The method of anesthesia during surgery

 

(57) Abstract:

The invention relates to medicine, anesthesiology and can be used as anesthesia during surgery. As one component of apoptosis and maintenance of anesthesia used epithalamin, and as a component of sedation epithalamin enter the first drug intravenous bolus at a dose of 0.20-0.25 mg/kg to 20.0 ml of 5% glucose solution; introductory anesthesia spend 5-10 minutes after sedation; as a component of anesthesia maintenance epithalamin diluted in 5% glucose solution and injected infusion drip throughout surgical intervention at a dose of 0.05-0.10 mg/kg/H. This invention contributes to the stabilization of hemodynamics and reducing the need for anesthetics during anesthesia due to the inclusion in anesthesiology Handbook of epithalamin in a specific dosage and sequence of administration. 5 table.

The invention relates to medicine, namely to anesthesiology, and can be used as anesthesia during surgery.

Surgery is arsm reacts set of complex reactions. They are the basis of a high level neuroendocrine tension, accompanied by a significant intensification of metabolism, pronounced hemodynamic changes, changes in the functions of the major organs and systems. The cause of these reactions are not only painful impulses, but also mechanical, chemical irritation, blood loss, changes of gas exchange, which sharply increase neurohumoral and reflex activity at all levels (Bunyatyan A. A. Manual of anesthesiology. - M.: Medicine, 1997. - S. 77). General anesthesia itself leads to certain changes homeosta and in conjunction with the operating trauma is also a component of operational stress (Azarov Century. And., Vanevski C. L. Vasil'ev, C. N., Plotkin Century B., Smirnov, Y. A. New method of monitoring the effectiveness of anesthesia // proceedings of the 4th all-Russian Congress of anesthesiology and intensive care. - M., 1994. - S. 97).

Insufficient protection of the patient from the operating injuries associated with neuroendocrine, cardiovascular, metabolic, autoimmunity shifts in homeostasis and leads to worsening of the current intra - and postoperative period and thus affects the outcome of the operation (Osipova N. A. Assessment of the effect of n CLASS="ptx2">

The degree of protection of the body from the operative trauma using different methods of anesthesia, as well as criteria of adequacy, currently still a matter of debate (Ovechkin A. M., A. Gnezdilov Century, Kukushkin M. L. et al. Tactics anesthetic management and the adequacy of anesthesia / Anesthesiology and critical care medicine. - 2000, No. 3. - S. 4).

Therefore, when deciding on the adequacy of anesthesia protection, you must consider the reaction of the body not only on the operating injury, but also on the used anesthetic, i.e., it is important to know what the price of this protection is achieved. To continuously develop and improve methods of anesthetic protection during surgery.

Criteria of adequacy of anesthesia should consist of assessing the effectiveness and impact of its components on the body of the patient (Belozertsev F. F. Components of General anesthesia. - M.: Medicine, 1977. - S. 261). However, in everyday practice anesthesiology impossible to evaluate all the functions and reactions of the body to separate the stages of anesthesia during surgery. The main danger during surgery and anesthesia is considered unstable hemodynamics, poststalinist. In this regard, in various stages of anesthesia or surgery, special attention should be paid to stabilization, primarily indicators of systemic hemodynamics (Lebedinsky K. M. Anesthesia and systemic hemodynamics. St. Petersburg, 2000. - S. 12, 88).

Currently the search for such options anesthetic management during surgery, which would allow not only to maintain but also to increase the compensatory response of the patient (Married C. M., Ovsyannikov C. G., Belyaev A. D., Aznauryan P. A. foundations of modern General anesthesia // Rostov-on-don, 1998. - S. 59). While conducting adequate anesthesia can reduce the negative effects of anesthesia, increase the body's resistance to stress factors and the effectiveness of the stress response of the body on the operating injury and thereby reduce the risk of the operation, to reduce the number of intra - and postoperative complications, reduce the number of deaths.

Conducted research on the medical-scientific and patent literature identified various methods for anesthesia during surgery.

Clipsal in combination with clonidine during General anesthesia, and after the operation of clonidine with baralgin. However, this method cannot be applied to patients with ischemic heart disease, increased intracranial pressure, with a number of other pathologies, it is not possible to avoid post anesthesia complications. Negative side effects of this method are postoperative bradycardia, hypotension, excessive sedation and partial depression of respiratory patients.

Author's certificate of the USSR No. 1639661 (1991, BI No. 13) secure "Method of anesthesia during operations on the abdominal organs, including puncture, catheterization of the epidural space at two different levels and the introduction to each catheter anesthetic. However, this method is characterized by increased invasiveness, also does not allow to reduce the number of postoperative complications and is accompanied by unstable hemodynamics.

In the author's certificate of the USSR No. 1666113 (1991, BI No. 28) described "the Way to prevent stress reactions in surgical trauma" by preoperative preparation of the patient, which for 4 days before surgery injected vitamin - calcium Pantothenate. However, this method cannot be applied in extrene vital functions and practically does not reduce the number of postoperative complications.

In the description of the invention the application No. 95108614 (1997, BI No. 6) the "Method of General anesthesia in emergency surgical interventions in patients with traumatic shock", which consists in the use of total intravenous anesthesia using Diprivan, ketamine and nubaina. However, since the implementation of this method requires the preoperative preparation of the patient, it may not always be applied in emergency anesthesiology. This method requires a significant consumption of anesthetics and also practically does not reduce the number of intra - and postoperative complications.

RF patent № 2193405 (2002, BIPM No. 33) protected Method anesthetic management of minimally invasive operations neuroactive". Premedication includes Ketonal, diphenhydramine, dormicum anaesthesia induction - fentanyl, demerol, thiopental sodium, tracrium. After intubation of the trachea impose dormicum and fentanyl. Maintenance of anesthesia produced by fentanyl, dormicum. Myorelaxation reach infusion tracrium artificial ventilation of the lungs. However, this method requires substantial consumption anestetikov and limited in scope. The disadvantages of this method can also be attributed nevozmozhnym as a prototype is a "Method of anesthetic management operations in severe traumatic brain injury" (Patent RF № 2173989, 2001, BIPM No. 27) by sedation intravenous atropine and demerol, in the opening anaesthesia use of non-depolarizing muscle relaxants type, in the maintenance phase of General anesthesia thiopental sodium; intraoperatively administered vitamin E and contrical.

The disadvantages of the prototype are significant haemodynamic instability, causing a high degree of surgery and anesthetic risk, and the need to use significant doses of anesthetics during anesthesia during surgery.

The aim of the present invention is to improve hemodynamic stability and reducing the need for anesthetics during anesthesia during surgery.

This goal is achieved through the use of epithalamin - regulatory peptide, which is used as one component of apoptosis and maintenance of anesthesia for anesthesia during surgery. As a component of sedation epithalamin enter the first drug intravenous bolus at a dose of 0.20-0.25 mg/kg to 20.0 ml of 5% glucose solution. After 5-10 min after sedation exercise% glucose solution and injected drip infusion during all surgical procedures and at a dose of 0.05-0.10 mg/kg/h

Epithalamin is a drug containing complex polypeptide fractions (Reg. ID No. 90/250/6, approved by the order of Ministry of health of the USSR № 250 from 19.06.1990 g), is able to make an impact on the level of regulatory centers of the Central nervous system, which allows the correction resulting from operative trauma disorders of the Central mechanisms of autonomic regulation through modulation of the hypothalamic-pituitary function (Kuznik B. I., Morozov Century BC, Khavinson C. H., Cytomedines. 25 years experience in clinical research. - SPb.: Science, 1998. - S. 126-133).

The method is as follows.

When entering the patient into the operating room are premedication. As a component of sedation epithalamin enter the first drug intravenous bolus at a dose of 0.20-0.25 mg/kg to 20.0 ml of 5% glucose solution. Then spend a standard premedication, which is based on individual choice of drugs taking into account the initial condition of the patient, the proposed form and method of anesthesia, the nature and extent of surgery (Anesthesiology and resuscitation: Textbook. The textbook/Under the editorship of O. A. Valley. - M.: Medicine, 1998. - S. 198-200).

Introductory anesthesia spend 5-10 minutes after okoncane enzodiazepine, ketamine, propofol and other selected individually in individual dose and selected methodologies depending on how the maintenance of anaesthesia (Bunyatyan A. A. Manual of anesthesiology. - M.: Medicine, 1997. - S. 149-150). If necessary, enter the muscle, perform tracheal intubation, the patient is hooked up to an artificial lung ventilation (ALV), taking into account the condition of the patient is injected anesthetics and muscle relaxants, and then start the operation.

Common tactics of carrying out the maintenance of anaesthesia on the background of anesthesia is the introduction of combination products to maintain adequate anesthesia. As a component of anesthesia maintenance epithalamin diluted in 5% glucose solution and injected infusion drip throughout surgical intervention at a dose of 0.05-0.10 m g/kg/h

During anesthesia continuously monitor the state of the vital functions of the patient, including such hemodynamic parameters like heart rate (HR), blood pressure (BP), mean arterial pressure (GARDEN), stroke index (si), cardiac index (SI) and the index of total peripheral vascular resistance (IOPS) defined methodology the NGO-transfusion therapy is carried out according to the standard technique.

During suturing of the wound infusion of epithalamin stop. Spontaneous breathing of the patient usually appears towards the end of the operation. When you restore spontaneous breathing, consciousness, full recovery of neuromuscular conduction are extubation and the patient transferred to the intensive care ward.

Practical application of the proposed method is illustrated by examples from clinical practice.

Example 1.

Patient P., 56 years history No. 47231, was admitted to the Department of abdominal surgery BSMP-2, Rostov-on-don. Diagnosis: chronic calculous cholecystitis. Hypertension stage II, grade 2, risk 3, NK0. Obesity 2 tbsp. Risks of anesthesia III ASA. Operation was performed: laparotomy, cholecystectomy, the dissection of the ligament Distance, drainage of the abdominal cavity. Operation duration - 1 hour 30 minutes Blood loss of 200 ml

Sedation: intravenous bolus epithalamin at a dose of 0.20 mg/kg 20,0 ml of 5% glucose solution, then atropine 0.01 mg/kg, sibazon 0.10 mg/kg, fentanyl 1.5 mcg/kg intravenously.

After 6 minutes after premedication induction of anaesthesia: intravenous thiopental sodium at a dose of 2.5 mg/kg

After intravenous call the RO-6 TO - 0.65 l, MOD - 10 l, Rpic-16 cm water. senior Diplegia: Arduan dose of 0.04 mg/kg

As a component of anesthesia maintenance epithalamin was introduced drip infusion at a dose of 0.075 mg/kg/hour in 5% glucose. Maintenance of anesthesia: intravenous thiopental sodium at a dose of 3.5 mg/kg/h fentanyl at a dose of 4 mcg/kg/hour, droperidol dose of 0.05 mg/kg/hour.

During suturing of the wound, the introduction of epithalamin stopped.

Intravenous intraoperative infusion of 1500 ml of crystalloid solutions diuresis - 300 ml Revival at the end of the operation. Extubate.

During anesthesia were monitored hemodynamic parameters whose values at different stages of anesthesia are shown in table. 1. Determine the maximum oscillation controlled hemodynamics conducted using the program "PRIMER OF BIOSTATISTICS", version 04.03.1998, showed that the benefits of heart rate fluctuations did not exceed 9.1%, fluctuations ADsistdoes not exceed 9.8 percent, fluctuations ADdietdo not exceed 9.9%, fluctuations in the GARDEN did not exceed 10.2%, the fluctuation IM not exceed 5.9%, and fluctuations in SI does not exceed 7.1 percent, and the fluctuations IOPS not exceed 18.5 percent.

During anesthesia smooth, after Prem the kinetic type of blood circulation in a more rational akineticheskie, without a decrease in contractility. Giperdinamicheski reaction of the circulatory system to intubation was insignificant. Hemodynamics remained stable at all stages of anesthesia. The patient was transferred to the Department of abdominal surgery in the state of moderate severity.

Example 2.

Patient N., 48 years old, medical history, No. 34151, entered the BSMP-2 by ambulance. Diagnosis: perforated gastric ulcer. Coronary heart disease, angina FC 2, NK0., chronic bronchitis in the acute stage. Risks of anesthesia IV e of the ASA. Was performed emergency surgery: laparotomy and closure of the ulcer, abdominal drainage. Operation duration - 1 hour 50 minutes. Estimated blood loss of 100 ml

Sedation: intravenous bolus epithalamin dose of 0.22 mg/kg to 20.0 ml of 5% glucose solution, then atropine 0.01 mg/kg, sibazon 0.08 mg/kg, fentanyl 1.5 mcg/kg intravenously.

After 8 minutes after premedication induction of anaesthesia: intravenous thiopental sodium at a dose of 2.3 mg/kg

After intravenous muscle relaxant - ditilina dose of 1 mg/kg was performed tracheal intubation thermoplastic tube No. 9,0 IVL RO - 6 TO 0.6 l, MOD - 9 l, Rpic - 17 cm water. senior Diplegia: ardua the Oze 0.09 mg/kg/hour in 5% glucose. Maintain benzocaine: intravenous thiopental sodium at a dose of 4.0 mg/kg/h fentanyl at a dose of 4 mcg/kg/hour, droperidol dose of 0.05 mg/kg/hour.

During suturing of the wound, the introduction of epithalamin stopped.

Intravenous intraoperative infusion of 2000 ml of crystalloid solutions diuresis - 250 ml Awakening and extubate 5 minutes before the end of the operation in the face of adequate pain relief.

During anesthesia were monitored hemodynamic parameters whose values at different stages of anesthesia are shown in table. 2. Determine the maximum oscillation controlled hemodynamics conducted using the program "PRIMER OF BIOSTATISTICS", version 04.03.1998, showed that the benefits of heart rate fluctuations did not exceed 9.9%, fluctuations ADsistdo not exceed 11.6 percent, fluctuations ADdietdo not exceed 8.8%, with fluctuations in the GARDEN is not exceeded by 10.7%, oscillations IM not exceed 10.5 per cent, fluctuations in SI does not exceed 9.4% and fluctuations IOPS not exceed 16,25%.

During anesthesia smooth, after sedation has decreased IOPS and GARDEN, increase the AP and SI, indicating that the transition hyperkinetic type of blood circulation of going to intubation was insignificant. Hemodynamics remained stable at all stages of anesthesia. The patient was transferred to the Department of abdominal surgery in the state of moderate severity.

In the departments of neurosurgery, abdominal surgery, purulent surgery, traumatology, as well as in the Department of gynecology BSMP-2, Rostov-on-don 39 patients during surgical intervention in routine and emergency procedure was performed anesthetic allowance according to the proposed method.

During anesthesia were monitored indicators of hemodynamics, the average values of which are at different stages of anesthesia are shown in table.3. Determination of values of controllable parameters of hemodynamics, conducted with the help of the program "PRIMER OF BIOSTATISTICS", version 04.03.1998, showed that the benefits of heart rate fluctuations did not exceed 11.2 percent, fluctuations ADsistdid not exceed 12.5%, and fluctuations ADdietdo not exceed 9.9%, fluctuations in the GARDEN did not exceed 11.3 per cent, oscillations IM not exceed 13.4 per cent, fluctuations in SI does not exceed 12.9 percent, and the fluctuations IOPS not exceed 20,81%.

Research 83 histories operated in BSMP-2, Rostov-on-don-treated patients traditionally biologicheskogo benefits of controlled hemodynamics, carried out using the program "PRIMER OF BIOSTATISTICS", version 04.03.1998, showed that the benefits of heart rate fluctuations did not exceed 19.5 per cent, fluctuations ADsistdo not exceed 25.6%, the fluctuations ADdietdo not exceed 26.3% of the fluctuations of the GARDEN did not exceed 20.8%, and oscillations IM not exceed 24.5% of the fluctuations SI does not exceed 21.8 percent, fluctuations IOPS not exceed 42,9%.

Thus, the analysis of the results of the inventive and conventional anesthetic benefits showed that when carrying out manuals according to the proposed method significantly increased the stability of hemodynamic parameters.

The estimation of consumption of drugs for anesthesia during surgery (table. 5) in a group of 39 patients who benefit were conducted according to the proposed method, and in the group of patients out of 83 patients who were traditional anesthetic allowance and whose history we have proana-

lysed showed that when performing anesthesia according to the proposed method significantly reduced the consumption of benzodiazepines, hypnotics and neuroleptics, namely sibazona droperidola and thiopental sodium, drugs that are used by Braz, the proposed solution allows to increase the stability of hemodynamics and reduce the need for anesthetics during anesthesia during surgery.

The method of anesthesia during surgery, including sedation, induction of anaesthesia and maintenance of anesthesia, characterized in that as one component of apoptosis and maintenance of anesthesia used epithalamin, and as a component of sedation epithalamin enter the first drug intravenous bolus at a dose of 0.20-0.25 mg/kg to 20.0 ml of a 5% glucose solution, introductory anesthesia spend 5-10 minutes after sedation, as a component of anesthesia maintenance epithalamin diluted in 5%Mr. glucose solution and injected infusion drip throughout surgical intervention at a dose of 0.05-0.10 mg/kg/H.

 

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