WAYS TO IMPROVE THE EFFICACY OF CONTROL OF STRESS AND HEMODYNAMIC RESPONSE IN SEPTOPLATICS
About the author:
Ayvardgi A. A., Kobeliatsky Yu. Yu.
CLINICAL AND EXPERIMENTAL MEDICINE
Type of article:
The aim of the research was to study the hemodynamic and stress response parameters in patients with septoplasty, as well as to find ways of improving hemodynamic management and preventing operational stress. Methods. The study recorded parameters of 116 patients who were divided into 4 groups – “K”, “P”, “D” and “P + D”. In the “P” group an intravenous infusion of paracetamol was performed. In the “D” group patients underwent infusion of dexmedetomidine. In the “P + D” group patients were administered infusion of dexmedetomidine and paracetamol. The parameters of hemodynamics, glucose level were recorded. Results. In the groups of patients undergoing dexmedetomidine infusion, there was a significant reduction in mean arterial pressure, especially in the “P + D” group during the induction of anesthesia and at the beginning of the surgery (p≤0,001). Мean arterial pressure in group “P” is within the norm (p≤0,001). In groups where dexmedetomidine infusion was administered, a decrease in heart rate was observed at all stages of observation from the moment of induction of anesthesia (p≤0,001). In the group “P” heart rate from the moment of induction of anesthesia and to awakening of patients is lower than the corresponding indicator in the group “K”, but higher than in groups “D” and “P + D” (p≤0,001). In groups with infusion of dexmedetomidine systolic index is within the norm at all stages of observation (p≤0,001). There were no significant differences in total peripheral vascular resistanc in patients of all observation groups during the induction of anesthesia. At the time of intubation, the tracheal total peripheral vascular resistance in the group “D” is significantly lower than the total peripheral vascular resistance in other groups (p≤0,001). At the beginning of the surgical intervention, the total peripheral vascular resistance level in the group “P + D” exceeds the corresponding indicator of the other groups, and at the traumatic moment of surgery total peripheral vascular resistance is higher in the “D” group (p≤0,001). The level of glucose in the groups where infusion of paracetamol and dexmedetomidine was performed at all stages of observation was within the norm (p≤0,001). Field of application of the results: The use of dexmedetomidine and intravenous form of paracetamol can be recommended for introduction into clinical practice for surgical interventions performed in the area of nasal septum to improve anesthesia. Conclusions. Infusion of dexmedetomidine allows to level the response of hemodynamic to surgical intervention. The use of dexmedetomidine and the intravenous form of paracetamol create the conditions to protect the body from surgical manipulation and prevent operational stress. Further investigations are needed to study the effect of dexmedetomidine and paracetamol on hemodynamic parameters and the stress response of the body in surgical interventions in other areas of medicine.
operational stress, septoplasty, hemodynamic, dexmedetomidine, paracetamol, analgesia
- Sel’е G. Stres bez dіstresu. Moskva: Progres; 1982. s. 12, 15. [in Ukrainian].
- Bunjatjan AA, Mizikov VM. Anesteziologija: nacional’noe rukovodstvo. Moskva: GJeOTAR-Media; 2011. s. 1104. [in Russiаn].
- Ovechkin AM. Hirurgicheskij stress-otvet, ego patofiziologicheskaja znachimost’ i sposoby moduljacii. Regionarnaja anestezija i lechenie ostroj boli. 2008;2(2):49-62. [in Russiаn].
- Desborough J. The stress response to trauma and surgery. British Journal of Anaesthesiа. 2000;85:109-17.
- Breivik H, Borchgrevink PC, Allen SM, Rosseland LA, Romundstad L, Hals EK, et al. Assessment of pain. British Journal of Anaesthesia. 2008;101(1):17-24.
- Polomano RC, Rathmell JP, Krenzischek DA, Dunwoody CJ. Emerging trends and new approaches to acute pain management. J. Perianesth. Nurs. 2008;23(1):43-53.
- Osipova NA, Petrova VV, Beresnev VA, Mitrofanov SV. Sovremennye sredstva i metody anestezii i analgezii v bol’shoj hirurgii. Regionarnaja anestezija i lechenie boli: Tematicheskij sbornik. Moskva – Tver’; 2004. s. 8-17. [in Russiаn].
- Borgeat A, Blumenthal S. Postoperative pain management following scoliosis surgery. Curr. Opin. Anaesthesiol. 2008;21(3):313-6.
- Ezhevskaja AA, Prusakova ZhB. Kliniko-biohimicheskie aspekty jendokrinno -metabolicheskogo stress-otveta i narushenij sistemy gemostaza pri operacijah na pozvonochnike vysokoj intensivnosti. Fundamental’nye issledovanija. 2012;4(1):53-6. [in Russiаn].
- Shurov AV, Iljukevich GV, Prushak AV. Vlijanie razlichnyh metodov anestezii na jendokrinno-metabolicheskoe zveno hirurgicheskogo stressotveta. Regionarnaja anestezija i lechenie ostroj boli. 2008;1(2):21-7. [in Russiаn].
- Zarzar AS, Kim EV, Ataxanov ShE, Maxmudov MA, Zabitova ZM. Ispolzovanie mikrokalkulyatorov dlya raschyota gemodinamicheskix parametrov levogo zheludochka. Anesteziologiya i reanimatologiya. 1991;2:2. [in Russiаn].
Publication of the article:
«Bulletin of problems biology and medicine» Issue 2 (144), 2018 year, 127-131 pages, index UDK 616.212 – 089.87.001: 612.176: 612.13