METHODS OF PERIOPERATIVE MULTIMODAL PROTECTION DURING LONG AND TRAUMATIC SURGICAL INTERVENTIONS

V.KH.SHARIPOVA

Republican scientific center for urgent medical care, Tashkent, UZBEKISTAN

The aim of our study was to improve methods of anesthesia and postoperative analgesia during prolonged and traumatic surgical interventions

Materials and methods. A total of 40 patients admitted to RRCUMC in 2009-2010, divided into 2 groups according to the method of anesthesia and postoperative analgesia, , in 20 patients in each group, respectively, were examined. Patients of the control group were administered a standard premedication in standard doses. General anesthesia in this group was carried out by conventional methods. The average duration of surgery constituted 4,6 ± 0,2 hours. In the postoperative period, analgesia was carried out by promedol. Premedication in the main group (on a pre-emptive analgesia and the blockade of peripheral receptors principle) included ketonal 100 mg / m 40 minutes before surgery. Patients of this group were performed puncture and catheterization of the epidural space at Th7-Th8. The analgetic component during the operation was supported by the introduction of local anesthetic 100-125 mg of 0.25% bupivacaine (the dose was adjusted individually) into the epidural space, and narcotic analgesic fentanyl 0.05 mg into the epidural space. For the maintenance of anesthesia in the main group there was used ketamine for the blockage of NMDA receptors in 0.8 mg / kg dose, inhalation of vapors of isoflurane 0.8-1 об%. If necessary, in the most traumatic moments of surgical intervention there was performed bolus injection of fentanyl –by 0.1 mg. The average duration of surgery in patients of this group was 4,5 ± 0,4 hours. In the postoperative period analgesia in this group was conducted with the use of EDA + NSAIDs + promedol (if necessary). The nature of surgical interventions: gastrectomy in 12 patients (30%), subtotal resection of the stomach in 21 patients (52.5%), gastrectomy with resection of abdominal segment of the esophagus in 7 patients (17.5%).

Results research. The use of EDA in combination with general anesthesia in the intraoperative period leads to a more stable stream with minimum strain parameters of central and peripheral hemodynamics. Multimodal approach to analgesia with an impact on all the links in the pathogenesis of pain (perception, transduction, transmission) in the intraoperative period, leans to the smooth flow of intra-operative period, manifested by the stability of humoral indicators of the adequacy of analgesia, sympathetic blockade and neurovegetative defense. This combination of general anesthesia and EDA leads to the reduction of the consumption of narcotic analgesics fentanyl by 60.8%, leads to early recovery of patients. In a comparative aspect of multimodal analgesia has more prolonged analgesic effect and better neurovegetative protection in the postoperative period.

Date: 2014-12-28; view: 921