Preview

Kuban Scientific Medical Bulletin

Advanced search

THE INFLUENCE OF PERIPHERAL CHEMOREFLEX SENSITIVITY ON THE CRITICAL INCIDENTS RATE DURING COMBINED ANESTHESIA

https://doi.org/10.25207/1608-6228-2018-25-3-113-118

Abstract

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.

About the Author

N. V. TREMBACH
State Budgetary Institution of Healthcare "Regional clinical hospital №2" of the Ministry of Healthcare of Krasnodar region
Russian Federation
Krasnykh Partizan St., 6/2, Krasnodar, Russia, 350012.


References

1. 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.).

2. 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.

3. 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.

4. 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:0376-2491.2007.15.005

5. 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.

6. 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.).

7. 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..

8. 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.2016.10.005

9. Morris 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.2002.004440

10. Paix 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.2002.004127

11. Cheung 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.2014.11.030

12. Dalesio 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.12647

13. 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.

14. Horn EP, Torossian A. Prevention of perioperative hypothermia. Anasthesiol Intensivmed Notfallmed Schmerzther. 2010; 45(3): 160-7. DOI: 10.1055/s-0030-1249396

15. Currie M. A prospective survey of anaesthetic critical events in a teaching hospital. Anaesthesiology and Intensive Care. 1989; 17: 403-11.

16. 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.x

17. Kumar 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.x

18. Kulikov 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.).

19. 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.

20. 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-y

21. Averyanov 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.).

22. 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.2009.02.030

23. Ponikowski 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/hc3101.093699

24. Ponikowski 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.96.8.2586

25. 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.

26. 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.x

27. Farges 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.0b013e31827241d5

28. Chow 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. 2012.06.017

29. Murat 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.x

30. Paterson N., Waterhouse P. Risk in pediatric anesthesia. Pediatr Anesth. 2011; 21: 848-857. DOI: 10.1111/j.1460-9592.2010.03366.x


Review

For citations:


TREMBACH N.V. THE INFLUENCE OF PERIPHERAL CHEMOREFLEX SENSITIVITY ON THE CRITICAL INCIDENTS RATE DURING COMBINED ANESTHESIA. Kuban Scientific Medical Bulletin. 2018;25(3):113-118. (In Russ.) https://doi.org/10.25207/1608-6228-2018-25-3-113-118

Views: 350


Creative Commons License
This work is licensed under a Creative Commons Attribution 4.0 License.


ISSN 1608-6228 (Print)
ISSN 2541-9544 (Online)