ANALYSIS OF ANESTHESIA BY SEVOFLURAN AT LAPAROSCOPIC CHOLECYSTECTOMY IN THE CONDITIONS OF EXTENDED MONITORING OF ANESTHESIA COURSE
About the author:
Mashin О. M., Kobelyatsky Yu. Yu.
CLINICAL AND EXPERIMENTAL MEDICINE
Type of article:
The aim of the study was to study changes in bioelectric activity of the brain, level of analgesia and nociception, hemodynamics in patients at different stages of anesthesia using the inhaled anesthetic sevoflurane during laparoscopic cholecystectomy. Objects and methods. The 40 patients with cholelithiasis who underwent laparoscopic cholecystectomy with inhalation anesthesia with sevoflurane were examined. The results of anesthetic monitoring were recorded at 7 stages of surgical intervention: onset (1), induction (2), intubation (3), insufflation (4), basis (5), desufflation (6), extubation (7). Patients were randomized into two groups. In patients of the Group 1 – control group (n=20), the change in the bioelectrical activity of the brain (BIS index) and the level of analgesia and nociception (ANI index) were studied retrospectively. The Group 2 (n=20) consisted of patients where, in addition to standard indicators, BIS and ANI indices were recorded, as well as indicators of the “Multigas” monitor integrated into the anesthesia station. Results. Changes in hemodynamics in both groups had regular fluctuations during anesthetic preparation of patients, providing carbodioxiperitoneum and the end of surgery. Comparison of changes in these indicators depending on the monitoring method showed more significant fluctuations in the level of systolic and diastolic blood pressure at stages 3, 4, 5 in Group 2, compared with the control group. Monitoring of central hemodynamics: stroke volume (SV) and cardiac output (CO) at stages 1 and 2 of anesthesia made it possible to identify patients with a violation of the volemic status and ensure its timely correction. According to the ANOVA analysis of variance, we did not establish significant fluctuations in the SV indicators during these observation stages in both clinical groups – for the Group 1: F=2.58, p=0.063; for the Group 2: F=2.07, p=0.114. The dynamics of CO indicators had statistically significant differences: F=3.35, p=0.025 and F=6.21, p=0.001, respectively, in the groups. The number of patients with fluctuations in CO indices of more than 10 % of the initial level was 37.5 % at the induction stage, classifies them as responders and without corresponding correction leads to CO fluctuations of 27.5 % at the insufflation stage and 20.0% at the stage desufflation with a sufficient level of analgesia and sedation. Analysis of ventilation and oxygenation (SaO2 , EtCO2 ) under carbodioxiperitoneum conditions showed their stability and controllability in patients of both groups. The analysis of indicators characterizing the depth of anesthetic sleep (BIS index) in two groups, firstly, showed a high consistency of estimates obtained using special equipment (control group) and calculated retrospectively (research group) – the concordance coefficient K=0.79 r<0.001. A retrospective assessment of the analgesia index (ANI index) was less accurate – the concordance coefficient was K=0.39 at p<0.001. However, taking this indicator into account, especially at the critical points of anesthesiology procedures (intubation – extubation), is important for timely correction. In particular, a low ANI at the intubation stage was recorded in 9 (22.5 %) patients, including 4 (20.0 %) and 5 (25.0 %) patients in the control and experimental groups, respectively. Anesthesia at the stages of surgical aggression in both groups tended to hyperalgesia in 17.5 – 30.0 % of patients, and during extubation – in 7 (17.5 %). Conclusions. Increased abdominal pressure due to carbodioxiperitoneum lasting up to 1 hour when using sevoflurane by the low-flow method does not cause significant changes in ventilation and oxygenation parameters and can be easily corrected by changing the settings of the ventilation parameters. The best stability, predictability of hemodynamics, in the intraoperative period, shows a group with advanced anesthesiological monitoring of the depth of anesthesia sleep and the level of analgesia, creating conditions for better anesthesia. Changes in cardiac output at various stages of surgery depend not only on changes in pressure in the abdominal cavity due to carbodiosciperitoneum and changes in the patient’s body position, but also on the level of analgesia during general anesthesia. With optimal indicators of the depth of anesthetic sleep and the level of analgesia, hemodynamic fluctuations may be associated with the patient’s volemic status before surgery.
cholecystectomy, laparoscopy, inhalation anesthesia, BIS – monitoring, ANI – monitoring, esCCO – monitoring, anesthesiology
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Publication of the article:
«Bulletin of problems biology and medicine» Issue 3 (152), 2019 year, 151-156 pages, index UDK 617.51-001.4