients, tubes without a cuff are used.

Laryngoscope with a set of straight and curved blades of different sizes. It consists of a handle into which batteries or an accumulator are inserted, and a blade, at the end of which there is a light bulb. The blade for tracheal intubation is connected to the handle with a bayonet lock, which allows you to change blades almost instantly if necessary. It is better to prepare TWO laryngoscopes before intubation, in case one suddenly fails, for example, if the light goes out.

Curved anesthesia forceps.

Conductor. This is a fairly thin, but strong and soft metal rod. It is used in cases of difficult intubation, when it is necessary to give the endotracheal tube the desired bend.

Local anesthetic nebulizer (this is almost never required).

In the conditions of the operating room or in the intensive care unit, everything is always “at hand”, and if the anesthesiologist-resuscitator is called to other departments of the hospital, he takes a bag with everything he needs. It always has a laryngoscope, endotracheal tubes of various sizes, a set for setting the central veins (subclavian or jugular), anti-shock solutions, analgesics, hypnotics and a lot of everything for resuscitation in full on the spot.

Types and features of tracheal intubation

There are 2 types of tracheal intubation: orotracheal (through the mouth) and nasotracheal (through the nasal passages). In the second case, we choose an endotracheal tube smaller by 1 - 2 numbers.

There is a separate concept of "tracheostomy" though it has nothing to do with intubation performed by an anesthesiologist. This is a surgical method to ensure free airway patency.

Tracheal intubation technique

The technique and algorithm for tracheal intubation through the mouth is not much different from nasotracheal intubation, we will consider in more detail.

Tracheal intubation during surgery begins after intravenous water anesthesia with an anesthetic, such as sodium thiopental, and the introduction of atropine. Atropine is administered to prevent vagal reactions with the development of bradycardia and laryngo-cardiac reflex. Simultaneously with the induction of anesthesia, auxiliary ventilation with an oxygen mask of the anesthesia machine begins, then relaxants are introduced. After the end of muscle fibrillation (this is a reaction to the introduction of relaxants), intubation begins.

Intubation can be performed blindly or under laryngoscope control. Laryngoscope blades are straight and curved, their choice depends on both the indications and the choice of the anesthesiologist. There are two body positions during intubation:

  1. the classic Jackson position (in the picture on the left): the back of the head is on the plane of the table, the head is somewhat thrown back, the lower jaw is pushed forward - an almost straight line is obtained from the upper incisors along the axis of the larynx and trachea, but a little more distance to the entrance to the larynx.
  2. improved Jackson position (in the picture on the right): the same, but we put a small flat pillow 6-10 cm under the head.

Carefully, without touching the teeth and soft tissues, we insert the laryngoscope blade on the right side of the mouth and bring the glottis into the field of vision.

Remove the laryngoscope.

To control the correctness of intubation, we listen to breathing on the left and right, connect it to the device, fix the tube to the head, and again listen to breathing.

In order to make sure that the tube is inserted correctly, doctors also focus on the stream of air coming out of the tube, it should appear if the patient breathes on his own, or when pressing on the chest if there is no breathing.

At this stage, it is rare, but the tube may not enter the trachea, but the esophagus. Already at the initial stage, this error is easy to detect - when listening, there will be pronounced stomach noises, while respiratory sounds will be completely absent. Symptoms suggestive of hypoxia may also occur.

Difficult (difficult) intubation is considered if it was carried out successfully, but it took several attempts, despite the fact that there are no pathologies of the trachea.

The technique is not much different from the intubation of adult patients, but has its own characteristics and indications.

In an emergency situation (for example, in case of sudden onset of clinical death, when there is no consciousness, reflexes and a precordial strike does not give a result), tracheal intubation is carried out immediately “on the live”, without induction of anesthesia right on the spot, even in the corridor of the hospital. The main task is to ensure breathing, and then we begin a closed heart massage, then we already carry out resuscitation measures.

You can watch the technique of tracheal intubation in this video with comments by an anesthesiologist in Russian.

It is interesting to know: the right bronchus has a more direct continuation from the trachea, and the left bronchus is at an angle, so if the intubation is incorrect, the tube often falls into it. As a result, the left lung does not breathe. The anesthesiologist needs to be extremely careful: listen to the uniformity of breathing on both sides, that is, the conduction of breath sounds in the lungs.

Contraindications

During a preliminary examination of the patient, the anesthesiologist pays attention to how the patient talks, whether nasal breathing is maintained.

Contraindications for intubation are traumatic and pathological changes in the organs of the neck or skull: rupture or swelling of the trachea, tongue, swelling of the pharynx, larynx, etc.

There are several features that also complicate intubation, but are not contraindications:

Obesity;

Short thick neck;

narrow mouth;

Thick tongue;

Protruding forward upper teeth - incisors;

Short, sloping lower jaw;

Abnormal structure of the larynx - this can only be seen at the time of intubation.

If orotracheal intubation (through the mouth) fails, then nasotracheal intubation (through the nasal passages) is performed, while smaller tubes by 1-2 numbers are used.

Complications

Consider the main complications that arise during tracheal intubation, methods for their prevention and causes. They can be traumatic:

Damage to the mucous membrane of the mouth, pharynx, tongue;

Breakage of teeth;

Dislocation of the lower jaw;

And also of a technical nature:

The tube enters the right bronchus;

Tube offset;

Violation of its patency due to kink and or blockage with mucus;

Regurgitation and aspiration of gastric contents.

With traumatic intubation after anesthesia, the following are possible:

laryngitis, hoarseness;

Less commonly, ulceration of the mucous membrane;

At the current level of anesthesiology and with a good qualification of the anesthesiologist, complications associated with intubation are extremely rare.

I created this project to tell you about anesthesia and anesthesia in simple language. If you received an answer to your question and the site was useful to you, I will be glad to support it, it will help to further develop the project and compensate for the costs of its maintenance.

Related questions

    Lera 04/24/2019 00:07

    Good night, difficult question. six months ago I was discharged from the hospital, because. I had a sore throat, which I told the anesthetist. We thought about ARVI, after two months of various treatments, we came to the conclusion that the cause of tonsillitis was GERD. The treatment does not help much, the throat hurts on an ongoing basis. Lor says that this is not infectious tonsillitis, and it is mono to be operated on. The anesthesiologist explains that there will be a tube in the bronchi and if microbes get in, there will be terrible consequences, pneumonia, the kidneys will fail, the wound will become infected. Operation will be on urology. I cannot postpone the operation until the end of my life, because This is chronic tonsillitis and there is no cure. And all doctors speak differently. They refused to put me on a spinal cord, because. Last time the doctor didn't seem to get in, and I felt pain. We can hear your opinion about the risks of general anesthesia, there may have been similar cases.

    Olga 02.08.2018 15:56

    Good day! Tonsillectomy under general anesthesia. My height is 164, weight 48, blood and urine tests are normal. The end time of clotting according to Sukharev is 2 minutes 30 seconds (the laboratory norm is from 3 to 5 minutes) My constant pressure is 90 to 60. When taking tests on an empty stomach, it lays my ears and darkens in my eyes - the pressure drops sharply. 1) is it possible to do anesthesia with such pressure? Previously, I had epidural anesthesia for hallux valgus - I tolerated it well 2) with my low weight, do I need / can I drink 3 days before the operation 3 times a day vikasol? General anesthesia for the first time. Allergy only to cefazolin and furadonin.

    Svetlana 19.06.2018 20:23

    During a caesarean section in 2009, the anesthesiologist was unable to insert the endotracheal tube. I woke up on the operating table, choking from this process. The anesthesiologist had to stop trying and introduce intravenous anesthesia. Then he said that my larynx structure was narrow and such anesthesia should not be done .What is it: is it really true or a medical mistake, for example, he put the tube into the wrong stage of anesthesia, and when I woke up and stenosis of the larynx occurred, the muscles had already “woke up”. I have an operation. a good modern hospital in Kazan.

    Natasha 04/15/2018 19:01

    Good afternoon! I have chronic vasomotor allergic rhinitis. Everything flows down the throat, so it is irritated all the time (according to Lora). Endotracheal anesthesia is coming, and my throat hurts and my nose is stuffed up (for half a year now, even though I am being treated for allergies with nasonex, tsetrin, rinses)! I have already undergone surgery because of this once. My throat sometimes hurts, sometimes it doesn’t. And since the operation is planned, it is difficult to predict whether it will hurt that day or not. I read that when a tube is inserted into an irritated throat, there can be a spasm and other troubles ...

    Elena 07.03.2018 15:37

    Please tell me if the patient has chronic renal failure and he is a dialyzer. The patient was intubated because his condition worsened. Is it possible to carry out hemodialysis if the pulse is maintained by the device and is not stable?

    Elvira 18.02.2018 22:06

    Good evening! Tell me, is it possible to do tracheal intubation (septoplasty operation) with a complete bone bracket over the left arch of the C1 vertebra (Kimmerley anomaly)? No nerves will pinch me? ((((

    Love 15.01.2018 19:38

    The son had a discharge of the contents of the stomach and had difficulty breathing, a tube was placed for ventilation of the lungs, and then they discovered that he had a fistula in the fistula of the trachea and esophagus, they said that they would observe, self-healing is possible. Now the tube has been taken out of the trachea, the son cannot eat and drink on his own, because water flows out through the incision in the neck. The doctor said that his son would have a tube inserted into his esophagus for tube feeding and would be discharged home until the incision in his neck that was made to install a ventilator tube had healed. After healing, the question of an operation to eliminate the fistula will be decided. Please tell me, is it not possible to do an operation to eliminate the fistula now and in what period does the incision heal after tracheostomy? How should I care for my son, my son has type 2 diabetes.

    Ekaterina 09/25/2017 23:37

    Good day! My female relative had an operation under general anesthesia. During the operation, three front teeth in the upper jaw were broken. The teeth were false. The operation went well. The next day she was transferred to her room. Only five days later, the anesthesiologist told her that it was a necessary measure. That while she was under anesthesia, she had a clinical death and had to choose either teeth or life. But the bottom line is that the problem arose when the tube was removed. Allegedly, there was swelling of the larynx and the tube could not be pulled out. And against this background, and clinical death and loss of teeth. The question is what. Is this even possible?

    Elena 09/07/2017 16:56

    Good day! Most likely, a laparoscopic removal of the gallbladder is to be done. I am very afraid of anesthesia. Namely, that I won’t breathe on my own after a ventilator. Tell me, is this possible? Thank you.

    Alexey 11/29/2016 19:14

    Good afternoon! My father will have an operation for an umbilical hernia and removal of the gallbladder, they will do general anesthesia. He was under general anesthesia 2 times, the first time he was not calculated the dose, since he himself is very fat (170 kg now, then he was thinner ) and didn’t wake up for a very long time, the second time his trachea seemed to be stuck together after the introduction of anesthesia and he didn’t breathe for 2 minutes, tell me how this can be avoided and what anesthesia is better for him, through a vein or through a mask

    Anatoly 11/14/2016 13:08

    I am getting ready for an operation (endoscopic decompression of the RCA root), but I am afraid that the vocal cords will be damaged during anesthesia. In 2007, a coronary angiography operation was performed, after which the voice disappeared, which was restored only after six months (the left valve does not fully work). How can I be in this situation please advise?

… pain in the face or oral cavity is the most common complaint in dental and neurological practice.

Stomalgia (SA) is a chronic disease characterized by burning pains and paresthesias in various parts of the mucous membrane of the tongue, lips, posterior pharyngeal wall, without visible local changes, accompanied by a decrease in working capacity, depression of the psyche, and a depressive state of patients (a shorter definition: a chronic disease, manifested by persistent orofacial pain). This disease is more common in women than in men (about 3 times), as well as in the elderly.

At the same time, it should be noted that the paresthetic phenomenon of SA (see below for clinical phenomenology) is extremely variable in prevalence: [ 1 ] only in the region of the tongue (in the region of the tip of the tongue or captures the entire or most of the surface of the tongue); [ 2 ] in the area of ​​the mucous membrane of the prosthetic bed; [ 3 ] in all parts of the oral cavity; [ 4 ] combination of SA with paresthesia of other mucous membranes (pharynx, larynx, esophagus, vagina, rectum) or skin (face, neck, chest, etc.). Based on the subjective sensations of the patient, there are: [ 1 ] mild SA (unsharply expressed paresthetic sensations); [ 2 ] SA ​​of moderate severity (more pronounced paresthetic sensations); [ 3 ] severe SA (burning paresthetic and pain sensations).

The term "stomalgia" has become widespread in the medical literature only in recent years. Previously, different terms were used to describe this symptom complex: glossalgia, glossodynia, paresthesia of the mucous membrane of the oral cavity and tongue, paresthesia of the oral cavity, neurosis of the tongue, neurogenic glossitis, stomatodynia. Some of these synonyms (paresthesia, glossalgia, glossodynia) are still used in clinical dentistry and scientific publications. Such a diversity in the terminology of this symptom complex is obviously due to problems in studying the etiology and treatment of this disease.

According to the current opinion, SA is considered a polyetiological disease. According to etiopathogenesis, the following types of SA are distinguished:

[1 ] neurogenic (psychogenic) form;
[2 ] symptomatic forms associated with: [ 2.1 ] with impaired activity of the digestive system (chronic diseases of the liver and biliary tract, chronic gastritis, peptic ulcer of the stomach or duodenum, colitis of various etiologies, etc.); [ 2.2 ] with endocrine disorders (diabetes mellitus, thyrotoxicosis, etc.); [ 2.3 ] with organic lesions of the central nervous system and autonomic nervous system; [ 2.4 ] with blood diseases (iron deficiency and B12 / folic acid deficiency anemia); [ 2.5 ] with helminthic invasion; [ 2.6 ] with a combination of several diseases;
[3 ] forms caused by local causes (prosthetic stomatitis, galvanism syndrome, surface electrification of the polymer base of the prosthesis, micro and macrotraumatization by the sharp edge of the tooth, fillings, changes in the microflora of the oral cavity, violation (decreased bite height, etc.);
[4 ] ischemic form caused by impaired blood microcirculation in the mucous membrane of the oral cavity and tongue due to diseases of the cardiovascular system (atherosclerosis of the common carotid and external carotid arteries, etc.);
[5 ] combined forms caused by the combined effect of endogenous and exogenous factors (occur in people with diseases of internal organs and systems, where general and local provoking factors are the decisive moment for the occurrence of SA).

note! The cause of SA may be myofascial pain syndrome [of the face] (MFPS). So, for example, in the study of Borisova E.G. (FGBVU VO "Military Medical Academy named after S.M. Kirov" of the Ministry of Defense of the Russian Federation, St. often complaints were made of numbness and pain in the back of the tongue (if the resulting trigger points (TP) were located in the head of the sternocleidomastoid muscle) or in the anterior sections of one side of the tongue (if the trigger points were located in the pterygoid muscles). Pain is excruciating for patients. They were not acute, paroxysmal, but more often they were insignificant, aggravated by taking spicy food and had various shades (for example, pain combined with burning or tingling of the tip, side surface or root of the tongue). Patients constantly thought about it, lost sleep and rest, suffered from carcinophobia (at the same time, the pain syndrome was reduced by prescribing the muscle relaxant tizanidine [Sirdalud] with a gradual increase in its dose and a thorough assessment of the patient's general condition, without reaching high dosages of the drug, which can lead to undesirable side effects) [source: Russian Journal of Pain, No. 1(52), 2017, pp. 16 - 17].

Patients with SA usually complain about the presence of paresthesia - sensitivity disorders of the oral mucosa, manifested in the form of burning, tingling, soreness, numbness [“tongue sprinkled with pepper”, “tongue burned”, etc.] ( note: neuralgia differs from SA by sharp short-term attacks of pain, which are almost always unilateral and localized in the zone corresponding to the innervation of a certain branch of the trigeminal or glossopharyngeal nerve). Pain is usually accompanied by vasomotor disorders, convulsive twitching of facial muscles. Neuralgia is also characterized by the presence of a provoking zone, touching which causes an attack. Neuritis is characterized by localization of pain, strictly corresponding to the affected nerve, and at the same time loss of sensitivity in this area, which manifests itself in a feeling of numbness and paresthesia, sometimes a decrease or perversion of taste. Pain in neuritis is aggravated by moving the tongue, eating, in contrast to stomalgia.). Pain is often spilled, without a clear localization. With stomalgia, the tone of the sympathetic section often prevails over the tone of the parasympathetic section, therefore, more than 30% of patients complain of dryness in the oral cavity - xerostomia (as a result, speech and sleep of patients are disturbed, since at night they are forced to moisten their mouths with water). The feeling of swelling, heaviness of the tongue is disturbing - when talking, patients spare their tongue from excessive movements (the symptom of “sparing” the tongue is observed in 20% of cases). Decrease or disappearance of the pharyngeal reflex is possible. As a rule, during a meal, pain in patients disappears (in contrast to SA, pain intensifies with neuritis when eating). In patients with SM, taste sensations may be disturbed. Then there are complaints of a metallic taste, bitterness in the mouth, a violation of taste sensitivity. Sometimes in areas of burning, slight hyperemia, swelling, friability of the mucous membrane or its pallor, some atrophy are observed ( note: the main difference between SA and organic lesions [inflammatory processes, tumors] is as follows: in SA there are no objective changes in the language or they are present in such minor manifestations that do not correspond to the severity of subjective sensations, for example, in severe SA). Saliva in patients with stomalgia is scanty, viscous or frothy, milky in color. Along with local manifestations, this category of patients is characterized by increased irritability and fatigue, persistent headaches, sleep disturbance, tearfulness, allergic reactions, etc. SA depresses the psyche of patients, causes depressive states, and reduces the ability to work.

More about AS (including diagnosis and treatment) in the following sources:

abstract “Stomalgia, clinic. Methods of treatment” Shemonaev A.V., 4th year student of the Faculty of Dentistry of the State Educational Institution of Higher Professional Education Volgograd State Medical University (supervisor: Vasenev E.E., Candidate of Medical Sciences, Assistant of the Department of Therapeutic Dentistry of the State Educational Institution of Higher Professional Education vocational education Volgograd State Medical University) [read];

article "Modern ideas about orofacial pain and stomalgia" E.N. Zhulev, V.D. Troshin, O.A. Uspenskaya, N.V. Tiunova, Federal State Budgetary Educational Institution of Higher Education "Nizhny Novgorod State Medical Academy" (magazine "Medical Almanac" No. 5, 2016) [read];

article "Pathogenetic aspects of chronic stomalgia" E.N. Zhulev, V.D. Troshin, N.V. Tiunova; Department of Therapeutic, Orthopedic Dentistry and Orthodontics, Neurology, Neurosurgery and Medical Genetics, SBEI HPE "Nizhny State Medical Academy of the Ministry of Health of Russia", Nizhny Novgorod (magazine "Kuban Scientific Medical Bulletin" No. 4, 2015) [read];

abstract of the dissertation for the degree of candidate of medical sciences "Clinical diagnostic and therapeutic features of stomalgia" Zolotarev A.S., the work was performed at the Department of Clinical Dentistry and Implantology, Federal State Educational Institution DPO "Institute for Advanced Studies of the Federal Medical Biological Agency" (FMBA of Russia), Moscow, 2011 [read]


© Laesus De Liro

  • May 31st, 2016 02:17 am

... the third molar is the 8th tooth in a row, the colloquial name is "eight".

Post-traumatic neuropathy of the lingual nerve(branches of the sensitive part of the III branch - ramus mandibulari - trigeminal nerve), after complex removals of impacted and dystopic mandibular third molars, accompanied by complications, occurs in 2-7% of clinical cases. This pathology is observed quite rarely, but, according to the experience of observations, it is this type of neuropathy that to a greater extent reduces the patient's quality of life, as it is accompanied by a diverse symptom complex. Patients complain simultaneously of numbness and burning pain in the affected area, loss of orientation of the tongue in the oral cavity, which leads to frequent injuries during the act of chewing and, as a result, especially excruciating and prolonged pain when biting, as well as eating disorders.

The etiology of the above phenomenon lies in the features of the topographic location of the lingual nerve and its attachment to the operating area, as well as the sensitivity of the nervous tissue to ischemia. Violation of the technique of anesthesia during surgery to remove a wisdom tooth, namely the introduction of a large volume of anesthetic with a high concentration of a vasoconstrictor and the dislocation of its depot, may be the primary factor in the development of neuropathy of the lingual nerve. In the case of complete retention and dystopia, the surgeon needs to make an incision and skeletonize the retromolar region. Excessive mobilization of soft tissues and strong, prolonged abduction of the latter with a surgical hook may be the second factor in the development of this complication. Creating access to the tooth through a compact plate and the trauma of its extraction is also a condition for the development of complications.

It must be remembered that the cause of the described pathology not is of central origin, and first of all, local complex treatment is required, aimed at stopping the pain syndrome, restoring normal conduction of the nerve fiber, eliminating nerve ischemia and restoring the mechanical function of the tongue.

Comprehensive treatment of postoperative neuropathy of the lingual nerve(Nikitin A.A. et al.; GBUZ of the Moscow Region "Moscow Regional Research Clinical Institute named after M.F. Vladimirsky", Moscow, 2015):

Before starting treatment, the severity of pain is determined using VAS and recorded throughout the entire period of treatment with a schedule. First of all, the pain syndrome is eliminated, which is stopped by anti-inflammatory therapy (Diclofenac 3.0 intramuscularly for 5 days) and TENS N10 for 35 minutes a day with fixation of the active electrode in the area of ​​the mental foramen, setting the operation of the device with an ultrashort pulse duration and a high current frequency . The next step to eliminate swelling of local tissues, patients receive Dexomethasone 8 mg and Tavegil 2.0 intramuscularly for 5 days, which was prescribed 2-3 hours after anesthesia. After the removal of edema and disturbance of tissue metabolism caused by ischemia, the next day, hyperbaric oxygenation No. 5-7 is started and vitamins of group B are prescribed (for example, Neuromultivit for 30 days). For the prevention of gastrointestinal diseases when taking NSAIDs, patients receive Omeprazole 1 tablet 20 minutes before meals in the morning for 7 days. Also, the patient is prescribed antioxidant therapy. The final stage, as a physical rehabilitation to normalize blood circulation and restore sensitivity, as well as the orientation of the tongue in the oral cavity, patients perform a set of differentiated physical exercises: tongue stretching with effort, neck muscle tension for a few seconds, relaxation and subsequent repetition 3, 9 or 21 once ; displacement of the tongue towards the soft palate with effort and fixation in this position for several seconds, followed by relaxation and repetition 3, 9 or 21 times; stretching and folding the tongue along, followed by breathing through the mouth for 20 seconds. Patients repeat this set of exercises for 5-7 days, 2-3 times a day, keeping a self-observation diary.

read also the article "Combined use of laser radiation in lingual nerve neuritis" Potego N.K., Tyupenko G.I., Sukhanova Yu.S.; GOU VPO "Moscow State University of Medicine and Dentistry", Department of Physiotherapy, Moscow, RF (Journal "Laser Medicine" No. 2, 2011) [read]


© Laesus De Liro

  • January 7th, 2016 05:52 pm

Among the neurological complications of dental interventions, neuropathies are the most well-known and studied. So, for example, according to the literature, the most common cause of lower neuropathy was the excessive removal of the filling material beyond the top of the roots of the teeth, as a rule, into the lumen of the mandibular canal. The formation of edema of perineural tissues also plays an important role due to idiosyncrasy or allergy to components (especially carpulated) or filling material, or the reaction of periapical tissues to damage associated with preparation for filling, leading to irritation and ischemia of the peripheral nerve.

The cause of a serious lesion of the mandibular (III branch of the trigeminal) nerve is often the improper installation of implants - when making a mucosal incision, drilling a bone to prepare an osteotomy hole for the purpose of inserting an implant, or when installing a long implant, a rupture or crushing of the nerve may occur, and with prolonged retraction, the mucosal - periosteal flap stretching and nerve ischemia. In this case, the innervation of the submandibular and sublingual salivary glands, the mucous membrane of the tongue and oral cavity is disturbed, and a severe neuropathic or mixed pain syndrome can also form. Also, due to overstretching during dental interventions, secondary perineural edema and the neurotoxic effect of local anesthetics, it is possible to develop neuropathy of the branches of the facial nerve, manifested by paresis of the corresponding muscles of the face.

Along with nerve damage, due to prolonged fixation in a biomechanically non-optimal position, various variants of myofascial pain syndromes often develop (including the formation and / or activation of trigger points), which manifest themselves as local spasm and pain, as well as various reflected phenomena. Another consequence of biomechanical problems is the risk of extravasal compression (and in some cases damage) of the main arteries and veins of the head and neck. The clinical manifestations of such damage to the arteries are the development of dizziness, nausea, fainting, focal neurological syndromes, and in severe cases, the development of various forms of stroke is possible. With compression of the veins, a characteristic symptom is a headache. At the same time, the mechanism of action on the vessels can be different - compression of the vertebral arteries by osteophytes in the presence of age-related degenerative changes or IVD hernia, if any, by vertebrae in the presence of hypermobility or developmental anomalies, excessive tension and injury with insufficient length and elasticity of the vessels, kinking with their excessive length etc.



© Laesus De Liro

  • August 9th, 2015 05:25 am

.

The most common causes leading to the development of neuritis of the inferior alveolar nerve (n.alveolaris inferior) are: a complication of conduction anesthesia, surgery on the lower jaw, defects in filling teeth and root canals as a result of excessive removal of the filling material into the lumen of the root canal. The above can be explained by the anatomical position of n.alveolaris inferior, which makes it easily accessible for injuries during various dental procedures. The etiological factor in the occurrence of neuritis of the upper alveolar nerves (nn.aiveoiaris superiores) is an excessively traumatic (complicated) removal of incisors and canines associated with trauma to the alveolar ridge.


1 - maxillary nerve; 2 - superior alveolar nerve; 3, 4 - lower orbital nerve; 5 - buccal nerve; 6 - buccal muscle; 7, 10 - lower alveolar nerve; 8 - chewing muscle (cut off and turned away); 9 - lingual nerve; 11 - lateral pterygoid muscle; 12 - chewing nerve; 13 - facial nerve; 14 - ear-temporal nerve; 15 - temporal muscle


1 - rear upper alveolar branches; 2 - zygomatic nerve; 3 - maxillary nerve; 4 - nerve of the pterygoid canal; 5 - ophthalmic nerve; 6 - trigeminal nerve; 7 - mandibular nerve; 8 - drum string; 9 - ear knot; 10 - connecting branches of the pterygopalatine node with the maxillary nerve; 11 - chewing nerve; 12 - lower alveolar nerve; 13 - lingual nerve; 14 - pterygopalatine node; 15 - lower orbital nerve; 16 - anterior upper alveolar branches

The main complaint of patients with odontogenic neuritis of the alveolar nerves is a feeling of numbness (or paresthesia) in the lower and upper teeth. With neuritis of the lower alveolar nerve, a feeling of numbness is also noted in the corresponding half of the lower lip and chin, which occurs especially sharply during a conversation, affecting the clarity of pronunciation. Often in patients, along with numbness (paresthesia), there are periodically increasing (paroxysmal) constant severe pain or pain with long light intervals. Provokes or exacerbates pain toilet mouth, eating, ie. mechanical irritation of the teeth. The pains are usually aching, dull in nature. Vertical percussion of the teeth is painful. Also, in all patients, there is a decrease in sensitivity of varying severity or hyperesthesia on the gums of the lower or upper jaw (complete restoration of sensitivity may indicate the absence of persistent damage to the fibers of the alveolar nerves). Odontogenic neuritis of the alveolar nerves proceeds for a long time, from 3 to 7 years.

Treatment of odontogenic lesions of the trigeminal nerve system, in particular odontogenic neuritis of the alveolar nerves, should be comprehensive, including oral cavity sanitation, the use of analgesics, drugs that affect the metabolism in the peripheral neuron, tranquilizers, biostimulants, vitamin therapy, physiotherapy, electroacupuncture, taking into account electrical conductivity of facial acupuncture points. Joint observation of patients with odontogenic neuritis of the alveolar nerves by a dentist and a neuropathologist is necessary.


© Laesus De Liro

  • April 18th, 2015 , 10:57 am

Relevance. Many surgeons and anesthesiologists experience intraoperative bradycardia and hypotension (due to the trigeminocardial reflex), which lead to hypoperfusion of the brain and the development of ischemic foci in it.

Trigeminal-cardiac reflex(trigemincardiac reflex, TCR) - a decrease in heart rate and a drop in blood pressure by more than 20% of the baseline values ​​during surgical procedures in the area of ​​the branches of the trigeminal nerve (Schaller, et al., 2007).

They share the central and peripheral type of the trigeminal-cardiac reflex, the anatomical boundary between which is the trigeminal (Gasserov) node. The central type develops during surgical manipulations at the base of the skull. The peripheral type, in turn, is subdivided into the ophthalmocardiac reflex (OCR) and the maxillomandibulocardiac reflex (MCR), such a division is mainly due to the area of ​​surgical interests of various specialists.

Violation of cardiac activity, arterial hypotension, apnea and gastroesophageal reflux as a manifestation of the trigemincardiac reflex (trigemincardiac reflex, TCR) was first described by Kratschmer in 1870 (Kratschmer, 1870) with irritation of the nasal mucosa in experimental animals. Later in 1908, Aschner and Dagnini described the oculocardiac reflex. But most clinicians consider the ocular-cardiac reflex to be the originally described peripheral subtype of the trigeminal-cardiac reflex (Blanc, et al., 1983). However, we can say with confidence that back in 1854 N.I. Pirogov predetermined and anatomically substantiated the development of the reflex. He outlined a detailed description of the autonomic innervation of the ocular complex in his work - "Topographic anatomy, illustrated by cuts made through the frozen human body in three directions." In 1977 Kumada et al. (Kumada, et al., 1977) described similar reflexes during electrical stimulation of the trigeminal complex in laboratory animals. In 1999, the anesthesiologist Schaller et al. (Schaller, et al., 1999) originally described the central type of the trigeminal-cardiac reflex, after irritation of the central part of the trigeminal nerve during surgery in the region of the cerebellopontine angle and the brainstem. It was then that Schaller combined the concept of central and peripheral afferent stimulation of the trigeminal nerve, which is recognized to the present, although detailed anatomical justifications are set out in the work of N.I. Pirogov.

Stimulation of any branch of the trigeminal nerve causes an afferent flow of signals (i.e. from the periphery to the center) through the trigeminal ganglion to the sensory nucleus of the trigeminal nerve, crossing efferent pathways from the motor nucleus of the vagus nerve. Efferent pathways contain fibers that innervate the myocardium, which in turn closes the reflex arc (Lang, et al., 1991, Schaller, 2004).


The clinical manifestations of the trigeminal-cardiac reflex are associated with a high risk of developing life-threatening conditions such as bradycardia and bradycardia climax - asystole, as well as the development of asystole without previous bradycardia or apnea (Campbell, et al., 1994, Schaller, 2004).

General prerequisites for the development of the reflex are hypercapnia, hypoxia, "superficial" anesthesia, young age, as well as prolonged exposure to external stimuli on the nerve fiber. The presence of a large number of external stimuli, such as mechanical compression, chemical intraoperative solutions (H2O2 3%), and prolonged use of painkillers contribute to additional sensitization of the nerve fiber and the development of cardiac manifestations of the reflex (Schaller, et al., 2009, Spiriev, et al., 2011 ) [
It is quite obvious that CCIs increase the risk of complications during dental interventions, so most researchers recommend dental treatment 6 months after CCI (stroke) or before the end of the first year (unless dental pathology requires urgent action). However, S. Elad et al. (2010) believe that the provision of dental care (SP) in some cases can be carried out as early as a few weeks after the onset of a stroke. Urgent dental intervention is necessary to improve the condition and functions of the oral cavity, but it must be carried out under the supervision of a neurologist.

A significant part of the success of the joint venture, along with the qualifications of the doctor, depends on the perfection of anesthesia and the implementation of measures aimed at maintaining adequate hemodynamics, ways to protect the brain. But no less responsible in ensuring the success of dental interventions is the management of patients after their implementation, including careful oral care, monitoring of the functions of vital organs, prevention and treatment of possible complications.

The organization of the joint venture - the treatment of teeth and their tissues - in persons with NMC should be performed taking into account the severity, type, subtype of stroke (see ischemic stroke) and the period of the post-stroke stage. The main goals of providing SP in the acute period of stroke are: the choice of optimal treatment tactics, the prevention of visceral complications.

Features of dental treatment of patients who underwent NMC (

(r. cardiocardialis) vegetative P: a change in the activity of the heart or its departments with a change in pressure in the cavities of the heart (for example, a drop in pressure in the left ventricle causes reflex acceleration and increased contractions).

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  • - K., introduced into the cavity of the right atrium or ear; part of the valvular drainage system used in the surgical treatment of hydrocephalus ...

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