ksmaКубанский научный медицинский вестникKuban Scientific Medical Bulletin1608-62282541-9544Kuban State Medical University10.25207/1608-6228-2018-25-3-113-118ksma-1234Research ArticleОРИГИНАЛЬНЫЕ СТАТЬИORIGINAL ARTICLESВЛИЯНИЕ ЧУВСТВИТЕЛЬНОСТИ ПЕРИФЕРИЧЕСКОГО ХЕМОРЕФЛЕКСА НА ЧАСТОТУ КРИТИЧЕСКИХ ИНЦИДЕНТОВ В ТЕЧЕНИЕ СОЧЕТАННОЙ АНЕСТЕЗИИTHE INFLUENCE OF PERIPHERAL CHEMOREFLEX SENSITIVITY ON THE CRITICAL INCIDENTS RATE DURING COMBINED ANESTHESIAТРЕМБАЧН. В.TREMBACHN. V.

ул. Красных Партизан, 6/2, Краснодар, Россия, 350012

Krasnykh Partizan St., 6/2, Krasnodar, Russia, 350012.

nikitkax@mail.ruГосударственное бюджетное учреждение здравоохранения «Краевая клиническая больница №2» Министерства здравоохранения Краснодарского краяРоссияState Budgetary Institution of Healthcare "Regional clinical hospital №2" of the Ministry of Healthcare of Krasnodar regionRussian Federation201825072018253113118Copyright © ТРЕМБАЧ Н.В., 20182018ТРЕМБАЧ Н.В.TREMBACH N.V.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://ksma.elpub.ru/jour/article/view/1234

Цель. Оценить влияние чувствительности периферического хеморефлекса на частоту развития критических инцидентов при обширных абдоминальных операциях.Материалы и методы. В исследование включено 176 пациентов, подвергавшихся обширным абдоминальным операциям в условиях сочетанной анестезии. Накануне оперативного вмешательства у всех исследуемых определялась чувствительность периферического хеморефлекса. Регистрировались также пол, возраст, исходный физический статус, сердечно-сосудистый риск. В течение анестезии регистрировали гемодинамические, респираторные и метаболические критические инциденты.Результаты. Всего наблюдали 158 критических инцидентов, которые достоверно чаще встречались у пациентов с высокой чувствительностью периферического хеморефлекса (72% против 48%, р<0,05). В структуре критических инцидентов преобладали гемодинамические, прежде всего гипотензия, при этом ее частота в 2 раза выше среди пациентов с высокой чувствительностью периферического хеморефлекса. Проведенная логистическая регрессия показала, что факторами, ассоциирующимися с риском критических инцидентов, являются высокая чувствительность периферического хеморефлекса, увеличение возраста и исходно высокий класс по ASA.Заключение. Чаще всего при обширных абдоминальных операциях встречаются гемодинамические инциденты, факторами риска их развития являются: высокая чувствительность периферического хеморефлекса, увеличение возраста и ухудшение исходного физического статуса.

Aim. The goal of the study was to assess the impact of peripheral chemoreflex sensitivity on the rate of critical incidents in extensive abdominal operations.Materials and methods. The study included 176 patients who underwent major abdominal surgery under combined anesthesia. On the eve of surgery, sensitivity of peripheral chemoreflex was determined in all subjects. Sex, age, initial physical status, cardiovascular risk were also registered. During anesthesia hemodynamic, respiratory and metabolic critical incidents were registered.Results. In total, 158 critical incidents were observed. They were significantly more common in patients with high sensitivity to peripheral chemoreflex (72% vs. 48%, p<0.05). The structure of critical incidents was dominated by hemodynamic, primarily hypotension, and its frequency was 2 times higher among patients with high sensitivity of peripheral chemoreflex.The logistic regression showed that factors associated with the risk of critical incidents are high sensitivity of peripheral chemoreflex, increased age, and initially high grade of ASA scale.Conclusion. Hemodynamic incidents are the most common in major abdominal surgery; risk factors for their development are high sensitivity of peripheral chemoreflex, increased age and deterioration of the initial physical status.

хеморефлексбарорефлексанестезиягемодинамикаchemoreflexbaroreflexanesthesiahemodynamicsReferencesЗаболотских И.Б., Иващук Ю.В., Григорьев С.В. Прогнозирование и профилактика расстройств гемодинамики и газового гомеостаза при длительных анестезиях в абдоминальной хирургии. Кубанский научный медицинский вестник. 2003; 6: 21-24.Zabolotskikh I.B., Ivashchuk Yu.V., Grigorev S.V. Prediction and prevention of hemodynamics disorders and homeostasis during long anesthesia in abdominal surgery. Kuban Scientific Medicine Bulletin. 2003; 6: 21-24. (In Russ.).Neligan P.J., Gutsche J. Major abdominal surgery. Newman M.F., Fleisher L.A., Fink M.P., eds. Perioperative Medicine: Managing for outcome. New York: Elsevier; 2008. 513-562.Neligan P.J., Gutsche J. Major abdominal surgery. Newman M.F., Fleisher L.A., Fink M.P., eds. Perioperative Medicine: Managing for outcome. New York: Elsevier; 2008. 513-562.Kawagoe I., Tajima K., Kanai M., Kimura S., Mitsuhata H. Comparison of intraoperative stress hormones release between propofol-remifentanil anesthesia and propofol with epidural anesthesia during gynecological surgery. Masui. 2011; 60(4): 416-424.Kawagoe I., Tajima K., Kanai M., Kimura S., Mitsuhata H. Comparison of intraoperative stress hormones release between propofol-remifentanil anesthesia and propofol with epidural anesthesia during gynecological surgery. Masui. 2011; 60(4): 416-424.Liu X.Y., Zhu J.H., Wang P.Y., Wang W., Qian Z.X., Wu X.M. Effects of different anesthetic methods and anesthetic drugs on stress reaction during surgical operation. Zhonghua Yi Xue Za Zhi. 2007; 87(15): 1025-9. DOI: 10.3760/j:issn:0376-2491.2007.15.005Liu X.Y., Zhu J.H., Wang P.Y., Wang W., Qian Z.X., Wu X.M. Effects of different anesthetic methods and anesthetic drugs on stress reaction during surgical operation. Zhonghua Yi Xue Za Zhi. 2007; 87(15): 1025-9. DOI: 10.3760/j:issn:0376-2491.2007.15.005Cooper J.B., DeCesare R., D'Ambra M.N. An engineering critical incident: direct current burn from a neuromuscular stimulator. Anesthesiology. 1990: 73(1): 168-172.Cooper J.B., DeCesare R., D'Ambra M.N. An engineering critical incident: direct current burn from a neuromuscular stimulator. Anesthesiology. 1990: 73(1): 168-172.Заболотских И.Б., Шеховцова С.А., Малышев Ю.П. Способ прогнозирования гемодинамики при длительных анестезиях. Патент РФ № 2146491; 20.05.1997.Zabolotskikh I.B., Shekhovtsova S.A., Malyshev Yu.P. A method of predicting hemodynamic during prolonged anesthesia. Patent RF № 2146491; 20.05.1997. (In Russ.).Оганесян К.А., Заболотских И.Б., Малышев Ю.П., Москалева М.В. Омегаметрия в прогнозировании гемодинамики на этапе вводной анестезии и интубации трахеи. Кубанский научный медицинский вестник. 1997; 1-3(23-25): 69-71.Oganesyan K.A., Zabolotskikh I.B., Malyshev Yu.P., Moskaleva M.V. Omegametry in hemodynamics forecasting at induction and tracheal intubation. Kuban Scientific Medicine Bulletin. 1997; 1-3(23-25): 69-71. (In Russ..Trembach N, Zabolotskikh I. Breath-holding test in evaluation of peripheral chemoreflex sensitivity in healthy subjects. Respir Physiol Neurobiol. 2017; 235: 79-82. DOI: 10.1016/j.resp.2016.10.005Trembach N, Zabolotskikh I. Breath-holding test in evaluation of peripheral chemoreflex sensitivity in healthy subjects. Respir Physiol Neurobiol. 2017; 235: 79-82. DOI: 10.1016/j.resp.2016.10.005Morris R.W., Watterson L.M., Westhorpe R.N., Webb R.K. Crisis management during anaesthesia: hypotension. Qual Saf Health Care. 2005; 14: 11. DOI: 10.1136/qshc.2002.004440Morris R.W., Watterson L.M., Westhorpe R.N., Webb R.K. Crisis management during anaesthesia: hypotension. Qual Saf Health Care. 2005; 14: 11. DOI: 10.1136/qshc.2002.004440Paix A.D., Runciman W.B., Horan B.F., Chapman M.J., Currie M. Crisis management during anaesthesia: hypertension. Qual. Saf. Health Care. 2005; 14(12): 17. DOI: 10.1136/qshc.2002.004127Paix A.D., Runciman W.B., Horan B.F., Chapman M.J., Currie M. Crisis management during anaesthesia: hypertension. Qual. Saf. Health Care. 2005; 14(12): 17. DOI: 10.1136/qshc.2002.004127Cheung C.C., Martyn A., Campbell N., Frost S., Gilbert K., Michota F., Seal D., Ghali W., Khan N.A. Predictors of intraoperative hypotension and bradycardia. Am. J. Med. 2015; 128(5): 532–538. DOI: 10.1016/j.amjmed.2014.11.030Cheung C.C., Martyn A., Campbell N., Frost S., Gilbert K., Michota F., Seal D., Ghali W., Khan N.A. Predictors of intraoperative hypotension and bradycardia. Am. J. Med. 2015; 128(5): 532–538. DOI: 10.1016/j.amjmed.2014.11.030Dalesio N.M., McMichael D.H., Benke J.R., Owens S., Carson K.A., Schwengel D.A., Schwartz A.R., Ishman S. Are nocturnal hypoxemia and hypercapnia associated with desaturation immediately after adenotonsillectomy? Paediatr Anaesth. 2015; 25(8): 778-85. DOI: 10.1111/pan.12647Dalesio N.M., McMichael D.H., Benke J.R., Owens S., Carson K.A., Schwengel D.A., Schwartz A.R., Ishman S. Are nocturnal hypoxemia and hypercapnia associated with desaturation immediately after adenotonsillectomy? Paediatr Anaesth. 2015; 25(8): 778-85. DOI: 10.1111/pan.12647Barone J.E., Tucker J.B., Cecere J., Yoon M.Y., Reinhard E., Blabey R.G. Jr., Lowenfels A.B. Hypothermia does not result in more complications after colon surgery. American Surgery. 1999; 65 (4): 356-359.Barone J.E., Tucker J.B., Cecere J., Yoon M.Y., Reinhard E., Blabey R.G. Jr., Lowenfels A.B. Hypothermia does not result in more complications after colon surgery. American Surgery. 1999; 65 (4): 356-359.Horn EP, Torossian A. Prevention of perioperative hypothermia. Anasthesiol Intensivmed Notfallmed Schmerzther. 2010; 45(3): 160-7. DOI: 10.1055/s-0030-1249396Horn EP, Torossian A. Prevention of perioperative hypothermia. Anasthesiol Intensivmed Notfallmed Schmerzther. 2010; 45(3): 160-7. DOI: 10.1055/s-0030-1249396Currie M. A prospective survey of anaesthetic critical events in a teaching hospital. Anaesthesiology and Intensive Care. 1989; 17: 403-11.Currie M. A prospective survey of anaesthetic critical events in a teaching hospital. Anaesthesiology and Intensive Care. 1989; 17: 403-11.Fasting S., Gisvold S.E. Data recording of problems during anaesthesia: presentation of a well-functioning and simple system. Acta Anaesthesiol Scand. 1996; 40: 1173-83. DOI: 10.1111/j.1399-6576.1996.tb05547.xFasting S., Gisvold S.E. Data recording of problems during anaesthesia: presentation of a well-functioning and simple system. Acta Anaesthesiol Scand. 1996; 40: 1173-83. DOI: 10.1111/j.1399-6576.1996.tb05547.xKumar V., Barcellos W.A., Mehta M.P., Carter J.G. An analysis of critical incidents in a teaching department for quality assurance. A survey of mishaps during anaesthesia. Anaesthesia. 1988; 43: 879-83. DOI: 10.1111/j.1365-2044.1988.tb05606.xKumar V., Barcellos W.A., Mehta M.P., Carter J.G. An analysis of critical incidents in a teaching department for quality assurance. A survey of mishaps during anaesthesia. Anaesthesia. 1988; 43: 879-83. DOI: 10.1111/j.1365-2044.1988.tb05606.xКуликов А.Ю., Кулешов О.В., Лебединский К.М. Критические инциденты и безопасность ксеноновой анестезии при оперативных вмешательствах на органах брюшной полости. Вестник интенсивной терапии. 2016; 3: 22-26Kulikov A. Yu., Kuleshov, O. V., Lebedinsky K. M. Critical incidents and safety of xenon anesthesia at abdominal surgeries. Bulletin of Intensive Care. 2016; 3: 22-26 (In Russ.).Schwilk B., Muche R., Treiber H, Brinkmann A., Georgieff M., Bothner U. A cross-validated multifactorial index of perioperative risks in adults undergoing anaesthesia for non-cardiac surgery. Analysis of perioperative events in 26907 anaesthetic procedures. Journal of Clinical Monitoring and Computing. 1998; 14: 283-294.Schwilk B., Muche R., Treiber H, Brinkmann A., Georgieff M., Bothner U. A cross-validated multifactorial index of perioperative risks in adults undergoing anaesthesia for non-cardiac surgery. Analysis of perioperative events in 26907 anaesthetic procedures. Journal of Clinical Monitoring and Computing. 1998; 14: 283-294.Munting K.E., van Zaane B., Schouten A.N., van Wolfswinkel L., de Graaff J.C.. Reporting of critical incidents in a tertiary hospital – a retrospective cohort study. Netherlands J Anesth. 2012; 25: 9. DOI: 10.1007/s12630-015-0492-yMunting K.E., van Zaane B., Schouten A.N., van Wolfswinkel L., de Graaff J.C.. Reporting of critical incidents in a tertiary hospital – a retrospective cohort study. Netherlands J Anesth. 2012; 25: 9. DOI: 10.1007/s12630-015-0492-yАверьянов Д.А., Бокатюк С.В., Щёголев А.В., Цыганков К.А. Возможность прогноза развития критических инцидентов при плановых оперативных вмешательствах в абдоминальной хирургии. Вестник интенсивной терапии. 2016; 2: 80-84Averyanov D.A., Bokatyuk S.V., Shchyogolev A.V., Tsygankov K.A. The possibility to forecast critical incidents development during elective abdominal surgery. Bulletin of Intensive Care. 2016; 2: 80-84 (In Russ.).Giannoni A., Emdin M., Bramanti F., Iudice G. Combined increased chemosensitivity to hypoxia and hypercapnia as a prognosticator in heart failure. J. Am. Coll. Cardiol. 2009; 53: 1975-80. DOI: 10.1016/j.jacc.2009.02.030Giannoni A., Emdin M., Bramanti F., Iudice G. Combined increased chemosensitivity to hypoxia and hypercapnia as a prognosticator in heart failure. J. Am. Coll. Cardiol. 2009; 53: 1975-80. DOI: 10.1016/j.jacc.2009.02.030Ponikowski P., Chua T.P., Anker S.D., Francis D.P., Doehner W., Banasiak W., Poole-Wilson P.A., Piepoli M.F., Coats A.J. Peripheral chemoreceptor hypersensitivity: an ominous sign in patients with chronic heart failure. Circulation. 2001; 104: 544-9. DOI: 10.1161/hc3101.093699Ponikowski P., Chua T.P., Anker S.D., Francis D.P., Doehner W., Banasiak W., Poole-Wilson P.A., Piepoli M.F., Coats A.J. Peripheral chemoreceptor hypersensitivity: an ominous sign in patients with chronic heart failure. Circulation. 2001; 104: 544-9. DOI: 10.1161/hc3101.093699Ponikowski P., Chua T.P., Piepoli M., Ondusova D., WebbPeploe K., Harrington D., Anker S.D., Volterrani M., Colombo R., Mazzuero G., Giordano A., Coats A.J. Augmented peripheral chemosensitivity as a potential input to baroreflex impairment and autonomic imbalance in chronic heart failure. Circulation. 1997; 96: 2586-2594. DOI: 10.1161/01.CIR.96.8.2586Ponikowski P., Chua T.P., Piepoli M., Ondusova D., WebbPeploe K., Harrington D., Anker S.D., Volterrani M., Colombo R., Mazzuero G., Giordano A., Coats A.J. Augmented peripheral chemosensitivity as a potential input to baroreflex impairment and autonomic imbalance in chronic heart failure. Circulation. 1997; 96: 2586-2594. DOI: 10.1161/01.CIR.96.8.2586Zabolotskikh I., Trembach N. The evaluation of the sensitivity of the peripheral chemoreceptors in predicting of hemodynamic instability during anesthesia in patients with chronic heart failure European Journal of Anaesthesiology. 2014; 31(S52): 67.Zabolotskikh I., Trembach N. The evaluation of the sensitivity of the peripheral chemoreceptors in predicting of hemodynamic instability during anesthesia in patients with chronic heart failure European Journal of Anaesthesiology. 2014; 31(S52): 67.Maaløe R., la Cour M., Hansen A., Hansen E.G., Hansen M., Spangsberg N.L., Landsfeldt U.S., Odorico J., Olsen K.S., Møller J.T., Pedersen T. Scrutinizing incident reporting in anaesthesia: why is an incident perceived as critical? Acta Anaesthesiol Scand. 2006; 50(8): 1005-13. DOI: 10.1111/j.1399-6576.2006.01092.xMaaløe R., la Cour M., Hansen A., Hansen E.G., Hansen M., Spangsberg N.L., Landsfeldt U.S., Odorico J., Olsen K.S., Møller J.T., Pedersen T. Scrutinizing incident reporting in anaesthesia: why is an incident perceived as critical? Acta Anaesthesiol Scand. 2006; 50(8): 1005-13. DOI: 10.1111/j.1399-6576.2006.01092.xFarges O., Goutte N., Bendersky N., et al. Incidence and risks of liver resection: an all-inclusive French nationwide study. Ann Surg. 2012; 256(5): 697-704. DOI: 10.1097/SLA.0b013e31827241d5Farges O., Goutte N., Bendersky N., et al. Incidence and risks of liver resection: an all-inclusive French nationwide study. Ann Surg. 2012; 256(5): 697-704. DOI: 10.1097/SLA.0b013e31827241d5Chow W.B., Rosenthal R.A., Merkow R.P., American College of Surgeons National Surgical Quality Improvement Program, American Geriatrics Society. Optimal preoperative assessment of the geriatric surgical patient: a best practices guideline from the American College of Surgeons National Surgical Quality Improvement Program and the American Geriatrics Society. J Am Coll Surg. 2012; 215(4): 453-66. DOI: 10.1016/j.jamcollsurg. 2012.06.017Chow W.B., Rosenthal R.A., Merkow R.P., American College of Surgeons National Surgical Quality Improvement Program, American Geriatrics Society. Optimal preoperative assessment of the geriatric surgical patient: a best practices guideline from the American College of Surgeons National Surgical Quality Improvement Program and the American Geriatrics Society. J Am Coll Surg. 2012; 215(4): 453-66. DOI: 10.1016/j.jamcollsurg. 2012.06.017Murat I., Constant I., Maud’huy H. Perioperative anaesthetic morbidity in children: a database of 24,165 anaesthetics over a 30- month period. Pediatr Anesth. 2004; 14: 158-166. DOI: 10.1111/j.1460-9592.2004.01167.xMurat I., Constant I., Maud’huy H. Perioperative anaesthetic morbidity in children: a database of 24,165 anaesthetics over a 30- month period. Pediatr Anesth. 2004; 14: 158-166. DOI: 10.1111/j.1460-9592.2004.01167.xPaterson N., Waterhouse P. Risk in pediatric anesthesia. Pediatr Anesth. 2011; 21: 848-857. DOI: 10.1111/j.1460-9592.2010.03366.xPaterson N., Waterhouse P. Risk in pediatric anesthesia. Pediatr Anesth. 2011; 21: 848-857. DOI: 10.1111/j.1460-9592.2010.03366.x

The authors declare that there are no conflicts of interest present.