RU2102068C1 - Method of xenon anesthesia carrying out by endotracheal type - Google Patents

Abstract

FIELD: medicine, anesthesiology. SUBSTANCE: method involves premedication with atropine and seduxen, denitrogenization with oxygen, prenarcosis, myoplegia, intubation, xenon feeding and anesthesia carrying out at small gas flow. Denitrogenization and mechanical ventilation of lungs (MVL) were carried out by semiopen contour at gas rate 6-8 and 6-8 l/min, respectively. After change for open contour content of oxygen in respiratory sac is 500 ml, not above. Xenon is fed at volume 1.3 vital capaciti of lungs (VCL) for 1.5-2 min and the following anesthesia is carried out at oxygen concentration 30%, not less. Method ensures xenon consumption decrease by 3-4-fold, narcosis onset is decreased to 4-5 min. EFFECT: enhanced effectiveness of method, decreased cost and xenon consumption.

Description

 The invention relates to medicine, namely to anesthesiology.

 Since 1945, numerous experimental and clinical studies have been carried out in various countries on the use of inert xenon gas (Xe) for anesthesia, confirming that it has more powerful narcotic properties than nitrous oxide. It was shown that Xe, in contrast to it, provides reliable anesthesia in the variant of mononarcosis during cavity surgery. In addition, it is non-toxic, indifferent in the body, easy to manage, environmentally friendly and safe for patients and surrounding personnel.

 However, the high cost of xenon ($ 7 abroad and $ 1-2 in our country for 1 liter) limits its widespread use in practical anesthesiology, especially abroad, because most countries are forced to import it.

 In our country, the industrial production of xenon of high purity 99.999% (GOST 10219-77 as amended 1, 2) has been established.

 There are large reserves of it, but the methods of xenon anesthesia have not yet been studied and need to be developed.

A known method of anesthesia with xenon endotracheal type (E. Boomsma, J. Rupreht at all. Haemodynamic and neurohumotal effects of xenon anesthesia. A comporison mith nitrous oxide-Anaesthosia, 1990, v. 45, p. 273-278), which consists in that after introductory anesthesia with barbiturates and intravenous administration of muscle relaxant, the patient is intubated, transferred to artificial lung ventilation (ALV), and after denitrogenation, a gas-narcotic mixture of xenon (Xe) with oxygen (O ₂ ) in the ratio of 0.7: 0 is connected , 3 with a small gas flow in a closed loop. Every 20 minutes the closed circuit is “washed” with a fresh portion of the narcotic mixture.

 The disadvantage of this method is the high consumption of xenon (up to 20-40 l), which limits the use of such an expensive anesthesia.

As a prototype, a method of xenon anesthesia according to the endotracheal type was adopted (B. Lachmann, S. Armbruster, W. Schirer at all. Safety and efficacy of xenon in routine use as an inhalational anaesthetis Lancet, 1990, v. 335, p. 1413- 15), which consists in the fact that after premedication with atropine at a dose of 0.002 mg / kg, denitrogenation of 100% O ₂ is carried out, thiopentone is administered anesthetically at a dose of 2.5-5 mg / kg and fentanyl at a dose of 0.1 mg. After myoplegia with pancuronium at a dose of 0.1 mg / kg, the patient is intubated, mechanical ventilation 100% O ₂ is carried out for 6-8 minutes in order to denitrogenation, then they switch to a closed circuit with a small gas flow of the Xe and O ₂ gas mixture in the ratio of 0.7: 0.3, which support the entire period of operation. At the same time, every 20 min the closed circuit is “washed” with a fresh portion of the drug mixture, and Xe is removed into the surrounding air without disposal.

 However, the known method has significant disadvantages.

 Spent xenon is not disposed of, but discarded in large quantities into the surrounding space of the operating room, which is an undesirable factor for maintenance personnel. In addition, xenon consumption is 10 liters per hour ($ 70-150), which makes anesthesia expensive and inaccessible.

 The objective of the invention is to provide a highly effective method of anesthesia with xenon endotracheal type, which allows to reduce the consumption of xenon and reduce the cost of anesthesia.

 The essence of the invention lies in the fact that in the method of anesthesia with xenon according to the endotracheal type, including premedication with atropine, denitrogenation with pure oxygen, induction of anesthesia, myoplegia, intubation, re-denitrogenation by means of artificial ventilation of the lungs with subsequent transition to a closed circuit, supplying xenon to the system anesthesia apparatus and anesthesia with low gas flow and a xenon / oxygen ratio of 0.7: 0.3, while conducting sedation in the patient’s body but seduxen is administered, denitrogenation is carried out on a half-open circuit at a gas flow of 6-8 l / min for 5 minutes, artificial lung ventilation is carried out on a half-open circuit at a gas flow of 6-8 l / min for 3-4 minutes, after switching to a closed circuit in no more than 500 ml of oxygen is left in the breathing bag, xenon is fed into the anesthesia system using a specially floated dosimeter in a volume equal to 1.3 vital capacity of the patient’s lungs for 1.5-2 minutes, maintaining its concentration in the gas-narcotic mixture not more than 70% from to with the help of an oxygen gas analyzer, subsequent anesthesia is carried out at low gas flow with a xenon-oxygen ratio of 0.3-0.2: 0.3, maintaining an oxygen concentration of at least 30% in the gas-narcotic mixture, which, when the respiratory bag is full, is removed through an outlet channel into the device for xenon regeneration, moreover, after anesthesia is completed and xenon is turned off, oxygen is supplied to the anesthesia apparatus at a gas flow of 6-8 l / min for 5 minutes, and the remaining narcotic mixture is removed to the xenon regeneration device.

 Using the invention allows to obtain the following technical result.

 When using the proposed method, a reduction in the cost of expensive xenon is achieved by 3-4 times in comparison with the known method.

 Anesthesia in conditions of utilization and regeneration of exhaled xenon becomes several tens of times cheaper, because 95% of the xenon used after regeneration can be reused.

 A better denitrogenation is achieved. The absence of nitrogen impurities in the closed loop contributes to the correct formation of a gas-narcotic mixture of xenon and oxygen and adequate anesthesia.

 The application of the method reduces the time of onset of anesthesia to 4-5 minutes

 The functionality of xenon is expanded and the anesthesia technique is simplified, because There is no need to save xenon and reduce its consumption.

 The simplicity and environmental cleanliness of the method allows us to recommend it for widespread use in various fields: surgery, obstetrics and gynecology, traumatology, etc.

 The technical result is achieved through the disposal and regeneration of exhaled xenon with the possibility of its reuse.

 The denitrogenation technique developed by the authors on a half-open circuit at a gas flow of 6-8 l / min contributes to a better nitrogen washout and adequate anesthesia.

 Reducing the time of onset of anesthesia is achieved by feeding xenon into a closed circuit in an amount equal to 1.3 VC within 1.5-2 minutes immediately after the end of denitrogenation.

 The method is as follows.

 Before starting the operation, a vacuum suction device for xenon regeneration from the gas-narcotic mixture is attached to the V-connector of the anesthesia apparatus at the place of attachment of the respiratory bag using a rubber hose (RF patent N 2049487, class A 61 M 16/01, 1995).

 After performing generally accepted preparation for surgery and anesthesia, the patient is premedicated by intravenous administration of atropine at a dose of 0.1 mg per 10 kg and 10 mg of seduxen 10 minutes before induction of anesthesia. During this period, through the face mask of the anesthesia apparatus, 100% oxygen is inhaled along a half-open circuit at a gas flow of 6-8 l / min for 5 minutes in order to denitrogenize the respiratory circuit.

 Then an induction anesthesia is performed using thiopental (4-6 mg / kg) or calypsol (2 mg / kg), myoplegia using listenone (1.5 mg / kg), after which the patient is intubated and mechanical ventilation is performed with 100% oxygen in a half-open circuit using a Ruben valve, with a gas flow of 6-8 l / min for 3-4 minutes for a more reliable elimination of alveolar nitrogen. Then they switch to a closed circuit, leaving no more than 500 ml of oxygen in the breathing bag, xenon is supplied for 1.5-2 minutes through a specially floated dosimeter in a volume equal to 1.3 of the patient’s lung capacity (VC). During this period, the xenon concentration in the anesthesia system system is set at 65-70% and oxygen 30-35% which is maintained using an oxygen gas analyzer. Subsequently, anesthesia is performed at low gas flow with a xenon-oxygen ratio of 0.3-0.2: 0.3, periodically changing it if necessary, preventing a decrease in oxygen concentration below 30%. When the respiratory bag is full, the gas-narcotic mixture is removed to the xenon regeneration device .

 After the end of anesthesia and disabling of xenon, oxygen is supplied to the anesthesia system in a volume of 6-8 l / min for 5 minutes to more completely eliminate xenon from the patient and the respiratory circuit of the anesthesia apparatus. Residues of the narcotic mixture are removed to the xenon regeneration device.

 Example. Patient K. 42. Diagnosis: chronic pulmonary cholecystitis.

 After the generally accepted preparation of the patient for surgery and anesthesia on the operating table, premedication was carried out by intravenous administration of atropine 1 mg, seduxen 10 mg, fentanyl 0.1 mg. Through the face mask of the anesthesia apparatus, 100% oxygen was inhaled along a half-open circuit at a gas flow of 6 l / min for 5 minutes in order to dehydrogenate. Then, an initial anesthesia was performed using theopental sodium 500 mg, myopelgia with listenone 100 mg and a tracrium 25 mg. After this, the patient was intubated. A mechanical ventilation was performed with 100% oxygen along a half-open circuit using a Ruben valve at a gas flow of 8 l / min for 4 minutes. Then they switched to a closed circuit, leaving 500 ml of oxygen in the breathing bag. Using a specially calibrated dosimeter, xenon was applied to the anesthesia system in an amount equal to 1.3 VC of the patient for 2 minutes.

 The oxygen concentration decreased to 40%; the xenon flow was reduced to 2 l / min; after 1 min, the oxygen concentration decreased to 30%, which was controlled by an oxygen gas analyzer. Anesthesia has come. 5 minutes after the start of xenon inhalation, surgery began, the duration of the operation was 70 minutes. All subsequent anesthesia was performed at low gas flow with an oxygen concentration control of not less than 30%. When the respiratory bag was full, the narcotic drug mixture was removed through the bypass channel into the xenon regeneration device. After the end of anesthesia, xenon was turned off, and oxygen was supplied into the anesthesia system system for 5 min in a volume of 6 l / min. Residues of the drug mixture were removed to the xenon regeneration device. 4 minutes after anesthesia, the patient was fully conscious, extruded. Hemodynamics during the operation is stable: BP = 140/90, pulse 80, CO 2-4 about. Anesthesia according to EMG, EEG and the clinical picture is adequate. Total consumption of Xe without disposal 12 liters. Subjective sensations of the patient after exit from anesthesia are pleasant. There were no complaints.

Claims (1)

 A method for anesthesia with xenon of the endotracheal type, including premedication with atropine, denitrogenation with pure oxygen, induction of anesthesia, myoplegia, intubation, repeated denitrogenation by means of artificial ventilation of the lungs with subsequent transition to a closed circuit, feeding xenon into the anesthesia system and performing anesthesia during anesthesia and the ratio of xenon and oxygen 0.7 0.3, characterized in that when conducting premidication, seduxen is additionally introduced into the patient’s body, d enitrogenation is carried out on a half-open circuit at a gas flow of 6-8 l / min for 5 minutes, artificial ventilation of the lungs is carried out on a semi-open circuit at a gas flow of 6 8 l / min for 3 to 4 minutes, after switching to a closed circuit, no more than 500 ml of oxygen, xenon is fed into the anesthesia system using a specially floated dosimeter in a volume equal to 1.3 of the patient’s lung capacity for 1.5 2.0 minutes, maintaining its concentration in the narcotic mixture of not more than 70% by gas analysis ora oxygen, subsequent anesthesia is carried out at low gas flow with a xenon-oxygen ratio of 0.3 0.2 0.3, maintaining an oxygen concentration of at least 30% in the gas-narcotic mixture, which when overfilling the respiratory bag is removed through the bypass channel into the xenon regeneration device, moreover, after the end of anesthesia and the shutdown of xenon, oxygen is supplied to the anesthesia apparatus at a gas flow of 6 8 L / min for 5 minutes, and the remnants of the gas narcotic mixture are removed to the xenon regeneration device.