COMBINED ANESTHESIA BY SEVOFLURANE AND FENTANYL IN ELDERLY PATIENTS WITH DIFFERENT REACTIVITY OF THE CARDIOVASCULAR AND RESPIRATORY SYSTEMS
https://doi.org/10.25207/1608-6228-2018-25-1-54-61
Abstract
Aim. To evaluate anesthesia according to the central hemodynamic, oxygen, acid-base, temperature homeostasis, neuromuscular conduction monitoring the depth of anesthesia and recovery postanesthesia consciousness.
Materials and methods. The research was performed in 78 patients who underwent major abdominal surgery under combined anesthesia. All patients were divided into 4 groups depending on the characteristics induced dynamics of constant potential.
Results. Anesthesia in patients with high cardiovascular and respiratory systems leads to the development of hyperdynamic type of circulation, increased fentanyl consumption, and an increased risk of slow postoperative awakening. In patients of other groups was observed stable during combined anesthesia.
Conclusion. In patients with high cardiovascular and respiratory systems, the use of combined general and epidural anesthesia is advisable. In patients of other groups, the use of combined anesthesia provides adequate protection against operational stress.
About the Author
R. V. VEYLER
Federal State Budgetary Educational Institution of Higher Education Kuban State Medical University of the Ministry of Healthcare of the Russian Federation.
Russian Federation
Russian Federation
Sedina str., 4, Krasnodar, 350063.
References
1. Neligan P.J., Gutsche J. Major abdominal surgery. In: Newman M.F., Fleisher L.A., Fink M.P., eds. Perioperative Medicine: Managing for outcome. New York: Elsevier; 2008. 513-562.
2. Chia-Ing Li, Lin C.H., Lin W.Y. et al. Successful aging defined by health-related quality of life and its determinants in community-dwelling elders. BMC Public Health. 2014 Sep; 28(14): 1013.
3. Tzeng C.W., Cooper A.B., Vauthey J.N., et al. Predictors of morbidity and mortality after hepatectomy in elderly patients: analysis of 7621 NSQIP patients. HPB (Oxford). 2014 May; 16(5): 45968.
4. Baldini G., Fawcett W.J. Anesthesia for colorectal surgery. Anesthesiol Clin. 2015 Mar; 33(1): 93-123.
5. Ganapathy S., McCartney C.J., Beattie W.S., Chan V.W. Best evidence in anesthetic practice: prevention: epidural anesthesia and analgesia does not reduce 30-day all-cause mortality and major morbidity after abdominal surgery. Can J Anaesth. 2003 Feb; 50(2): 143-6.
6. Shi W.Z., Miao Y.L., Yakoob M.Y., Cao J.B., Zhang H., Jiang Y.G., Xu L.H., Mi W.D. Recovery of gastrointestinal function with thoracic epidural vs. systemic analgesia following gastrointestinal surgery. Acta Anaesthesiol Scand. 2014 Sep; 58(8): 923-32.
7. Hollmann M.W., Wieczorek K.S., Smart M., Durieux M.E. Epidural anesthesia prevents hypercoagulation in patients undergoing major orthopedic surgery. Reg Anesth Pain Med. 2001 MayJun; 26(3): 215-22.
8. Rosenfeld B.A., Beattie C., Christopherson R., Norris E.J., Frank S.M., Breslow M.J., Rock P., Parker S.D., Gottlieb S.O., Perler B.A. et al. The effects of different anesthetic regimens on fibrinolysis and the development of postoperative arterial thrombosis. Perioperative Ischemia Randomized Anesthesia Trial Study Group. Anesthesiology. 1993 Sep; 79(3): 435-43.
9. Kida H., Nishikawa N., Matsunami K., Katsuyama R., Kawahito M. The effect of epidural anesthesia on reducing blood loss during upper abdominal surgery. Masui. 1999 Mar; 48(3): 265-70.
10. Lee Y.C., Park S.J., Kim J.S., Cho C.H. Effect of tranexamic acid on reducing postoperative blood loss in combined hypotensive epidural anesthesia and general anesthesia for total hip replacement. J Clin Anesth. 2013 Aug; 25(5): 393-8.
11. Carli F., Kehlet H., Baldini G., Steel A., McRae K., Slinger P., Hemmerling T., Salinas F., Neal J.M. Evidence basis for regional anesthesia in multidisciplinary fast-track surgical care pathways. Reg Anesth Pain Med. 2011 Jan-Feb; 36(1): 63-72.
12. Hodgson P.S., Liu S.S. Epidural lidocaine decreases sevoflurane requirement for adequate depth of anesthesia as measured by the Bispectral Index monitor. Anesthesiology. 2001; 94: 799– 803.
13. Goldmann A., Hoehne C., Fritz G.A., Unger J., Ahlers O., Nachtigall I., Boemke W. Combined vs. Isoflurane/Fentanyl anesthesia for major abdominal surgery: Effects on hormones and hemodynamics. Med Sci Monit. 2008 Sep; 14(9): 445-52.
14. Kawagoe I., Tajima K., Kanai M., et al. Comparison of intraoperative stress hormones release between propofolremifentanil anesthesia and propofol with epidural anesthesia during gynecological surgery. Masui. 2011; 60(4): 416-424.
15. Kouraklis G., Glinavou A., Raftopoulos L., Alevisou V., Lagos G., Karatzas G. Epidural analgesia attenuates the systemic stress response to upper abdominal surgery: a randomized trial. Int Surg. 2000 Oct-Dec; 85(4): 353-7.
16. Овечкин А.М. Анестезия и анальгезия в онкологии: чем обусловлен выбор. Регионарная анестезия и лечение острой боли. 2012; 6(2): 5-15. [Ovechkin A.M. Anesteziya i anal'geziya v onkologii: chem obuslovlen vybor. Regionarnaja anestezija i lechenie ostroj boli. 2012; 6(2): 5-15. (in Russ.)].
17. Gottschalk A., Poepping D.M. Epidural analgesia in combination with general anesthesia. Anasthesiol Intensivmed Notfallmed Schmerzther. 2015 Jul; 50(7-8): 484-93.
18. Wuethrich P.Y., Thalmann G.N., Studer U.E., Burkhard F.C. Epidural analgesia during open radical prostatectomy does not improve long-term cancer-related outcome: a retrospective study in patients with advanced prostate cancer. PLoS One. 2013 Aug 19; 8(8): e72873.
19. Pei L., Tan G., Wang L., Guo W., Xiao B., Gao X., Wang L., Li H., Xu Z., Zhang X., Zhao J., Yi J., Huang Y. Comparison of combined general-epidural anesthesia with general anesthesia effects on survival and cancer recurrence: a meta-analysis of retrospective and prospective studies. PLoS One. 2014 Dec 30; 9(12): e114667.
20. Axelrod T.M., Mendez B.M., Abood G.J., Sinacore J.M., Aranha G.V., Shoup M. Peri-operative epidural may not be the preferred form of analgesia in select patients undergoing pancreaticoduodenectomy. J Surg Oncol. 2015 Mar; 111(3): 306-10.
21. Carlisle J.B. Pre-operative co-morbidity and postoperative survival in the elderly: beyond one lunar orbit. Anaesthesia. 2014 Jan; 69(1): 17-25.
22. Partridge J.S., Harari D., Martin F.C., Dhesi J.K. The impact of pre-operative comprehensive geriatric assessment on postoperative outcomes in older patients undergoing scheduled surgery: a systematic review. Anaesthesia. 2014 Jan; 69(1): 8-16.
23. Luger T.J., Kammerlander C., Luger M.F., Kammerlander-Knauer U., Gosch M. Mode of anesthesia, mortality and outcome in geriatric patients. Z Gerontol Geriatr. 2014 Feb; 47(2): 110-24.
24. 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.)].
25. Заболотских И.Б., Миндияров А.Ю., Рудометкина Е.Ю. Регистрация постоянного потенциала в прогнозировании течения анестезии и постнаркозного восстановления при длительных абдоминальных операциях. Кубанский научный медицинский вестник. 2009; 1(106): 38-43. [Zabolotskikh I.B., Mindiyarov A.Yu., Rudometkina E.Yu. Registratsiya postoyannogo potentsiala v prognozirovanii techeniya anestezii i postnarkoznogo vosstanovleniya soznaniya pri dlitel'nykh abdominal'nykh operatsiyakh. Kubanskiy nauchnyy meditsinskiy vestnik. 2009; 1(106): 38-43. (in Russ.)].
26. Заболотских И.Б., Илюхина В.А. Сверхмедленные физиологические процессы: новое направление в оценке патологических состояний. Вестник интенсивной терапии. 1997; 1–2: 43–48. [Zabolotskikh I.B., Ilyukhina V.A. Sverkhmedlennyye fiziologicheskiye protsessy: novoye napravleniye v otsenke patologicheskikh sostoyaniy. Vestnik intensivnoy terapii. 1997; 1–2: 43–48. (in Russ.)].
27. Заболотских 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., Grigor'ev S.V. Prognozirovaniye i profilaktika rasstroystv gemodinamiki i gazovogo gomeostaza pri dlitel'nykh anesteziyakh v abdominal'noy khirurgii. Kubanskiy nauchnyy meditsinskiy vestnik. 2003; 6: 21–24. (in Russ.)]
28. Заболотских И.Б., Магомедов М.А. Омегаметрия в прогнозировании гемодинамики на вводном этапе анестезии. Вестник интенсивной терапии. 2005; 5: 85-88. [Zabolotskikh I.B., Magomedov M.A. Omegametriya v prognozirovanii gemodinamiki na vvodnom etape anestezii. Vestnik intensivnoy terapii. 2005; 5: 85-88. (in Russ.)].
29. 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. [Oganesjan K.A., Zabolotskikh I.B., Malyshev Ju.P., Moskaleva M.V. Omegametriya v prognozirovanii gemodinamiki na etape vvodnoy anestezii i intubatsii trakhei. Kubanskij nauchnyj medicinskij vestnik. 1997; 1-3(23-25): 69-71. (in Russ.].
30. Стаканов А.В. Омегаметрия в прогнозировании течения длительной анестезии у гастроэнтерологических больных. Вестник интенсивной терапии. 2000; 5-6: 49-54. [Stakanov A.V. Omegametriya v prognozirovanii techeniya dlitel'noy anestezii u gastroenterologicheskikh bol'nykh. Vestnik intensivnoj terapii. 2000; 5-6: 49-54. (in Russ.)].
31. Guay J. The epidural test dose: a review. Anesth Analg. 2006; 102(3): 921-929.
32. Bromage P.R. Spinal epidural analgesia. Edinburgh and London: E & S Livingstone LTD; 1954. 57-8.
33. Xiang Y., Chen C.Q., Chen H.J., Li M., Bao F.P., Zhu S.M. The effect of epidural lidocaine administration on sedation of propofol general anesthesia: a randomized trial. J Clin Anesth. 2014; 26(7): 523-9.
34. Заболотских И.Б., Миндияров А.Ю. Способ прогнозирования восстановления сознания после анестезии при длительных абдоминальных операциях. Патент на изобретение RUS № 2375967; 03.04.2008. [Zabolotskikh I.B., Mindiyarov A.Yu. A method of predicting recovery of consciousness after anesthesia during prolonged abdominal operations: Patent RUS № 2375967; 03.04.2008. (in Russ.)].
35. Вейлер Р.В., Дашевский С.П., Мусаева Т.С., Трембач Н.В. Влияние функционального состояния пациентов пожилого и старческого возраста на частоту интраоперационных критических инцидентов. Вестник анестезиологии и реаниматологии. 2015; 12(5): 15-23. [Veyler R.V., Dashevskiy S.P., Musaeva T.S., Trembach N.V. Vliyaniye funktsional'nogo sostoyaniya patsiyentov pozhilogo i starcheskogo vozrasta na chastotu intraoperatsionnykh kriticheskikh intsidentov. Vestnik anesteziologii i reanimatologii. 2015; 12(5): 15-23. (in Russ.)].
36. Козлов И.А., Кричевский Л.А. Севофлуран: основные свойства и применение в кардиоанестезиологии. Вестник интенсивной терапии. 2008; 1: 14-20. [Kozlov I.A., Krichevskiy L.A. Sevofluran: osnovnyye svoystva i primeneniye v kardioanesteziologii. Vestnik intensivnoy terapii. 2008; 1: 14-20 (in Russ.)].
37. Ekstein M., Gavish D., Ezri T., Weinbroum A.A. Monitored anaesthesia care in the elderly: guidelines and recommendations. Drugs Aging. 2008; 25(6): 477-500.
Review
For citations:
VEYLER R.V. COMBINED ANESTHESIA BY SEVOFLURANE AND FENTANYL IN ELDERLY PATIENTS WITH DIFFERENT REACTIVITY OF THE CARDIOVASCULAR AND RESPIRATORY SYSTEMS. Kuban Scientific Medical Bulletin. 2018;25(1):54-61. (In Russ.) https://doi.org/10.25207/1608-6228-2018-25-1-54-61
Views:
440
Email this article 