RU2118140C1 - Method of anesthetizing ophthalmologic operations - Google Patents

Abstract

FIELD: ophthalmology. SUBSTANCE: invention relates to problems in patients with idiosyncrasy to local anesthetics. Dipidolor solution (0.05-0.06 mg/kg) and pentamine (0.35 mg/kg) are simultaneously administered locally. EFFECT: achieved adequate and durable anesthetization.

Description

 The invention relates to medicine, namely to ophthalmology, and can be used to anesthetize ophthalmic surgery, especially in patients with idiosyncrasy to local anesthetics.

 A known method of analgesia during ophthalmic surgery (RF patent N 2004224, published 15.12.93), where calipsol is administered parabulbarly at a dose of 12.5-25 mg in combination with tubocurarine. However, the known method has the following disadvantages: calypsol has a quick, but short analgesic effect (with intramuscular administration of 30 to 35 minutes), which limits the use of the method for long-term operations; calypsol has a hallucinogenic effect and in small doses can lead to psychomotor agitation; contraindicated in older people with cerebrovascular accidents and with hypertension.

 The task of the invention is to achieve adequate and prolonged anesthesia when performing eye operations.

 The technical result consists in creating optimal conditions for performing an ophthalmic surgery and reducing surgical and postoperative complications.

 The technical result is achieved by the fact that in the method of anesthesia of ophthalmic surgery, including parabulbar injection, according to the invention, a solution of dipidolor from 0.05 to 0.06 mg / kg and pentamine 0.35 mg / kg of the mass are administered simultaneously at the same time 10 to 15 minutes before the operation. and start the operation.

 Initially, patients are given intramuscularly standard sedation 40–45 minutes before surgery, including sedatives (seduxen 0.14 mg / kg), antihistamines (dimedrol 0.14 mg / kg or suprastin 0.3 mg / kg) and anticholinesterase (atropine 0.007 mg / kg) preparations. The method is as follows: in the patient's position lying 10 to 15 minutes before the operation, a parabulbar injection of dipidolor from 0.05 to 0.06 mg / kg and pentamine 0.35 mg / kg is performed, after which the ophthalmic surgery is started.

 Dipidolor has a local effect on the sensitive receptors of the eye, which allows for stable and prolonged anesthesia. The negative property of dipidolor as a central analgesic in ophthalmic surgery - to narrow the pupil - is leveled by the action of pentamine. The latter, blocking the autonomic structures of the ciliary ganglion, dilates the pupil and reduces intraocular pressure.

 The dose of dipidolor should not exceed 0.06 mg / kg, as this can lead to inhibition of the respiratory and vasomotor centers.

 The dose of dipidolor can not be less than 0.05 mg / kg, since it does not cause blockade of pain receptors, which in turn will require additional administration of anesthetics.

 The dose of pentamine should not be more than 0.35 mg / kg, as this can cause central hemodynamic disorders.

 The dose of pentamine cannot be less than 0.35 mg / kg, since in a lower dose, pentamine will not block the vegetative structures of the ciliary ganglion.

 An interval of 10-15 minutes was chosen because this time is sufficient for the resorption of parabulbar infiltrate and exposure to the nerve structures of the eye.

The method is illustrated by the following clinical examples:
Example 1. Patient T., 40 years old, a / c N 266190.

 Received treatment with a diagnosis of OD relapse of retinal detachment. A history of intolerance to local anesthetics. The first operation was performed under endotracheal anesthesia. The early postoperative period was complicated by vomiting, which affected the outcome of surgical treatment.

On admission:
Vis OD = 0.05 eccentric.

 Field of view: OD - narrowed to 4-5 gr. from 3 to 12 hours.

 Ophthalmoscopically: OD - subtotal retinal detachment from 6 to 10 hours, a gap of 9 hours.

 Operation: cryopexy, sectoral filling, release of subretinal fluid.

 After sedation, the patient in the supine position 10 minutes before the operation received a parabulbar injection of dipidolor at a dose of 0.06 mg / kg and pentamine 0.35 mg / kg, after which the main stages of the operation were performed. Throughout the course of the operation (1 hour 40 minutes), the course of anesthesia is smooth, which is confirmed by monitoring data: heart rate 78 ± 6 per min; HELL 115 ± 5/70 mm Hg; BH 16 ± 2 per min. Variational pulsography during the entire operation showed a balanced state of the autonomic nervous system, which indicates the adequacy of anesthesia. The postoperative period was uneventful. The patient did not notice pain during 5 hours after the operation.

At discharge:
Vis OD = 0.3 with correction.

 Field of view: OD - narrowed to 35-40 gr. from 3 to 12 hours.

 Ophthalmoscopically: OD - the retina lies throughout.

 Example 2. Patient P. 57 years old, a / c N 422720.

 Received with a diagnosis of OD subtotal retinal detachment. According to the patient, he does not tolerate novocaine and lidocaine. The patient refused endotracheal anesthesia.

On admission:
Vis OD = hand movement in the face.

 Field of view: OD - candles from 5 to 7 hours on the periphery.

 Ophthalmoscopically: OD - total retinal detachment from 8 to 5 hours, capturing the macula, with a gap of 2 hours in the paramacular region.

 Operation: cryopexy, circular scleral depression, release of subretinal fluid.

 After sedation, the patient 15 minutes before the operation gave a parabulbar injection of dipidolor at a dose of 0.05 mg / kg and pentamine 0.35 mg / kg, after which the main stages of the operation were performed. Throughout the course of the operation (1 hour 10 minutes), the course of anesthesia is smooth. Monitoring data: heart rate 80 ± 3 per min; HELL 105 ± 5/60 mm Hg; BH 14 ± 2 per min. According to variational pulsography, a balanced state of the autonomic nervous system throughout the operation. The postoperative period was uneventful. The patient did not notice pain during 8 hours after the operation.

At discharge:
Vis OS = 0.1.

 Field of view: OS - narrowed to 15-20 gr. from 12 to 4 hours.

 Ophthalmoscopically: OS - the retina lies all along.

 Examples show the safety of anesthesia and the favorable course of the early postoperative period.

 Compared with the prototype adopted as the basic version, the proposed method eliminates additional drug effects and provides a stable analgesic effect during surgery and in the immediate postoperative period.

 Anesthesia according to the proposed method was successfully carried out in 59 patients with intolerance to local anesthetics.

Claims (1)

 \ \ \ 1 A method of anesthetizing ophthalmic surgeries, including parabulbar injection of drugs, characterized in that a centrally acting analgesic is administered simultaneously - dipidolor at a dose of 0.05 to 0.06 mg / kg and ganglion blocker - pentamine 0.35 mg / kg body, 10 - 15 minutes before surgery.