RU2254124C1 - Agent for removing post-narcosis depression - Google Patents

Abstract

FIELD: medicine, pharmacy.

SUBSTANCE: invention proposes an agent for removing the post-narcosis depression after combined anesthetic assistances with applying sedative and narcotic preparations. As such agent the preparation "Reamberin" is used based on succinic acid that is a natural metabolite in human body. The preparation provides reducing time for adequate spontaneous breathing and awaking time by 1.5-fold and the absence of complications and negative adverse responses.

EFFECT: valuable properties of agent.

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Description

The present invention relates to medicine, namely to pediatric anesthesiology and intensive care, and is intended for use in intensive care units, anesthesiology, surgery, interventional radiology of medical diagnostic institutions.

It is known that naloxone is used to eliminate post-narcotic depression caused by opioid analgesics (Morgan J. Edward - Jr., Magid S. Mikhail. Clinical anesthesiology. M. "Binom", St. Petersburg. "Nevsky dialect", v. 1, 1998, pg. 268-269).

It is also known that to eliminate the aftereffect of benzodiazepine-type drugs, anexate is used (IV Molchanov. Rational use of benzodiazepines and their antagonist flumazenil (anexate) in anesthesiology practice // Intensive Care Bulletin, collection “Topical Issues of General Anesthesia and Sedation”, 1998. pg. 23-25).

However, the known methods operate exclusively narrowly (naloxone when using opioid analgesics, anexate when using benzodiazepines), which complicates their use. Moreover, these funds are inaccessible due to their relative high cost.

The aim of the invention is a means to eliminate post-narcotic depression, devoid of the above disadvantages.

This goal is achieved by the fact that as a means to eliminate post-narcotic depression using the drug "Reamberin".

The infusion solution "Reamberin 1.5%" is a domestic drug. It is intended for use in children and adults as an antihypoxic and detoxifying agent in acute intoxications of various etiologies. It basically has succinic acid, which is a natural and important substrate of the processes of cellular metabolism in the human body. Unlike other drugs used to eliminate post-narcotic depression, which are synthetic substances that are foreign to the body, reamberin has no side effects, because is a natural metabolite. In addition, it has a positive effect on all cells of the body (membrane-stabilizing, energy-synthesizing, etc.), promotes the formation of macroergic compounds (Obolensky S.V. Reamberin - a new tool for infusion therapy in the practice of critical state medicine; Methodical recommendations, C- Petersburg, 2002, p.23).

To relieve post-narcotic depression, Reamberin was not previously used.

Figure 1 presents the dynamics of cerebral oximetry indicators of patient K. Figure 2 is a graph of cytochrome oxidase and regional saturation of patient K. Figure 3 is a graph of cerebral oximetry indicators of patient M. Figure 4 is a graph of cytochrome oxidase and regional saturation of patient M.

The method is illustrated by the following clinical examples:

Example 1

Patient K-a, 14 years old, medical history 4187, was admitted to the operating room for transposition of the tibia flexors into the calf muscle.

In the preoperative period, according to laboratory and instrumental examinations, there were no violations, the condition was satisfactory.

In the operating room, the child recorded cerebral oximetry: total hemoglobin, oxyhemoglobin, deoxyhemoglobin, regional saturation, cytochrome oxidase; electroencephalography; acid-base condition; indicators of systemic hemodynamics: heart rate, systolic blood pressure, diastolic blood pressure, average blood pressure; the time from the beginning of withdrawal from anesthesia to awakening, assessed by the following signs: conscious speech and movement, in infants - an active motor reaction, screaming, crying, opening eyes; recovery time of adequate spontaneous breathing after mechanical ventilation, estimated by the end-respiratory concentration of carbon dioxide, respiratory rate and tidal volume.

Combined general anesthesia was carried out using fentanyl (6.05 μg / kg / h), sibazon (0.29 mg / kg), nimbex (0.29 mg / kg) with controlled mechanical ventilation.

The duration of anesthesia was 85 minutes. The duration of the operation is 55 minutes.

10 minutes before the end of the operation, a Reamberin solution at a dose of 2 ml / kg was injected iv. The drug was re-introduced in the same dose 10 minutes after the first injection.

According to cerebral oximetry, there was a slight increase in blood supply to the brain (an increase in total hemoglobin), a significant increase in regional saturation in the pericortical parts of the brain due to an increase in the oxyhemoglobin fraction and a decrease in the deoxyhemoglobin fraction (Fig. 1 on the x axis marks the time of administration of reamberin, on the axis in ^{1, the} indicators of total hemoglobin (tHb), oxyhemoglobin (О ₂ Нb), deoxyhemoglobin (ННb) are expressed in optical absorption units μMstA ^-1 , on the axis ^{2 the} data region Saturation Saturation (RSat), measured as a percentage). There was an increase in metabolic activity, characterized by a decrease in the level of the oxidized form of cytochrome oxidase (Fig. 2 on the y-axis ¹ , regional saturation data (RSat), measured in percent, on the y-axis, ² cytochrome oxidase (Cytaa3) values are estimated in arbitrary optical units, on the x-axis, markers noted the time of administration of reamberin). Changes in electroencephalography were manifested by an increase in the total power of wave activity and changes in the wave spectrum, characterized by an increase in the percentage of alpha waves and a decrease in theta waves.

Estimated hemodynamic parameters did not undergo significant changes. According to the acid-base state, no significant changes were also noted.

The recovery time of adequate spontaneous breathing (19 minutes) and the time of awakening (22 minutes) after the first injection of the drug was on average 1.5 times less than in children for whom this drug was not administered.

Example 2

Patient Ma, 3 years old, medical history 5318, was admitted to the operating room for ventriculoatrial bypass grafting.

In the preoperative period, according to laboratory and instrumental examinations, there were no violations, the condition corresponded to moderate.

In the operating room, the child recorded cerebral oximetry: total hemoglobin, oxyhemoglobin, deoxyhemoglobin, regional saturation, cytochrome oxidase; electroencephalography; acid-base condition; indicators of systemic hemodynamics: heart rate, systolic blood pressure, diastolic blood pressure, average blood pressure; the time from the beginning of withdrawal from anesthesia to awakening, assessed by the following signs: conscious speech and movement, in infants - an active motor reaction, screaming, crying, opening eyes; recovery time of adequate spontaneous breathing after mechanical ventilation, estimated by the end-respiratory concentration of carbon dioxide, respiratory rate and tidal volume.

Combined general anesthesia was carried out using fentanyl (4.68 μg / kg / h), diprivan (10.8 mg / kg), nimbex (0.4 mg / kg) with controlled mechanical ventilation.

The duration of anesthesia was 108 minutes. The duration of the operation is 62 minutes.

10 minutes before the end of the operation, a “Reamberin 1.5%” solution was injected intravenously in a dose of 2 ml / kg. The drug was re-introduced in the same dose 10 minutes after the first injection.

According to cerebral oximetry, there was a slight increase in blood supply to the brain (an increase in total hemoglobin), a significant increase in regional saturation in the pericortical parts of the brain due to an increase in the oxyhemoglobin fraction and a decrease in the deoxyhemoglobin fraction (Fig. 3 on the x-axis indicates the time of administration of reamberin, on the axis in ^{1, the} indicators of total hemoglobin (tHb), oxyhemoglobin (О ₂ Нb), deoxyhemoglobin (ННb) are expressed in optical absorption units μMcmA ^-1 , on the axis ^{2 the} data are regional th saturation (RSat), measured as a percentage). A decrease in the level of the oxidized form of cytochrome oxidase testified to an increase in metabolic activity (Fig. 4 on the y-axis ¹ shows regional saturation data (RSat), measured in percent, on the y-axis, ² cytochrome oxidase values (Cytaa3) are estimated in arbitrary optical units, on the x-axis, markers indicate time of administration of reamberin). Changes in electroencephalography were manifested by an increase in the total power of wave activity up to 20% and changes in the wave spectrum, characterized by an increase in the percentage of alpha and beta waves, as well as a decrease in theta waves.

Estimated hemodynamic parameters did not undergo significant changes. According to the acid-base state, there were no significant changes.

The recovery time for adequate spontaneous respiration and extubation was 15 minutes after the first administration of reamberin 1.5%. Awakening time 16 minutes.

Example 3

Patient K-a, 1 year 1 month, medical history 2769. Operation - installation of drainage in the third ventricle of the brain, due to internal progressive hydrocephalus.

Anesthesia was performed using fentanyl (5 μg / kg / h), diprivan (2.5 mg / kg), nimbex (0.175 mg / kg). The duration of anesthesia is 60 minutes, the duration of the operation is 14 minutes. The course of anesthesia was stable, without complications. During the anesthesiology manual, indicators were evaluated similar to those described in example 1.

10 minutes before the end of the operation, a “Reamberin 1.5%” solution was injected intravenously in a dose of 2 ml / kg. The drug was re-introduced in the same dose 10 minutes after the first injection.

With the introduction of reamberin according to cerebral oximetry, an increase in regional saturation by 10% from the initial one and a decrease in the level of the oxidized form of cytochrome oxidase by 1.5-2% were established. Total hemoglobin in the pericortical regions increased slightly. Changes in the wave spectrum of the electroencephalogram were of the same nature as in example 2.

The recovery time for adequate spontaneous respiration and extubation was 14 minutes after the first administration of reamberin. Awakening time 23 minutes.

In total, at the moment, Reamberin has eliminated depression in 37 children aged 1 year to 14 years, operated on for various surgical pathologies. In this case, in any of the cases, no negative manifestations on the administration of the drug were noted.

Despite the popularity of this drug used in intensive care, the very possibility of its use as a means to eliminate post-narcotic depression was unknown to resuscitation anaesthesiologists and to this day remains unobvious to specialists in this field.

We first developed a method for using the Reamberin 1.5% infusion solution to eliminate post-narcotic depression after general anesthesia in children.

The claimed method is used in the children's city clinical hospital No. 13 named. NF Filatov and the Russian Children's Clinical Hospital in Moscow and is currently the method of choice for eliminating post-narcotic depression.

The developed method has important socio-economic importance in terms of reducing the number of expensive drugs used to eliminate the effects of anesthesia drugs. The use of the Reamberin 1.5% infusion solution does not cause complications and negative reactions.

The tool is fully developed and ready for use in the departments of anesthesiology, intensive care, surgery, interventional radiology of health facilities. The drug is commercially available, is affordable and relatively cheap.

Claims (1)

The use of the drug "Reamberin" as a means to eliminate post-narcotic depression.

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