The method of anesthesia during operations on the brain

 

(57) Abstract:

The invention relates to medicine, in particular to anesthesia and anesthetic concerns brain protection in patients operated on for a brain tumor, chronic intracranial hematomas, intracerebral aneurysms of vessels. How is that in combination with different anesthetics used synthetic opioid peptide - dalargin. Dalargin is introduced intravenous bolus 1 mg every 30 minutes throughout the operation, beginning with the initial opening of the Dura. The method improves the efficiency of protection of the brain. table 2.

The invention relates to medicine, in particular to anesthesiology.

The choice of the method of anesthesia in operations on the brain is a complex problem, which largely depends on the outcome of the disease. The Central nervous system violates the natural protective mechanisms and mechanisms regulating the functions of vital organs and systems: adrenal insufficiency, dehydration - with the defeat of the hypothalamic-pituitary system, apistatus - with the defeat of the relevant departments of the bark, often there is a multiorgan nadota drugs must meet the following requirements:

1. Not increase intracranial pressure.

2. Quickly eliminirovat from the body, so as not to disrupt neurological symptoms.

3. To be minimally toxic, even at very long-term use.

4. Be combined with other drugs - muscle relaxants, ganglioblokatorami and others (A. H. Manevich, V. I. Salolikin "Neuroanesthesiology", M, "Medicine", 1977, 320 S.).

There is a method of protecting the brain from the circulatory hypoxia, which consists in injecting 1 mg of dalargin for 2 minutes before turning off blood flow in the operated carotid or vertebral artery by applying vascular clamps. The time of reconstructive surgery on the vessel is 30-40 minutes, and the time anti-ischemic actions of dalargin lasts 50 minutes, which ensures the safety execution of the main stage surgical correction of cerebral circulation. (RF patent N 2099077 M CL a 61 K 38/01, publ. 20.12.97, Bulletin No. 35).

The disadvantage of this method is short-term protection of the brain from ischemia, is not taken into account the ability of dalargin in providing adequate neuro brain protection, its analgesic properties. The known method using the (centuries) Liventsev "Comparative aspects of the use of dalargin in complex anesthetic protection during surgical correction of congenital heart defects", "Anesthesiology and reanimatology" N 4 1993 S. 23-26). When surgical correction of atrial septal defect and tetralogy of Fallot shown dosed intravenous infusion of dalargin (0.40-0.55 g/kg/min), used its cardioprotective and polonoroeste steps.

The disadvantage of this method is the lack of consideration of the anti-ischemic effect of dalargin on the brain, its effect on cerebral blood flow.

Closest to the claimed method is a method of intraoperative protection used in onlinecasinogame and chosen as a prototype. The method is based on the intravenous injection of dalargin by the following method: on the background supporting anesthesia ferrous-oxygen mixture 3:1, 2:1, intravenous drip dalargin average dose of 58 mg/kg/h (speed limited to 25-30 drops per minute), which replaces the use of narcotic analgesics during operations on the thoracic and abdominal cavity (A. C. Elenochkin. "Neuropeptides in onlinecasinogame". In the book: "Regulatory peptides in normal and p means intraoperative protection from pain, anaesthesia for cancer operations on the thoracic and abdominal cavities, which determines the method of injection of dalargin.

The present invention is to increase the effectiveness of the anesthetic brain protection in patients operated on for a brain tumor, chronic intracranial hematomas, intracerebral aneurysms of the blood vessels.

This object is achieved in that, in combination with different anesthetics used synthetic opioid peptide - dalargin. Dalargin is introduced intravenous bolus every 30 minutes during the whole operation is based 0.003 mg/kg/min, starting from the stage of opening of the Dura.

The novelty of the method consists in the following.

1. Dalargin in combination with drugs neyroleptanalgezii (fentanyl, droperidol) prevents the inhibition of aerobic and anaerobic activation of processes of oxidation, reduces the level of metabolism in nerve cells, preserving their functional ability.

2. Neuropeptide reduces the intensity of catabolic reactions and the need for tissue oxygen.

3. For withdrawal reflex reactions with Dura in time). The introduction of dalargin every 30 minutes of operation due time the most effective action of the drug.

The method consists in the following: all patients operated on for brain tumors, chronic intracranial hematomas, intracerebral aneurysms of vessels under General anesthesia, total diplegia and mechanical ventilation was introduced dalargin intravenous bolus calculation of 0.003 mg/kg/min, pre-dissolved in 5 ml of physiological saline immediately before injection. Induction of anaesthesia was performed by a combination of thiopental sodium and sodium oxybutyrate (fast), intubation according to standard methods. Artificial ventilation of the lungs was performed ferrous-oxygen mixture in a ratio of 2:1 with ventilation parameters according to the nomograms of Redford. By the time of skin incision was introduced the calculated dosage droperidola (0.25 mg/kg) and fentanyl (0.005 mg/kg), which provide adequate protection at the stage of incision, osteoplastic craniotomy, access to the meninges. After opening the Dura was introduced to the calculated dose of dalargin 0.003 mg/kg/min, which continued to be administered every 30 minoguie, was not carried out, only when the suturing of the Dura once, as needed introduced fentanyl. Adequacy of obezbolevanija were assessed by blood pressure, heart rate, Central venous pressure, acid-base and gas composition venous and arterial blood, hourly diuresis.

This technique allows you to:

1. Significantly reduce the input dose of CNS depressants (fentanyl and droperidola) that contributed to the rapid restoration of adequate breathing and consciousness, appeared an assessment of the neurological deficit in the nearest postoperative period.

2. Reduce dose with the aim of neuro brain protection droperidola, along with fentanyl may also cause respiratory depression.

3. To ensure adequate protection of the brain from hypoxia, improve microcirculation, metabolism of nerve cells, which ensures the safety of operations due to the anti-ischemic effects of the neuropeptide in the brain cells.

This method of anesthesia with dalargin increases the efficiency of anesthetic protection of patients during operations on the brain, predupreditelnii.

Example 1. Patient K., 58 years old, history N 930, was admitted to the hospital with a diagnosis of tumor of the left lateral ventricle of the brain. A patient weight of 70 kg 29.05.98, operation: osteoplastic trepanation of the skull in the left fronto-parieto - temporal region, removal of the tumor of the left lateral ventricle. The operation was carried out in conditions neyroleptanalgezii with fractional injection of dalargin. Premedication: on the eve of operation Relanium 10 mg and diphenhydramine 1% 1.0 intramuscularly 30 minutes before surgery promedol 2% 1.0 intramuscularly. Induction of anaesthesia: thiopental sodium 1% of 300 mg and sodium oxybutyrate 20% 4G - quick scheme". Artificial ventilation of the lungs was performed by semi-closed circuit ferrous-oxygen mixture in a ratio of 2: 1. Tidal volume 550 ml, minute ventilation 12 l/min Flow at all stages of operations remained stable, blood pressure 130 - 140/80 - 90 mm RT. Art., pulse 76-90 1 min Diplegia was carried out fractional introduction ardoyne 6 mg. operation Time was 2 hours and 15 minutes After intubation of the trachea is entered droperidol 7.5 mg, fentanyl 0,3 mg every 30 minutes of operation beginning with the initial opening of the Dura, was introduced dalargin 1 mg intravenous bolus total dose of 3 mg. Main display after operation recovered a clear consciousness, clinically adequate spontaneous breathing. Exuberan in the operating room.

Rapid awakening the patient is allowed in the immediate postoperative period to comprehensively evaluate the neurological status of the patient. The postoperative period was uneventful.

Example 2. Patient O., 60 years, history N678, was admitted to the hospital with a diagnosis of a tumor in the parietal lobe on the right. Weight 74 kg 22.04.98, operation: osteoplastic trepanation of the skull to the right, the removal of a tumor in the parietal lobe. Premedication: luminal 0.2 mg before surgery, 30 minutes before surgery promedol 2% - 1.0 ml intramuscularly. Induction of anaesthesia: thiopental sodium 1% 300 mg, sodium oxybutyrate 4 g - quick scheme". Artificial ventilation of the lungs was performed by semi-closed circuit ferrous - oxygen mixture in a ratio of 2:1. Tidal volume of 600 ml, minute ventilation 12 l/min, hemodynamics at all stages of operation of the 120 - 130/70 - 80 mm RT. Art., pulse 84-102 in 1 min. operation Time is 2 hours and 30 minutes. Method of pain - neuroleptanalgesia. During operation entered 27,5 mg droperidola, of 0.95 mg of fentanyl. Main indicators of acid-base and gas composition venous and arterial blood are presented in table. 2. At the end of surgery the fir, the recovered consciousness after 1 hour 10 minutes. Assessment of neurological status of the patient was made possible through 1 hour after the operation. On the 4th day after surgery the patient was transferred to the Department of neurosurgery.

Thus, when comparing clinical example 1 (with the introduction of dalargin) and example 2 (without the use of dalargin) it is obvious that:

1. When the use of dalargin was able to lower the dose of the drugs neyroleptanalgezii - fentanyl, droperidola.

2. Rapid recovery of consciousness has enabled an assessment of the neurological status of the patient immediately after surgery.

3. The use of dalargin provides adequate protection of the brain from hypoxia and adequate neuro protection.

The method of anesthesia during operations on the brain, including the use of anesthetics and intravenous bolus injection of dalargin, characterized in that dalargin is administered at a dose of 1 mg every 30 minutes throughout the operation, beginning with the initial opening of the Dura.

 

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