Method for spinal anesthesia at prolonged adrenoganglioplegia

FIELD: medicine, anesthesiology, surgery.

SUBSTANCE: in preoperational and early postoperational periods after planned and urgent operations one should intramuscularly inject adrenogangliolytics: benzohexonium 0.18 - 0.22 mg/kg, droperidol 0.078 - 0.083 mg/kg and obzidan 0.016 - 0.022 mg/kg thrice daily; moreover, the time for their introduction after operation depends upon the type of anesthetic preparation applied to carry out spinal anesthesia, that is: if one applied lidocaine as local anesthetic the above-mentioned adrenogangliolytics should be introduced 2 h after the end of operation, and if marcaine was applied as local anesthetic - 3 h after the end of operation. The innovation enables to prevent disorders of central and peripheral hemodynamics at carrying out spinal anesthesia in perioperational period.

EFFECT: higher efficiency.

 

The invention relates to medicine, namely to anaesthesia and surgery.

Known methods:

- spinal anaesthesia with the use of agonists for prevention of arterial hypotension include premedication with 0.5-1 ml of 5% solution of ephedrine [12], using 5% solution of ephedrine in the development of hypotension [18];

- spinal anaesthesia with holding giperwolemicescoy hemodilution: before anesthesia spend infusion of 1.2-1.6 l of saline solution [8].

The disadvantages of these methods: for the prevention of arterial hypotension include sedation adrenoceptor agonist or spend giperwolemicescoy hemodilution before or after intrathecal injection of local anesthetic. These methods do not always prevent the development of arterial hypotension, often breaking the Central [7] and peripheral blood [15].

The closest is the way spinal anesthesia proposed Ipinapaalam and Neerajanam [15]. This way the SA includes an introduction to the patient during the days before the planned operation to be performed three times intramuscularly: 0,18-0,22 mg/kg benzogeksoniya, 0,078-0,083 mg/kg droperidola, 0,016-0,022 mg/kg obsidan; and twice intramuscularly: 0,13-0,18 mg/kg Dimedrol, and 0.09-0.16 mg/kg Relanium; emergency anesthesiology intramuscularly for 30-50 minutes before surgery: 0.18 to 0.22 mg/kg benzogeksoniya, 0,078-0,083 mg/kg droperidola, 0,016-0,mg/kg obsidan; on the operating table intravenously: 0,06-0,085 mg/kg benzogeksoniya, 0,039-0,043 mg/kg droperidola, 0,016-0,022 mg/kg obsidan, 0,13-0,18 mg/kg Dimedrol, 0.12 to 0.16 mg/kg Relanium, then on the operating table - the treatment of the skin with an antiseptic before manipulation, the definition of anatomical landmarks and infiltration of the skin with local anesthetic solution at the level of the selected intervertebral space, the puncture of the subarachnoid space and intrathecal injection of local anesthetic solution.

Disadvantages: in the early postoperative period, after the expiration of the local anesthetic and termination medical sympathectomy in patients, especially those with concomitant diseases of the cardiovascular system, develop violations of the first, Central (hypertension or significantly less hypotension), and then and peripheral hemodynamics.

The objective of the invention to prevent the development of disorders of the Central and peripheral hemodynamics in the perioperative period, to improve the quality and safety of anesthesia.

The task to solve due to the fact that the patient in the early postoperative period three times a day intramuscularly: 0,18-0,22 mg/kg benzogeksoniya, 0,078-0,083 mg/kg droperidola, 0,016-0,022 mg/kg obsidan; introduction of adrenocorticolytic begin after the operation: after 2 hours the - when used as a local anesthetic is lidocaine or 3 hours when using marcaine.

The method is carried out: the patient during the days before the planned operation to be performed three times intramuscularly: 0,18-0,22 mg/kg benzogeksoniya, 0,078-0,083 mg/kg droperidola, 0,016-0,022 mg/kg obsidan; and twice intramuscularly: 0,13-0,18 mg/kg Dimedrol, and 0.09-0.16 mg/kg Relanium; emergency anesthesiology intramuscularly for 30-50 minutes before surgery: 0.18 to 0.22 mg/kg benzogeksoniya, 0,078-0,083 mg/kg droperidola, 0,016-0,022 mg/kg obsidan; on the operating table intravenously: 0,06-0,085 mg/kg benzogeksoniya, 0,039-0,043 mg/kg droperidola, 0,016-0,022 mg/kg obsidan, 0,13-0,18 mg/kg Dimedrol, 0.12 to 0.16 mg/kg Relanium. In the early postoperative period in patients after conducting both scheduled and emergency operations three times a day intramuscularly: 0,18-0,22 mg/kg benzogeksoniya, 0,078-0,083 mg/kg droperidola, 0,016-0,022 mg/kg obsidan. The introduction of adrenocorticolytic begin after the operation: after 2 hours when used as a local anesthetic is lidocaine or 3 hours when using marcaine.

Literature data on the application of SA in the Russian Federation is very heterogeneous. Thus, according to one research the use of SA, depending on the regions varies from 0 to 40% [4]. Although an increasing number of authors gives the data of the regional preference is Nastasia (RA) over the total in obstetrics and gynecology, orthopedics and traumatology, vascular surgery [6, 20, 23]. But the other [1] Express an opinion about a cautious approach to the use of RA and that combined endotracheal anaesthesia is preferred. In some publications [21] note that in the presence of concomitant somatic pathology of RA is the method of choice when performing anesthesia.

Currently, patients of elderly and senile age are increasingly subjected to surgical intervention [3, 17]. As the age of patients with disorders of rhythm and conduction of the heart is on average about 60 years, the ageing surgical contingent led to a higher incidence of this pathology in anesthetic practice [5]. Some authors consider that it is at risk (elderly age, comorbidities) in the provision of anesthesia care should be given preference RA [14].

SA is a simple and relatively safe method of anesthetic management. Major surgery, where spinal anesthesia can be a exclusive method, it gynaecology and urology[19, 20, 22].

Controversial is the age criterion in the planning of holding SA patients. Some authors believe that the safety of patients during the traditional SA is directly dependent on hell is tatiannah capabilities of the organism. For patients belonging to the group of increased risk (expressed atherosclerosis, diabetes mellitus, hypertension, chronic ischemic heart disease, heart failure, elderly and senile age), according to some authors, should be abandoned in favor of another method of pain [13, 18], as there has been a sharp (48,9%) increase in the number of hemodynamic disorders in persons older than 50 years. Other authors [19] believe that the application of CA in all groups of patients provides an adequate level of protection from operational stress, more stable hemodynamic parameters.

The main parameters of the circulation is largely dependent on the functional state of the terminal segment of the vascular bed. The blood flow in the terminal division of the vascular bed is regulated by nervous and humoral mechanisms [2]. Neurological regulation is mainly due to vasoconstrictor fibers of the sympathetic nervous system and circulating in the blood vasoactive substances, changing the adaptation of blood vessels, affect their reactivity [9].

Ganglioblokatory, acting on autonomic ganglia, causing a break not only outward, but also the local viscero-visceral reflexes. Ganglion blockade causes a noticeable increase blood circulation, and increase krovatka skin vessels greater than in the blood vessels of muscles [2]. Use in the preoperative preparation of alpha - and beta-blockers prevents excessive neuroendocrine response. The combined use of adrenergic and ganglioblokatorov in the preoperative preparation allows to strengthen the role of humoral regulation of vascular tone due to neuroendocrine inhibition [10, 11], and in the early postoperative period to prevent the pathological effects of the sympathetic nervous system on vascular tone after stopping medication sympathectomy [9].

The advantages of the proposed method: the prevention of disorders of the Central and peripheral hemodynamics when performing spinal anesthesia in the perioperative period, improving the quality and safety of anesthesia, especially in patients with concomitant diseases of the cardiovascular system.

Literature used

1. Adigezalov SO, Negotino IV, Koklyaev NV Improve the quality of combined anesthesia cesarean section when using clonidine // all-Russian Congress of anesthesiology and resuscitation, 8: proc. Dokl. - Omsk, 2002. - P.41.

2. Azarov V.I. Ganglion blockade during surgery and anesthesia. - Krasnoyarsk, - 1987. - P.17-67.

3. Antinociceptive protection of patients of elderly and senile age with hepatobiliary pathology /Golub IE, Gwak HS., Eremenko VG etc. // Proceedings of the regional scientific-practical conference of anesthesiology and resuscitation "Modern problems of anaesthesia and intensive care". - Krasnoyarsk. - 2001. - P.23-27.

4. Bizyaev M.A. Objective and subjective aspects of regional anesthesia // Congress of anesthesiology and resuscitation of the South of Russia, 1: MES. Dokl. - Rostov-on-don, 2001. - P.14.

5. The influence of some reingestion anesthetics on the function of automatism and conductivity of the heart in patients with the syndrome sick sinus / Vdelali, Amidino, Aggarwala etc. // Anestesiol. and Reanimator. - 1991. No. 5. - P.61-66.

6. Guryanov, VA, Bales V.L. Anesthesia for cesarean section in pregnant women with late gestosis // all-Russian Congress of anesthesiology and resuscitation, 8: proc. Dokl. - Omsk, 2002. - 49.

7. Getaref. Regional anesthesia and pain management // Clinical anesthesiology. - SPb., 2000. - S-273.

8. Dobson MB Anaesthesia at the district hospital // who. Geneva, 1989. - 106-109 C.

9. Nazarov Ippolita ganglioplegic in anesthesiology and surgery. - Krasnoyarsk, 1999. - P.61-63.

10. Nazarov I.P. Condition of some neuroendocrine systems in patients in the operative and postoperative period in terms of extended ganglion blockade with normotone // Anestesiol. and Reanimator. - 1981. No. 5. - P.17-21.

11. Nazarov I.P., Voloshenko E.V., Ostrovsky A.I Antitr Sorna protection in anesthesiology and surgery. - Krasnoyarsk, 2000. - P.64-68.

12. Nikolaev E.K., O. Makarov, Y. Kononov Spinal-epidural anesthesia - hemodynamics and hemostasis // Anestesiol. and Reanimator. - 1995. No. 4. - P.61-63.

13. The experience of pain in cancer patients older /Ovchinnikov, VA, Ivashchenko E.A., Voronkin YU. and others // all-Russian Congress of anesthesiology and intensive care, 7th: proc. Dokl. - SPb., 2000. - P.205.

14. Peculiarities of anesthesia in patients of elderly and senile age with operations osteosynthesis of hip /Antonkosenko, Achromatize, Masolov and others // all-Russian Congress of anesthesiology and resuscitation, 8: proc. Dokl. - Omsk, 2002. - S.

15. RF patent for the invention №2200030, And 61 M 21/00, And 61 R 23/00, 10.03.2003. Bulletin no.7.

16. Indications for epidural, spinal and combined peridural-spinal anesthesia /Aigrette, Vauhan, Apiece and others // all-Russian Congress of anesthesiology and intensive care, 7th: proc. Dokl. - SPb., 2000. - P.62.

17. Remezov, V.N., Brukowa NV, Medvedev, A. the Experience of epidural anesthesia during surgery in elderly patients // Proceedings of the regional scientific-practical conference of anesthesiology and resuscitation "Modern problems of anaesthesia and intensive care". - Krasnoyarsk. - 2001. - S-325.

18. The Semenikhin A.A., Chomutov VB, Mazaev VP Complications and adverse the effects of spinal anesthesia // Anestesiol. and Reanimator. -1991. No. 4. - P.59-62.

19. Tretyakov A.P., Smirnov I.V., Politov CENTURIES of Experience conducting anesthesia benefits in geriatric patients in terms of district hospital // all-Russian Congress of anesthesiology and intensive care, 7th: proc. Dokl. - SPb., 2000. - S.

20. Yudin S. Selected works. The problems of anaesthesia in surgery. - M.: Medgiz, 1960. - 127-321 C.

21. Anesthetic management of parturients with cerebrovascular diseases /T.Abe, K.Kinouchi, T.Kita et al. // Masui. - 1999. - V.48, no. 7. - P.773-777.

22. Gogarten W. A. century of regional analgesia in obstetrics // Anesth. Play mode display. - 2000. - V.91, No. 4. - P.773-775.

23. Stober H.D., Mencke T. General anesthesia or spinal anesthesia for hip replacement prosthesis? Studies of acceptance of both procedures by patients // Anaesthesiol. Reanim. - 1999. - V.24, No. 6. - R-156.

How spinal anesthesia with extended adenohypophysial, including the introduction in the preoperative period of adrenocorticolytic: benzogeksoniya 0,18-0,22 mg/kg, droperidola 0,078-0,083 mg/kg and obsidan 0,016-0,022 mg/kg, puncture of the subarachnoid space and intrathecal injection of local anesthetic solution: lidocaine or marcaine, characterized in that after elective and emergency operations in the early postoperative period three additional times during the day to enter these adrenocorticolytic intramuscularly in the same doses, with their introduction begin after the operation: after 2 hours when used as a local anesthetic, lidocai the a or 3 hours - when using marcaine.



 

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