Method for providing higher efficacy and safety of ultrafast opioid detoxification

FIELD: medicine.

SUBSTANCE: what is involved is infusion therapy with crystalloid solutions at 15 ml/kg of a patient's body weight. That is followed by puncturing and catheterising an epidural space at the level of ThVII-ThVIII according to the standard practice and introducing a test dose of 2% lidocaine 3 ml. If observing no signs of intrathecal introduction of local anaesthetics 10 minutes later, a basic dose containing 0.75-1% naropin 10 ml or 0.25-0.5% marcaine 10 ml and clofelin 3-5 mcg/kg is introduced. Total intravenous anaesthesia follows 20 minutes after pre-medication with atropine 0.01 mg/kg, 1% diphenylhydramine 1 ml and relanium 10 mg and urethral catheterisation. A narcosis is induced with propofol in a dose of 2 mg/kg. Anaesthesia is maintained with propofol 2-4 mg/kg·h. After that, within the first hour following the detoxification, naloxone 12 mg is introduced intravenously; a naloxone measurement rate is supposed to make 0.8 mg/h for 4-5 following hours of general anaesthesia. The repeated introduction of 0.75-1% naropin 6 ml or 0.25-0.5% marcaine 6 ml and clofelin 2-3 mcg/kg into the epidural space is performed 90 minutes later. After the procedure is terminated, and the patient recovers, prolonged epidural analgesia is conducted by introducing 0.2% naropin 10 ml and clofelin 1 mcg/kg into the epidural space every 4 hours for 24-48 hours.

EFFECT: method provides safety of ultrafast opioid detoxification and prolongs the remission in the given category of patients.

1 ex

 

The invention relates to medicine, in particular to anesthesiology and addiction, and for improving the efficiency and safety of ultra-fast opioid detoxification in patients with opiate addiction.

Opiate addiction is among the serious diseases. In the Russian Federation continues rapid growth in the number of heroin users, there is a "rejuvenation" of the disease [3]. Now the problem has become, except medical, and even socio-political overtones, as it affects the interests and security of Russia.

Treatment of opiate addiction begins with edema acute phase of withdrawal symptoms. For this purpose increasingly used ultra-fast method of opiate detoxification (UBOD), which helps to significantly reduce the most painful period of withdrawal syndrome. The principle of the method consists in the acceleration phase of abstinence by introducing into the patient large doses of opioid receptor antagonist (naloxone) on the background of deep sedation or General anesthesia[1, 2, 4].

There is a way of holding UBOD under endotracheal anesthesia with the use of intravenous anesthetics and muscle relaxants (prototype).

The disadvantages of this method are the risk of the development of vital complications of intubation, during the artificial veins is the customer service of light (for example, barotrauma) development expressed autonomic changes during anesthesia (expressed tachycardia, hypertension, hypersalivation, profuse diarrhea), and in the early pokemonpalace.net period (diarrhea, electrolyte disturbances, tremor). According to the authors, during the procedure of UBOD under endotracheal anesthesia plasma adrenaline levels increased 30 times, and norepinephrine 3 times [1].

Known the second method of UBUD in terms of sedation midazolam without intubation of the trachea. Using large doses of midazolam (0.5-0.7 mg/kg).

Its disadvantages include development during the procedure, psychomotor stimulation, erections, shivering. This methodology UBOD accompanied by a significant inhibition of reflexes, which leads to unnecessary risk to patients.

When these two ways of holding UBOD autonomic withdrawal symptoms, require the inclusion in the premedication and application during the procedure of complementary medicines: the histamine receptors blockers (ranitidine), octreotide, antihypertensive agents, β-adrenergic blocking agents.

The technical result of the claimed method are the increased security for ultra-fast opioid detoxification and increase the time of remission in patients with opiate addiction.

Technical the result is achieved by what way to increase the efficiency and safety of ultra-fast opioid detoxification begin its implementation with crystalloid infusion therapy solutions at the rate of 15 ml/kg of patient's weight, then the dotted line and kateteriziruyut epidural space at the level of ThVII-ThVIII according to the standard technique, inject a test dose of lidocaine 2% to 3 ml, and 10 minutes later, with no signs of intrathecal injection of local anesthetics injected primary dose, including solutions naropin of 0.75-1% - 10 ml or marcaine of 0.25-0.5% - 10 ml and clonidine 3-5 µg/kg, and 20 minutes after sedation solutions of atropine 0.01 mg/kg, Dimedrol 1% - 1 ml and Relanium 10 mg and catheterization of the bladder spend total intravenous anesthesia: induction of anaesthesia - propofol 2 mg/kg, maintenance anesthesia - propofol 2-4 mg/kg·h; then in the first hour detox/enter 12 mg of naloxone, then the titration rate of naloxone should be 0.8 mg/h during the next 4-5 hours of General anesthesia, re-introduction into the epidural space of solutions naropin of 0.75-1% - 6 ml or marcaine of 0.25-0.5% to 6 ml and clonidine 2-3 mcg/kg carry every 90 minutes, and after the procedure and Wake the patient spend extended epidural analgesia, for which every 4 hours for 24 to 48 hours into the epidural space VV is out solutions naropin 0,2% - 10 ml and clonidine 1 mcg/kg

The essence of the proposed method.

Improving the safety and efficiency of the ultra-fast opioid detoxification in patients with opiate addiction is achieved through the use of combined anesthesia, including epidural anesthesia local anesthetics (solutions naropin 0.75 to 1% or marcain 0,25-0,5%) and α2-adrenomimetics Central action (clonidine 3-5 µg/kg) in combination with total intravenous anesthesia (propofol 2-4 mg/kg·h).

During the prospective clinical study of treatment outcomes 112 patients on the basis goose "Volgograd oblast clinical narcological dispensary" in 2008-2011 proved that UBOD using epidural anesthesia with local anesthetics and clonidine eliminates artificial lung ventilation, to reduce almost 2 times the frequency and duration of patients taking psychotropic drugs. Long-term results indicate that the time of remission of patients increased by 43%.

Increase the effectiveness of this technique by increasing remission, reduce the dosage, frequency and duration of patients taking psychotropic drugs is achieved, apparently, by reducing the severity of autonomic disorders, stress response, prevent deficit neuro is editorof.

Methodology the proposed method.

The method is as follows. After crystalloid infusion therapy solutions at the rate of 15 ml/kg of patient's weight the dotted line and kateteriziruyut epidural space at the level of ThVII-ThVIII according to the standard technique. Enter the test dose of lidocaine 2% to 3 ml, and 10 minutes later, with no signs of intrathecal injection of local anesthetics injected main dose: solutions naropin of 0.75-1% - 10 ml or marcaine of 0.25-0.5% - 10 ml and clonidine 3-5 mcg/kg

20 minutes after sedation solutions of atropine 0.01 mg/kg, Dimedrol 1% - 1 ml and Relanium 10 mg and catheterization of the bladder spend total intravenous anesthesia: induction of anaesthesia - propofol 2 mg/kg, maintenance anesthesia - propofol 2-4 mg/kg·h

In the first hour detox/enter 12 mg of naloxone, then the titration rate of naloxone should be 0.8 mg/h during the next 4-5 hours of General anesthesia. Re-introduction into the epidural space of solutions naropin of 0.75-1% - 6 ml or marcaine of 0.25-0.5% to 6 ml and clonidine 2-3 mcg/kg carry every 90 minutes. After the procedure, and the awakening of the patient spend extended epidural analgesia, for which every 4 hours for 24 to 48 hours into the epidural space of the injected solutions naropin of 0.2% to 10 ml and clonidine 1 mcg/kg

An example of the spiral is its execution.

Patient D., 26 years old, weight 70 kg, case history No. 2243, was admitted to the Department No. 9 goose WEKND" 06.05.2010, with a diagnosis of Opium addiction. The withdrawal syndrome. Chronic viral hepatitis C.

Experience in the use of heroin for 5 years. The last use 16 hours ago.

Repeatedly hospitalized in narcological dispensary treated with psychotropic drugs under the program of rehabilitation of drug addicts. The duration of remission 1-3 months.

At the urgent request of the patient decided to run a session UBOD.

Protocol for ultra-fast opioid detoxification

In aseptic conditions under local anesthesia Sol. Novocaini a 0.5% 10 ml produced puncture and catheterization v. Subclavia dextra Seldinger method. There were no complications. The catheter is fixed by the adhesive tape, aseptic bandage.

Infusion therapy: NaCl 0,9% - 500 ml, aq glucose 5% - 400 ml.

In aseptic conditions under local anesthesia Sol. Lidocaini 2% - 2 ml level ThVII-ThVIII produced puncture and catheterization of the epidural space. Put the test dose: Sol. Lidocaini 2% to 3 ml in 5 minute signs of intrathecal injection of anesthetic no. Aseptic dressing, catheter fixed with adhesive tape.

Catheterization of the urinary bladder.

12.00 h entered the main dose: naropin 0,75% - 10 ml, 300 µg clonidine. Premedication: atropine 0.7 mg, diphenhydramine 1 - 1 ml, Relanium 10 mg

12.20 h for induction of anaesthesia: propofol 140 mg. maintenance anaesthesia, perfusion: propofol 200 mg/h

12.30-13.30 h perfusion entered 12 mg of naloxone.

13.30, 15.00, 16.30 h - re-introduction into the epidural space: naropin 0,75-6 ml, 200 mcg clonidine.

13.30-17.30 h perfusion introduced 3.2 mg of naloxone.

Anaesthesia - smooth. Breathing independent, adequate, BH 20-22 in 1 min, SpO295-98%. Stable hemodynamics, BP 120/60-140/70 mm RT. Art., PS 92-96 in 1 minute, rhythmic.

The recovery from anesthesia quick.

Infusion therapy amounted to 2800 ml of crystalloids. Diuresis - 900 ml.

In the early pokemonpalace.net period was conducted sedative therapy, prolonged epidural analgesia (every 4 hours for 48 hours in the epidural space was introduced solutions naropin of 0.2% to 10 ml and clonidine 70 mg).

After 3 days normalized background mood, sleep and wakefulness.

Discharged in a satisfactory condition 11.05.2010,

Advantages, the positive effect of the claimed method:

- the effectiveness of the inventive method more efficient than all known methods of carrying out UBOD by increasing the time of remission in patients with opiate addiction;

- the use of this method reduces the risk of anesthesia, postdetoxification and fatal complications;

- the heart of the Saint in patients with severe concomitant (in particular, cardiovascular) pathology;

compared with other methods allows you to more quickly restore the social activity of patients by reducing the dosage, frequency and duration of patients taking psychotropic drugs.

References

1. Burrow AV, Cimbalom YEAR Ultrafast opioid detoxification // journal of intensive care 1999; 2:52-56.

2. Shcherban AV, Burrow A.V. Application of plasmapheresis and ultrafast opioid detoxification in patients with heroin addiction // Russian medical journal 2007; 6:28-32.

3. Entin G.M., Chamotte AS, Ovchinsky A.S., Ashikhmin O.A. Situation with alcohol and drugs in Russia in 1994-1997: dynamics and forecast. // Addiction issues 1999; 1:71-78.

4. Tretter F., Burkhardt d, Bussello-Spieth Century, J. Reiss, S. Walcher, Buchele W. Clinical experience with antagonist-induced opiate withdrawal under anaesthesia // Addiction 1998; 2(93):269-275.

The way to increase the efficiency and safety of ultra-fast opioid detoxification, characterized in that after the infusion therapy crystalloid solutions at the rate of 15 ml/kg of patient's weight the dotted line and kateteriziruyut epidural space at the level of ThVII-ThVIII according to the standard technique, inject a test dose of lidocaine 2% to 3 ml, and 10 minutes later, with no signs of intrathecal injection of local anesthetics injected primary dose, VK is causou solutions naropin of 0.75-1% - 10 ml or marcaine of 0.25-0.5% - 10 ml and clonidine 3-5 µg/kg and 20 minutes after sedation solutions of atropine 0.01 mg/kg, Dimedrol 1% - 1 ml and Relanium 10 mg and catheterization of the bladder spend total intravenous anesthesia: induction of anaesthesia - propofol 2 mg/kg, maintenance anesthesia - propofol 2-4 mg/kg·h; then in the first hour detox/enter 12 mg of naloxone, then the titration rate of naloxone should be 0.8 mg/h for 4-5 hours later General anesthesia, re-introduction into the epidural space of solutions naropin of 0.75-1% - 6 ml or marcaine of 0.25-0.5% to 6 ml and clonidine 2-3 mcg/kg carry every 90 minutes, and after the procedure and Wake the patient spend extended epidural analgesia, for which every 4 hours for 24 to 48 hours into the epidural space of the injected solutions naropin of 0.2% to 10 ml and clonidine 1 mcg/kg



 

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EFFECT: method provides higher accuracy and simplification of measuring the sympathetic block.

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4 dwg, 3 ex

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3 ex

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1 ex

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EFFECT: method ensures prevention of development of high spinal blockade due to correction of local anesthetic dose before surgical intervention with taking into account patient's individual peculiarities.

1 tbl, 1 dwg, 3 ex

FIELD: medicine.

SUBSTANCE: invention refers to medicine, namely to anaesthesiology, and may be used as an anaesthesia care of a surgical intervention for carotid endaterectomy or internal carotid artery resection after pathological deformation thereof. That is ensured by general anaesthesia in a combination with deep and superficial cervical plexus blockade. Pre-medication is used the day before the operation and on the operative day in the morning. Diazepam is introduced intramuscularly 30 minutes before the operation in a combination with phentanyl; the introduction is followed by ECG monitoring and heart rate count, plethysmography with arterial blood saturation, non-invasive blood pressure measurement and neuromonitring according to a bispectral index or entropy. Catheterisation of patient's peripheral or central vein is followed by an infusion therapy, an ionotropic therapy, a cardiotropic therapy, peripheral resistance maintenance. If heart rate is no more than 80 beats per minute, the anaesthesia is induced to reach an anaesthetic depth according to the bispectral index or entropy within 40-60 units. Analgesia is provided by the intravenous introduction of 0.005% phentanyl; myoplegia is ensured by the intravenous introduction of a myorelaxant. After tracheal intubation, the patient is transferred to forced volumentic artificial pulmonary ventilation with the CO2 level within 35-45 mm Hg according to capnography. The anaesthesia is maintained by supplying an inhalation anaesthetic to the steam level of 0.8-1.0 MAK 0.8-0.9 litre of the air and oxygen flow containing 50% oxygen with controlling the inhalation anaesthetic volume by the level of the anaesthetic depth according to the bispectral index or entropy. That is followed by deep cervical plexus blockade. A tubercle of the VI cervical vertebra (a carotid tubercle) and a mastoid process are localised; thereafter a line connecting the above reference points is drawn on skin. The second line is drawn 1 cm below the first one in parallel. To verify an injection point of a local anaesthetic, the spines of IV, III, II cervical vertebras being at 1.5 cm from each other are palpated, and the reference point is the VI cervical vertebra. The needle is inserted perpendicularly to the skin and slightly in the caudal direction to reach the spines. The anaesthetic is introduced in a dose of 5-7 ml in each point C4, C3, C2. Another 5-7 ml of the anaesthetic is introduced in a point found in an apex of the mastoid process. The superficial cervical plexus blockade requires introducing he fan-shaped introduction of the anaesthetic solution in a dose of 15 ml in a point found in the middle of a lateral crus of the nodding muscle under the above muscle, 4-5 ml in each direction from the same point; the first and following injections are performed at a depth of a usual intramuscular needle perpendicularly to nodding muscle.

EFFECT: method provides the adequate and safe anaesthesia ensured by avoiding linear blood velocity reduction in the medial cerebral artery during the surgical intervention, preventing intracranial pressure increase, reducing cerebral perfusion pressure in a combination with providing adequate protection against surgical invasion with maintaining stroke volume and arterial pressure.

4 cl, 3 ex

FIELD: medicine.

SUBSTANCE: invention refers to medicine, namely anaesthesia, and may be used as a postoperative anaesthesia accompanying low- and medium-injury operations. For this purpose, at the stages of anaesthetising and de-anaesthetising, nonsteroidal anti-inflammatory compounds (NSAICs) are introduced intravenously. The NSAIC dose is equivalent to ketorol 0.5-3.0 ml. The introduction is performed 1-3 times.

EFFECT: method provides the complete prevention of developing postoperative pain syndrome ensured by the intravenous introduction of the NSAIC at the specific stages of anaesthesia in certain doses.

1 tbl, 5 ex

FIELD: medicine.

SUBSTANCE: invention refers to medicine, namely to anaesthesiology and neurology, and may be used in spinal anaesthesia. Laser Doppler flowmetry is used to measure skin microcirculation on an anterolateral body surface. For this purpose, before the spinal anaesthesia the microcirculation is measured at T10 and 5 minutes after the spinal anaesthesia, at L1, T12, T11, T10, T9, T8, T7, T6, T5, T4, T3, T2. If the microcirculation appears to increase by 40% or more of the initial values, the effective sympathetic block from this segments and below is diagnosed. When the microcirculation increases less than 40%, it is stated that the sympathetic block is absent.

EFFECT: method enables the most quick determination of the levels of the sympathetic block component in the spinal anaesthesia ensured by measuring the skin microcirculation parameters of the anterolateral body surface.

1 ex

FIELD: medicine.

SUBSTANCE: thoracic epidural analgesia is conducted by puncturing and catheterisation of an epidural space at ThVIII - ThIX before the expiry of 24 hours from the onset of a disease after a moderate intravenous infusion therapy in the amount of 15-20 mg/kg of crystalloid solutions. 20 minutes before an expected endoscopic papillosphincterotomy, a catheter is moved 4-5 cm in a cranial direction. At ThV-ThX, 0.4% naropin 10-12 ml or 0.2% Marcaine 10-12 ml and clonidine 100 mcg are administered through a catheter. That is followed by a pre-medication by administering 0.1% atropine 0.5-1 ml and 0.5% relanium 1-2 ml. Thereafter, the patient is taken to an X-ray operation room to conduct the endoscopic papillosphincterotomy without an endoscopic retrograde cholangiopancreatography with general pancreatic duct stenting. After the operation has been completed, the patient is taken to an intensive care unit wherein an extended epidural analgesia is conducted by administering 0.2% naropin 10-12 ml or 0.15% marcaine 10-12 ml into the epidural space every 4 hours until the patient is taken to a department of surgery.

EFFECT: early intestinal motility recovery, increased pancreatic secretion, prevented spasm of the gastrointestinal sphincter ensured by a pathological complete blockade of sympathetic impulsing.

1 ex

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