INDICATORS OF EXTERNAL RESPIRATION AND ANALGESIA UNDER CONDITIONS OF VARIOUS TECHNOLOGIES OF ANESTHESIA WITH VENTILATOR AND EXTRACURRICULAR BLOCKADES WITH MORPHINE
Анестезиология
UDC 617-089
INDICATORS OF EXTERNAL RESPIRATION
AND ANALGESIA UNDER CONDITIONS OF VARIOUS TECHNOLOGIES OF ANESTHESIA WITH VENTILATOR AND EXTRACURRICULAR BLOCKADES WITH MORPHINE
V.A. Fomichev, MD, PhD, Professor
Novosibirsk State Medical University
(630091, Russia, Novosibirsk, Krasny Prospekt, 52)
E-mail: fomichev.va@med54.ru
A.Y. Maloletneva, MD, Assistant Professor
Novosibirsk State Medical University
(630091, Russia, Novosibirsk, Krasny Prospekt, 52)
E-mail: malolet67@mail.ru
A.S. Busin, Anesthesiologist
Clinical Hospital at Novosibirsk station
(630003, Russia, Novosibirsk, Vladimirovsky descent, 2a)
E-mail: kms.novosibirsk1989@yandex.ru
Abstract. Prolonged blockades reduce the depressive effect on the parameters of external respiration and improve analgesia in the postoperative period. The effects of variants of combined general anesthesia with ventilator on external respiration parameters and analgesia level in the postoperative period were determined in 162 patients with surgical abdominal diseases with various variants of combined general anesthesia with ventilator and extracurricular morphine blockades in comparable groups. In group 1 (control) (n=64), patients were operated under combined general anesthesia with ventilator and NLA drugs. In group 2 (comparison), patients (n=54) were operated on against the background of combined general anesthesia with ventilator and epidural morphine analgesia; in group 3 patients (n=46), combined general anesthesia with a ventilator was performed under conditions of paravertebral morphine analgesia. The groups analyzed changes in the parameters of external respiration and the level of analgesia on a visual analog scale in the postoperative period. It was revealed that combined general anesthesia with a ventilator against the background of paravertabral morphine administration implements a less pronounced depression of the parameters of external respiration and prolonged effective anesthesia in the postoperative period.
Keywords: extracurricular morphine analgesia, surgical diseases of the abdominal cavity, parameters of external respiration, evaluation of the effectiveness of analgesia by VAS.
Introduction
It is known that the inclusion of conductive anesthesia in the anesthetic manual helps to reduce the severity of adverse effects on gas exchange in the lungs [13]. In addition, the use of prolonged blockades improves the assessment of analgesia in the postoperative period [10].
The task of the study.
To evaluate the effect of options of combined anesthesia with ventilator and extradural morphine blockades on the parameters of external respiration and the level of analgesia on a visual analog scale (VAS) in the postoperative period in patients using these techniques
Material and method
To solve this problem, 162 patients with various surgical diseases of the abdominal cavity were examined. The patients were operated on as planned after appropriate preparation and examination.
The patients were divided into 3 groups depending on the method of anesthesia: group 1 – patients who were operated under general combined anesthesia with ventilator and NLA preparations – 64 people;
Group 2 – patients in whom general combined anesthesia with ventilator was performed against the background of epidural morphine analgesia – 54 people;
Group 3 – patients, who underwent general combined anesthesia with a ventilator under conditions of paravertebral morphine blockade – 46 people.
Of the 162 patients examined at the stages of surgical operations and in the first three days of the postoperative period, there were 118 women (78.8%) and 44 men (21.2%). The groups were comparable by gender, age, weight of talus, height, volume of surgical interventions and severity of surgical and anesthetic risk on the MNOAR scale.
Combined general anesthesia with ventilator and NLA drugs represented a modification of the classical technique. Premedication: atropine in usual dosages of 0.1 mg / kg, diphenhydramine 10-20 mg, 1/2-1/3 doses of droperidol at the rate of 0.2 mg / kg of body weight, depending on the condition, age, blood pressure. Introductory anesthesia with sodium thiopental at a dose of 6-8 mg /kg.Myoplegia was supported by arduan in conventional doses (0.05 mg/kg). Ventilation with nitrous-oxygen mixture 2:1. Analgesia and vegetative protection were provided by fentanyl at a dose of 0.01 mg / kg h and droperidol at a dose of 0.2 mg / kg h. Drug-induced sleep was further deepened by seduxen and ketamine at doses of 0.17 mg/kg hour and 1 mg/kg hour.
To perform combined general anesthesia with a ventilator in the conditions of epidural analgesia, the epidural space was catheterized according to the generally accepted method at the appropriate level of the operation. Morphine hydrochloride was used at a dose of 0.08-0.1 mg/kg, taking into account the age and condition of the patient (on average 5-8 mg) in 6-8 ml of saline solution.
During catheterization of the paravertebral space after anesthesia of the interstitial space, the needle moved in the segital direction with a deviation from the midline of 10-20 degrees maximum with simultaneous administration of 0.25% novocaine ( if another anesthetic is intolerant) until the appearance of the "loss of resistance" test in the nearest cellular paravertebral space. Since the movement of the needle was necessarily preceded by the introduction of a local anesthetic, slight signs of irritation of the spinal roots appear before the moment when further manipulations can damage the structure of the spinal nerves. If it was necessary to identify the position of the needle, the spinal roots were blocked with a local anesthetic or ultrasound control, as with the ESP block. The fiber in the paravertebral space is denser than in the epidural, which will require a lot of effort. After fixing the catheter, morphine hydrochloride was injected at a dose of 8 mg in 6-8 ml of saline solution.
In the future, the scheme was as follows: premedication – atropine in normal dosages, diphenhydramine 10-20 mg, droperidol 0.05-0.1 mg / kg of weight. Introductory anesthesia and intubation are similar to group 1 patients. Anesthesia was maintained by inhalation of nitrous oxide with oxygen in a ratio of 2:1, if necessary, the hypnotic effect was potentiated by bolus administration of seduxen 0.12 mg / kg hour or ketamine at a dose of 0.7 mg / kg hour.
When using general combined anesthesia with a ventilator against the background of epidural analgesia with morphine, analgesia and vegetative protection were enhanced with fentanyl and droperidol at doses of 0.004 mg/kg hour and 0.07 mg/kg hour. When using general combined anesthesia with a ventilator against the background of paravertebral analgesia with morphine, the doses of fentanyl and droperidol were 0.005 mg / kg hour and 0.07 mg / kg hour.
In order to assess the degree of possible negative impact of the studied variants of the anesthetic aid on the parameters of external respiration, the following parameters were recorded using a ventilometer and monitoring equipment of the Johnson and Johnson company of the Criticon type: respiratory volume (RV), minute volume of respiration (MVR), respiratory rate (RR), saturation (Sat) – percentage of oxygen content in arterial blood. Studies were conducted before and 1 hour after surgery in 36 patients, 12 each in a group with different methods of anesthetic support.
The intensity of pain and the degree of analgesia were assessed by the visual analog pain scale (VAP) on 1, 2, 3 days of the postoperative period.
The results and discussion
The dynamics of external respiration indicators in the conditions of various variants of the anesthetic manual is presented in Table 1.
Table 1
Dynamics of indicators of external respiration
in the conditions of various variants of the anesthetic manual
Indicators |
Before the operation |
After the operation |
|
Group 1 |
|
RV, l |
0,490±0,00342 |
0,425±0,00432 |
MVR, l/min |
8,53±0,108 |
5,79±0,098* |
RR min-1 |
17,4±0,248 |
13,6±0,274* |
SatO2, % |
97,63±3,163 |
92,86±3,859 |
|
Group2 |
|
RV, l |
0,480±0,00435 |
0,053±0,00641* |
MVR, l/min |
8,25±0,0904 |
7,96±0,112 |
RR min-1 |
17,2±0,216 |
14,4±0,196* |
SatO2, % |
97,59±4,185 |
95,75±5,112 |
|
Group3 |
|
RV, l |
0;472±0,00525 |
0,462±0,00427 |
MVR, l/min |
7,798±0,126 |
7,39±0,204 |
RR min-1 |
16,9±0,311 |
15,8±0,285 |
SatO2, % |
97,78±3,493 |
96,89±4,947 |
• p<0.05 differences between the initial and subsequent stages are significant
From the data presented in Table 1, it can be seen that the greatest changes were observed in the 1 group of patients. In particular, in this group, in the postoperative period, there was a significant decrease in MVR indicators by 32.2%, and RR indicators by 22% (p<0.05). At the same time, RV decreased by 13.3%, as for saturation, its level decreased by 5%.
The dynamics of external respiration indicators in the comparison group, where the anesthetic aid was combined general anesthesia with a ventilator against the background of epidural morphine analgesia, there were some features. Thus, in the postoperative period, there was a decrease in RR by 15.2% in relation to preoperative data. MVR and Sat changes were insignificant by 3.52% and 2% less than the preoperative level.
When analyzing the parameters of external respiration in the study group, where combined general anesthesia with ventilator was used against the background of paravertebral analgesia with morphine, a decrease in average values was noted: RV to 2.1%, MVR by 7.4%, RR by 6.5%, Sat by 1.02% compared with baseline data (p<0.05).
The data obtained allow us to conclude that the greatest respiratory depression was observed in the group of patients operated under the conditions of the first variant of combined general anesthesia with a ventilator. The absence of significant dynamics in the parameters of external respiration at the stages of the study in patients operated under the conditions of 3 variants of the anesthetic manual indicates a minimal negative effect of combined general anesthesia with ventilator and paravertebral analgesia with morphine on the functions of external respiration.
Our studies have allowed us to establish differences in the need for pharmacological support of the perioperative period in different groups of patients, depending on the anesthetic support. Thus, when using methods of combined general anesthesia with a ventilator against the background of epidural and paravertebral analgesia with morphine, there was a significant decrease in fentanyl consumption by 50% and 60% (p<0.05), droperidol by 75% (p<0.05), seduxene and ketamine by 30% (p<0.05) compared with the needs of the above-mentioned drugs in patients operated under general combined anesthesia with ventilator and NLA preparations. The need for non-depolarizing muscle relaxants in groups 2 and 3 decreased by 25% (p<0.05) in comparison with the control group. In this regard, a more rapid exit of patients from the state of general anesthesia is natural: group 2 -8.1 ± 1.4 min, group 3-8.4 ± 2.1 min.
Table 2
Dependence of the duration and effectiveness of analgesia on the volume
of surgery on the background of paravertebral morphine administration
The nature of the operation |
quantity |
Duration of analgesia (hours) |
|||||
|
|
1 |
day |
2 |
day |
3 |
day |
|
|
9-10 points |
6 points |
9-10 points |
6 points |
9-10 points |
6 points |
Cholecystectomy |
30 |
10,2± 1,74 |
6,4± 1,12 |
16,4± 0,98 |
8,2± 1,64 |
- |
- |
Abdominal wall plastic surgery |
5 |
10,2± 1,74 |
6,4± 1,12 |
16,4± 0,98 |
8,2± 1,64 |
- |
- |
Gastroenteroanastamosis |
3 |
10,2± 1,74 |
6,4± 1,12 |
16,4± 0,98 |
8,2± 1,64 |
- |
- |
Operation in the hepatoduodenal zone |
5 |
6,8± 1,24 |
12,6± 1,86 |
10,2± 1,9 |
11,6± 1,26 |
16,4± 0,88 |
8,21± 1,83 |
Gastricresection |
2 |
“-“ |
“-“ |
“-“ |
“-“ |
“-“ |
“-“ |
Gastrectomy |
1 |
“-“ |
“-“ |
“-“ |
“-“ |
“-“ |
“-“ |
10 minutes after extubation, analgesia in a group of patients where the perioperative period was provided with general combined anesthesia with ventilator and paravertebral analgesia with morphine (Table 2),
It differed slightly from the same indicator in group 2 of patients where morphine epidural analgesia was used (Table 3) 8.2±0.1 points and 9.2±0.09 points, respectively (p<0.05). Whereas, the difference between the quality of analgesia in groups 1 and 3 of patients was more significant 5.8 ± 0.01 points and 8.2± 0.1 points, respectively (p<0.05).
The time of analgesia recorded during the first 3 days after surgery in patients operated under conditions of epidural administration morphine was varied from 16 to 36 hours, under conditions of paravertebral opiate blockade from 14 to 28 hours, averaging 24.4 ±1.34 hours and 19.8±3.6 hours (p<0.05).
Our studies have shown that the effectiveness depended on the degree of trauma of the operation. Especially this dependence was traced in the temporal and qualitative aspect in 1 day of observation against the background of 1 epidural morphine application. After operations in the 1st subgroup, analgesia lasted 16.0± 1.86 hours, and after operations in the 2nd subgroup 11.3± 0.87 hours, which corresponded to 70% and 45.4% respectively of the total time of the analgesic effect. Against the background of 1 paravertebral injection of morphine, analgesia of the same quality was 10.2 ± 1.74 and 6.8 ± 1.24 hours, accounting for 60.1% and 28.6% of the total time of anesthesia, respectively, which is significantly less than similar indicators in the previous group of patients (p< 0.05).
With each subsequent administration of morphine, the period of analgesia with an estimate of 8-10 points increased, and the duration of analgesia by 6 points decreased in both study groups. The duration of the "satisfactory" analgesia effect under the conditions of paravertebral administration of opiate was significantly longer on the 2nd day after surgery in 1 subgroup of patients by 2 times (p<0.05), in the 2nd subgroup by 55% (p<0.05), on the 3rd day by 47.7% (p<0.05), respectively, than the duration of analgesia of similar quality under conditions of epidurally administered morphine.
Table 3
Duration and effectiveness of analgesia during operations performed
against the background of epidural morphine
The nature of the operation |
quantity |
Duration of analgesia (hours) |
|||||||
|
|
1 |
day |
2 |
day |
3 |
day |
||
|
|
9-10 points |
6 points |
9-10 points |
6 points |
9-10 points |
6 points |
||
Cholecystectomy |
27 |
16,0± 1,86 |
6,8± 1,42 |
20,4± 1,34 |
4,0± 1,96 |
22,0± 1,64 |
4,2± 1,34 |
||
Abdominal wall plastic surgery |
6 |
16,0± 1,86 |
6,8± 1,42 |
20,4± 1,34 |
4,0± 1,96 |
22,0± 1,64 |
4,2± 1,34 |
||
Qastroenteroanastamosis |
2 |
16,0± 1,86 |
6,8± 1,42 |
20,4± 1,34 |
4,0± 1,96 |
22,0± 1,64 |
4,2± 1,34 |
||
Amputation of the uterus |
2 |
16,0± 1,86 |
6,8± 1,42 |
20,4± 1,34 |
4,0± 1,96 |
22,0± 1,64 |
4,2± 1,34 |
||
Operation in the hepatoduodenal zone |
4 |
11,3± 0,87 |
13,6± 0,84 |
16,6± 0,88 |
6,4± 0,67 |
19,4± 0,72 |
4,3± 0,87 |
||
Gastricresection |
8 |
“-“ |
“-“ |
“-“ |
“-“ |
“-“ |
“-“ |
||
Intestinal resection |
2 |
“-“ |
“-“ |
“-“ |
“-“ |
“-“ |
“-“ |
||
Gastrectomy |
1 |
“-“ |
“-“ |
“-“ |
“-“ |
“-“ |
“-“ |
||
Total |
52 |
|
|
|
|
|
|
||
Thus, in comparison with traditional combined general anesthesia with ventilators and NLA preparations, the use of paravertebral and epidural analgesia with opiates as a component of an anesthesiological aid allows to reduce the total dose of narcotic analgesics, sedatives and intravenous anesthetics, thereby reducing the severity of post-acute depression. In addition, paravertebral morphine analgesia, although inferior in effectiveness to epidural, has a long-term antinociceptive effect with clinically acceptable quality of anesthesia.
Conclusions:
1. Combined general anesthesia with a ventilator on the background of preliminary paravertebral morphine administration provides at the stages of the perioperative period a less pronounced depression of the parameters of external respiration than combined general anesthesia with a ventilator and NLA preparations and combined general anesthesia on the background of epidural analgesia with an opiate.
2. Paravertebral administration of morphine allows for effective and prolonged anesthesia in the postoperative period and can be the method of choice of anesthetic protection after surgery on abdominal organs.
REFERENCES
1. Aydin, G., Aydin, O. The Efficacy of Ultrasound-Guided Paravertebral Block in Laparoscopic Cholecystectomy // Medicina. – 2018. – Vol. 54. – N 5. doi: 10.3390/medicina54050075.
2. Batra, R.K., Krishnan, K., Agarwal, A. Paravertebral block // J AnaesthesiolClinPharmacol. – 2011. – Vol. 27. – N 1. – Pp. 5-11. PMC3146159.
3. Carney, J., Finnerty, O., Rauf, J., et al. Studies on the spread of local anaesthetic solution in transversusabdominis plane blocks // Anaesthesia. – 2011. – Vol. 66. – N 11. – Pp. 1023-1030. doi: 10.1111/j.1365-2044.2011.06855.x.
4. Cowie, B., McGlade, D., Ivanusic, J., Barrington, M.J. Ultrasound-Guided Thoracic Paravertebral Blockade // Anesthesia & Analgesia. – 2010. – Vol. 110. – N 6. – Pp. 1735-1739. doi: 10.1213/ANE.0b013e3181dd58b0.
5. Gorobets, E.S., Gruzdev, V.E., Zotov, A.V. et al. Multimodal combined anesthesia in traumatic operations // General resuscitation. – 2009. – Vol. 3. – Pp. 45-50.
6. Hasanov, F.D., Aslanov, A.A., Muradov, N.F. and others. Features of the course of combined anesthesia with an epidural component depending on the type of autonomic nervous system // Anesthesiology and resuscitation. – 2016. – Vol. 61. – No. 1. – Pp. 23-27.
7. Karmakar, M.K., Kwok, W.H., Kew, J. Thoracic paravertebral block: radiological evidence of contralateral spread anterior to the vertebral bodies // British Journal of Anaesthesia. – 2000. – Vol. 84. – N 2. – Pp. 263-265. doi: 10.1093/oxfordjournals.bja.a013417.
8. Kuznetsov, A.A., Borisov, N.V., Ashanin, B.S. Prolonged blockade of thoracic autonomic nerve trunks: (topographic and anatomical justification) // Abstracts of the VIIIVseros reports. Congress of anesthesiologists-resuscitators. – St. Petersburg, 2000. – p. 139.
9. Lebedinsky, K.M. Blood circulation and anesthesia. Assessment and correction of systemic hemodynamics during surgery and anesthesia / Edited by Prof. K. M. Lebedinsky. – St. Petersburg: Man, 2012. – Pp. 514-537.
10. Nair, V., Henry, R. Bilateral paravertebral block: a satisfactory alternative for labour analgesia // Canadian J. of Anesthesia. 2001. 48: 179–184.
11. Novak-Jankovic, V. Regional Anaesthesia in Thoracic and Abdominal surgery // ActaClinicaCroatica. 2019. doi: 10.20471/acc.2019.58.s1.14.
12. Ovechkin, A.M. Postoperative anesthesia in abdominal surgery, a new look at an old problem // Anesthesiology and resuscitation. 2003. 5: 45–50.
13. Ozcan, P.E., Sentürk, M., SungurUlke, Z. et al. Effects of thoracic epidural anaesthesia on pulmonary venous admixture and oxygenation during one-lung ventilation // ActaAnaesthesiol Scand. – 2007. – Vol. 51. – № 8. – Pp. 1117-1122.
14. Rawal, N. Epidural technique for postoperative pain: gold standard no more? Reg. Anesth. Pain Med. 2012; 37 (3): 310-317.
15. Sabirov, D.M., Sabirov, K.K., Batyrov, U.B., Saidov, A.S. The experience of using paravertebral blockade when providing anesthetic aids in operative urology // News of surgery. – 2010. – Vol. 18. – No. 2. – Pp. 142-145.
16. Thavaneswaran, P., Rudkin, G.E., Cooter, R.D., et al. Paravertebral Block for Anesthesia // Anesthesia & Analgesia. – 2010. – Vol. 110. – N 6. – Pp. 1740-1744. doi: 10.1213/ANE.0b013e3181da82c8.
17. Tighe, S.Q.M., Greene, M.D., Rajadurai, N. Paravertebral block // Continuing Education in Anaesthesia Critical Care & Pain. – 2010. – Vol. 10. – N 5. – Pp. 133-137. doi: 10.1093/bjaceaccp/mkq029.
REFERENCES
1. Aydin G., Aydin O. The Efficacy of Ultrasound-Guided Paravertebral Block in Laparoscopic Cholecystectomy. Medicina. 2018. Vol. 54. No. 5. doi: 10.3390/medicina54050075.
2. Batra R.K., Krishnan K., Agarwal A. Paravertebral block. J AnaesthesiolClinPharmacol. 2011. Vol. 27. No. 1. Pp. 5-11. PMC3146159.
3. Carney J., Finnerty O., Rauf J., et al. Studies on the spread of local anaesthetic solution in transversusabdominis plane blocks. Anaesthesia. 2011. Vol. 66. No. 11. Pp. 1023-1030. doi: 10.1111/j.1365-2044.2011.06855.x.
4. Cowie B., McGlade D., Ivanusic J., Barrington M.J. Ultrasound-Guided Thoracic Paravertebral Blockade. Anesthesia & Analgesia. 2010. Vol. 110. No. 6. Pp. 1735-1739. doi: 10.1213/ANE.0b013e3181dd58b0.
5. Gorobets E.S., Gruzdev V.E., Zotov A.V. et al. Multimodal combined anesthesia in traumatic operations. General resuscitation. 2009. Vol. 3. Pp. 45-50.
6. Hasanov F.D., Aslanov A.A., Muradov N.F. and others. Features of the course of combined anesthesia with an epidural component depending on the type of autonomic nervous system. Anesthesiology and resuscitation. 2016. Vol. 61. No. 1. Pp. 23-27.
7. Karmakar M.K., Kwok W.H., Kew J. Thoracic paravertebral block: radiological evidence of contralateral spread anterior to the vertebral bodies. British Journal of Anaesthesia. 2000. Vol. 84. No. 2. Pp. 263-265. doi: 10.1093/oxfordjournals.bja.a013417.
8. Kuznetsov A.A., Borisov N.V., Ashanin B.S. Prolonged blockade of thoracic autonomic nerve trunks: (topographic and anatomical justification). Abstracts of the VIIIVseros reports. Congress of anesthesiologists-resuscitators. St. Petersburg, 2000. p. 139.
9. Lebedinsky K.M. Blood circulation and anesthesia. Assessment and correction of systemic hemodynamics during surgery and anesthesia. Edited by Prof. K. M. Lebedinsky. St. Petersburg: Man, 2012. Pp. 514-537.
10. Nair V., Henry R. Bilateral paravertebral block: a satisfactory alternative for labour analgesia. Canadian J. of Anesthesia. 2001. 48: 179–184.
11. Novak-Jankovic V. Regional Anaesthesia in Thoracic and Abdominal surgery. ActaClinicaCroatica. 2019. doi: 10.20471/acc.2019.58.s1.14.
12. Ovechkin A.M. Postoperative anesthesia in abdominal surgery, a new look at an old problem. Anesthesiology and resuscitation. 2003. 5: 45–50.
13. Ozcan P.E., Sentürk M., SungurUlke Z. et al. Effects of thoracic epidural anaesthesia on pulmonary venous admixture and oxygenation during one-lung ventilation. ActaAnaesthesiol Scand. 2007. Vol. 51. No. 8. Pp. 1117-1122.
14. Rawal N. Epidural technique for postoperative pain: gold standard no more? Reg. Anesth. Pain Med. 2012; 37 (3): 310-317.
15. Sabirov D.M., Sabirov K.K., Batyrov U.B., Saidov, A.S. The experience of using paravertebral blockade when providing anesthetic aids in operative urology. News of surgery. 2010. Vol. 18. No. 2. Pp. 142-145.
16. Thavaneswaran P., Rudkin G.E., Cooter R.D., et al. Paravertebral Block for Anesthesia. Anesthesia & Analgesia. 2010. Vol. 110. No. 6. Pp. 1740-1744. doi: 10.1213/ANE.0b013e3181da82c8.
17. Tighe S.Q.M., Greene M.D., Rajadurai, N. Paravertebral block. Continuing Education in Anaesthesia Critical Care & Pain. 2010. Vol. 10. No. 5. Pp. 133-137. doi: 10.1093/bjaceaccp/mkq029.
Материал поступил в редакцию 01.09.24
ПАРАМЕТРЫ ВНЕШНЕГО ДЫХАНИЯ И АНАЛГЕЗИЯ ПРИ
РАЗЛИЧНЫХ ВАРИАНТАХ КОМБИНИРОВАННОЙ АНЕСТЕЗИИ
С ИВЛ И ЭКСТРАДУРАЛЬНЫМИ БЛОКАДАМИ МОРФИНОМ
В.А. Фомичев, доктор медицинских наук, профессор
Новосибирский государственный медицинский университет
(630091, Россия, Новосибирск, Красный просп., 52)
E-mail: fomichev.va@med54.ru
А.Ю. Малолетнева, кандидат медицинских наук, ассистент профессора
Новосибирский государственный медицинский университет
(630091, Россия, Новосибирск, Красный просп., 52)
E-mail: malolet67@mail.ru
А.С. Бусин, Врач- анестезиолог
Дорожная клиническая больница на ст. Новосибирск
(630003, Россия, Новосибирск, Владимировский спуск, д. 2а)
E-mail: kms.novosibirsk1989@yandex.ru
Аннотация. Длительные блокады уменьшают депрессивный эффект на параметры внешнего дыхания и улучшают аналгезию в послеоперационном периоде. Оценка параметров внешнего дыхания и аналгезии в послеоперационном периоде при различных вариантах комбинированной общей анестезии с ИВЛ на фоне НЛА и экстрадуральных блокад морфином. Определяли влияния вариантов комбинированной общей анестезии с ИВЛ на показатели внешнего дыхания и уровень аналгезии в послеоперационном периоде у 162 больных с хирургическими заболеваниями брюшной полости при различных вариантах комбинированной общей анестезии с ИВЛ и экстрадуральными блокадами морфином в сопоставимых группах. В 1 группе (п=64) больные оперированы в условиях комбинированной общей анестезии с ИВЛ и препаратами НЛА. Во 2 группе больные (п=54) оперированы на фоне комбинированной общей анестезии с ИВЛ и эпидуральной аналгезией морфином; в 3 группе больных (п=46) комбинированную общую анестезию с ИВЛ проводили в условиях паравертебральной аналгезии морфином. Изменения параметров внешнего дыхания и уровень аналгезии по визуальной аналоговой шкале в послеоперационном периоде в исследуемых группах больных. Выявлено, что комбинированная общая анестезия с ИВЛ на фоне паравертабрального введения морфина реализует менее выраженную депрессию параметров внешнего дыхания и продолжительное эффективное обезболивание в послеоперационном периоде.
Ключевые слова: экстрадуральная аналгезия морфином, хирургические заболевания органов брюшной полости, параметры внешнего дыхания, оценка эффективности аналгезии по ВАШ.