RU2465927C1 - Method of estimating efficiency of anesthesiologic aid in surgery in abdominal region in pigs - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: invention relates to veterinary, and can be used in estimation of anesthesiologic aid efficiency in the course of surgery in abdominal region in pigs. For this purpose registration of clinical-behavioral indices during operation at the time of skin cut and abdominal wall cut is performed in points. Correspondence of points is the following: 1 - excitation no "0", slight "1", strong "2", dangerous "3"; 2 - type of excitation - anxiety "1", , convulsions "2"; 3 - state of cardio-vascular and respiratory system - good "1", satisfactory "2", dangerous "3"; 4 - state of pupil constricted "0", dilated "1"; 5 - urination and defecation - present "1", absent ""0"; 6 - salivation - no "0", slight "1", moderate "2", expressed "3", increased "4"; 7 - muscle rigidity - no "0", slight "1", expressed "2", tetanus "3"; 8 - general reaction - good "1", satisfactory "2", dangerous "3"; 9 - pain reaction - no "0", slight "1", usual "2", expressed "3"; 10 - state of mucous membranes - pale-pink colour, moderately wet "0", cyanotic, bluish, pale "1"; 11 - position of animal's body - tense, curled up- "0", immobile, half-conscious- "1", relaxed, uninterested, apathetic- "2"; 12 - level of intraoperative sedation - unstable with episodes of wakening "0", stable "1", moderately-deep level "2". After that, the points are summed up, and if sum of the points is 5-12, anesthesia is estimated as efficient, 13-18 points - anesthesia is at the middle level, 19-23 anesthesia is not efficient.

EFFECT: method makes it possible to ensure adequate and safe anesthesia due to possibility of timely regulation of anesthetic dose as a result of constant control over clinical-behavioral indices.

3 ex, 4 tbl

Description

The invention relates to veterinary medicine, and in particular to methods of anesthesia during surgical interventions in the abdominal area. To achieve analgesia in a comparative aspect, methods of general anesthesia and neuroleptoanalgesia are used and the effectiveness of anesthetic protection during surgery is evaluated by the specified criteria.

A known method for assessing the adequacy of the block during conduction anesthesia (RF patent No. 2357660, АВВ 5/02, А61М 19/00, publ. 10.06.2009). The invention relates to medicine, namely to anesthesiology, and can be used if necessary to assess the adequacy of the unit in the implementation of conduction anesthesia. For this, after a blockade, every minute for 5 minutes, the pulse filling index is measured on a healthy and blocked limb. Then calculate its average value for each limb and calculate the block coefficient as the ratio of the average value of the filling index of the pulse of the blocked limb to a similar indicator of a healthy limb. If the block coefficient value is ≥3, then such a blockade is assessed as adequate, and if the block coefficient value is ≤3, additional anesthesia potentiation is prescribed. A disadvantage of the known invention is the use of the method for assessing the quality of only conduction anesthesia.

There is a method of evaluating various options for the anesthetic management of abdominal operations (V.M.Zhenilo, V.G. Ovsyannikov, A.D. Belyavsky, P.A. Aznauryan / Fundamentals of modern general anesthesia, Rostov-on-Don, "Phoenix", 1998 p. 54-260).

The known method includes evaluating the reactions of the human body under operational or preoperative (emotional) stress according to indirect hemodynamic, hormonal and metabolic criteria, has several significant drawbacks: the latter state already developed stress at different, including deep levels (metabolism). The use of an electrophysiological method for recording somatosensory and auditory evoked potentials seems to be a more promising direction. This method allows objective monitoring of changes in pain caused by testing electrodermal or electrovisceral stimuli under the influence of various pharmacological drugs used in intravenous combined anesthesia regimens. The obtained data on the overstrain of regulatory systems make it possible to prevent pathological changes in homeostasis and to further predict the course of anesthesia and the immediate postoperative period. A comprehensive assessment of the adequacy of anesthesia is also based on the study of compensatory mechanisms, which was carried out according to the results of radioimmunological studies of the concentration of adrenocorticotropic hormone (ACTH), cortisol, somatotropic hormone (STH) and β-endorphin in 97 patients. The disadvantages of this method is the narrow scope only for the human body.

There is a method of evaluating the effectiveness of anesthesiology benefits (RF patent 2231290, A61B 5/145, A61B 5/0205, publ. 06/27/2004), which relates to medicine - to anesthesiology, resuscitation and surgery and can be used to assess the effectiveness of anesthesiology benefits. The effectiveness of the anesthesiological aid includes a 6-degree evaluation of the functions of 8 clinical indicators of 3 systems, and each indicator is assigned a score: with a score of 0-10, the patient’s condition is regarded as critical, with 11-20 points, the patient’s condition is poor — the anesthesiological aid was ineffective; at 21-30 points, the patient's condition is satisfactory - the anesthetic benefit is manageable; more than 30 points - the patient's condition is good - the anesthesiological aid meets all the requirements. The disadvantages of the known invention are the large volume of criteria, the need for instrumental monitoring, which is not always possible to achieve productive animals in veterinary medicine.

The objective of the present invention is to increase the effectiveness of anesthesia during surgical interventions in the abdominal region in pigs by registering clinical and behavioral indicators during surgery (with a cut of the skin and subcutaneous tissue) and with a cut of the abdominal wall and scoring. By monitoring clinical and behavioral indicators, it is possible to timely regulate the dose of anesthetic substance, stabilize the state of the body, and neutralize side effects, i.e. increase the effectiveness of anesthesia.

The task is achieved by using the assessment of 12 clinical and behavioral indicators, expressed in points:

1 - excitation is not “0”, weak “1”, strong “2”, dangerous “3”;

2 - the nature of the excitement - anxiety "1", convulsions "2";

3 - the state of the cardiovascular and respiratory system - good “1”, satisfactory “2”, dangerous “3”;

4 - the state of the pupil - narrowed "0", expanded "1";

5 - urination and defecation - there is a "1", no "0";

6 - salivation - no “0”, weak “1”, moderate “2”, expressed “3”, enhanced “4”;

7 - muscle rigidity - no “0”, weak “1”, pronounced “2”, tetanus “3”;

8 - general reaction - good “1”, satisfactory “2”, dangerous “3”;

9 - pain reaction - no “0”, weak “1”, normal “2”, pronounced “3”;

10 - the condition of the mucous membranes is pale pink, moderately moist “0”, cyanotic, cyanotic, pale “1”;

11 - the position of the animal’s body - tense shrunken - “0”, frozen, semi-conscious - “1”, relaxed, indifferent - “2”;

12 - the level of intraoperative sedation is unstable with episodes of prompting "0", stable - "1", moderately deep level "2",

with their subsequent total assessment with a score of 5-12 - anesthesia meets all the requirements - high, effective, from 13-18 points - anesthesia at an average level - effective, from 19-23 - anesthesia is not effective.

To achieve this goal, we have formed 4 groups of animals (piglets-hernia carriers).

Piglets of the first group were operated using transcranial electroanalgesia (TCEA), 2nd s (TCEA) in combination with droperidol, 3rd with chlorpromazine in combination with novocaine, 4th with vetranquil combined with novocaine.

The dynamics of the indicators was recorded at 2 stages of the operation: the first - during the dissection of the skin and subcutaneous tissue, the second - during the incision of the abdominal wall.

Examples of specific embodiments of the invention

Example 1. When the current was connected in animals operated using TCEA, the stage of excitation was observed, which lasted for 1-2 minutes, the animals threw back their heads, the tension of the trunk and limbs was observed until the respiratory arrest; then recorded increased heart rate and respiration, dilated pupil, the palpebral fissure was half-closed, a pronounced trismus of the masticatory muscles, at the same time fibrillar muscle contraction, decreased pain sensitivity, weakened skin reflexes.

When the skin was cut, the eyes were closed, during convulsive spasm and exetor rigidity they gradually opened, the eyeballs remained motionless, the pupils were dilated, and the corneal reflex was absent. Piglets lacked general and local reactions to irritations when the skin and abdominal wall were cut. After turning off the current, the muscle tone of the extremities again increased to the extent of extensor rigidity, which lasted for 1-2 minutes, then the muscle tone gradually decreased and turned into hypotension. The movement of the eyeballs, the corneal reflex and the pupils in the light were restored, the tongue was peretic. All animals recovered respiration. It is important to note that the change in respiration in piglets during the operation (TCEA) was unreliable, and a change in the nature of respiration could be observed even after the current was turned off. After turning off the current, animal activity restored motor activity and reduced facial and masticatory muscles. Animals began to look around. The response to sound and light stimuli was adequate. Thus, in the group of piglets operated using TCEA, the following scores were obtained.

At the 1st stage - during a cut of the skin and subcutaneous tissue - 10 points, anesthesia meets all the requirements, high, effective.

At the second stage, with an abdominal wall incision - 9 points, anesthesia meets all the requirements, high, effective (table 1).

Example 2. After the introduction of droperidol in animals operated using combined anesthesia of TCEA and droperidol, inhibition of the general condition was observed. After 30 minutes, lethargy and drowsiness appeared, relaxation of skeletal muscles, drowsiness, a sharp decrease in pain response. So after 30-35 minutes, with a tingling needle and dissection of the skin, a decrease in pain response and pulse rate was noted, however, all animals responded to external stimuli, some had deep breathing, a decrease in respiratory movements of 1-2 units.

After connecting the current, the same characteristic signs were observed as in piglets operated using only TCEA, however, in the absence of an increase in muscle tone of the lips, cheeks, limbs and a sharp increase in the frequency of respiratory movements. In animals operated using TCEA and droperidol, the estimated score was:

at the first stage, with a cut of the skin and subcutaneous tissue - 8, anesthesia meets all the requirements, high, effective;

at the second stage, with an abdominal wall incision - 9 points, anesthesia meets all the requirements, high, effective (table 2).

Example 3. So, after 10-15 minutes after intramuscular administration of vetranquil to animals, muscle relaxation, straightening of the tail, and a shaky gait were observed; then the animals lay first on the stomach, and then on their side. In this state, they did not react much to the environment; a sedative state and sleep developed. Animals reacted to sound and mechanical stimuli by awakening, but immediately calmed down quickly. When fixing and laying on the table, a noticeable relaxation of the muscles was observed, the animals resisted little and soon fell asleep again. When the skin was cut, the animals showed no obvious resistance, however, they periodically flinched, raised their heads and trembled with limbs. During dissection of the abdominal wall, signs of anxiety, agitation were clearly observed, the pupils were dilated, the respiratory rate increased, and a positive reaction to pain was observed. After the operation, the animals were markedly depressed, reacted poorly to stimuli (response to pain and tactile stimuli was reduced), muscles were relaxed, pupillary and palpebral reflexes were reduced. This condition persisted for a day and a half. In animals operated using vetranquil, the estimated score was:

at the first stage, with a cut of the skin and subcutaneous tissue - 12, the condition of the animal is satisfactory, anesthesia at an average level is effective;

at the second stage, when the abdominal wall is cut, it is 15, the condition of the animal is satisfactory, anesthesia at an average level is effective (table 3).

Example 4. So, 30 minutes after intramuscular administration of chlorpromazine to animals, muscle relaxation, straightening of the tail, and a shaky gait were observed; then the animals lay first on the stomach, and then on their side. In this state, they did not react much to the environment; a sedative state and sleep developed. Animals reacted to sound and mechanical stimuli by awakening, but immediately calmed down quickly. When fixing and laying on the table, a noticeable relaxation of the muscles was observed, the animals resisted little and soon fell asleep again. When the skin was cut, the animals showed no obvious resistance, however, they periodically flinched, raised their heads and trembled with limbs. During dissection of the abdominal wall, signs of anxiety, agitation were clearly observed, the pupils were dilated, the respiratory rate increased, and a positive reaction to pain was observed. After the operation, the animals were markedly depressed, reacted poorly to stimuli (response to pain and tactile stimuli was reduced), muscles were relaxed, pupillary and palpebral reflexes were reduced. This condition persisted for one and a half to two days. For piglets operated using chlorpromazine, the estimated score was:

at the first stage, with a cut of the skin and subcutaneous tissue - 15, the condition of the animal is satisfactory, anesthesia at an average level is effective;

at the second stage, when the abdominal wall is cut - 20, the condition of the animal is not satisfactory - anesthesia is not effective (table 4).

An advantage of the present invention is that our method does not require hardware monitoring, which is not available for surgeons in the workplace, while recording and analyzing these clinical and behavioral indicators will allow us to judge the effectiveness of anesthesia, since they all characterize the state of hemodynamic and neurohumoral homeostasis.

Table 1 Assessment in points of clinical and behavioral indicators in operated animals with electroanalgesia (example 1) Indicators one 2 3 four 5 6 7 8 9 10 eleven 12 During surgery (dissection of the skin and subcutaneous tissue) 0 one 2 2 one 0 one one 0 0 one one During an abdominal incision 0 0 one one 0 0 one one 0 one 2 2

table 2 Evaluation in points of clinical and behavioral indicators in operated animals with electroanalgesia and droperidol (example 2) Indicators one 2 3 four 5 6 7 8 9 10 eleven 12 During surgery (dissection of the skin and subcutaneous tissue) 0 0 one one one 0 one one 0 0 one 2 During an abdominal incision 0 0 2 one 0 0 one one 0 0 2 2

Table 3 Evaluation in points of clinical and behavioral indicators in operated animals with vetranquil (example 3) Indicators one 2 3 four 5 6 7 8 9 10 eleven 12 During surgery (dissection of the skin and subcutaneous tissue) one 0 2 0 one 0 one 2 one one 2 one Section of the abdominal wall (2nd stage) one one 2 one one 0 2 2 2 one one one

Table 4 Evaluation in points of clinical and behavioral indicators in operated animals with chlorpromazine (example 4) Indicators one 2 3 four 5 6 7 8 9 10 eleven 12 During surgery (dissection of the skin and subcutaneous tissue) one one 2 0 one one 2 2 2 one one one Section of the abdominal wall (2nd stage) 3 one 3 0 0 3 2 3 3 one one 0

Claims (1)

A method for assessing the effectiveness of anesthetic benefits for surgical interventions in the abdominal region in pigs by recording clinical and behavioral indicators during surgery with a skin incision and an abdominal wall incision in points:
1 - excitation - no “0”, weak “1”, strong “2”, dangerous “3”;
2 - the nature of the excitement - anxiety "1", convulsions "2";
3 - condition of the cardiovascular and respiratory system - good “1”, satisfactory “2”, dangerous “3”;
4 - the state of the pupil - narrowed "0", expanded "1";
5 - urination and defecation - there is a "1", no "0";
6 - salivation - no “0”, weak “1”, moderate “2”, expressed “3”, enhanced “4”;
7 - muscle rigidity - no “0”, weak “1”, pronounced “2”, tetanus “3”;
8 - general reaction - good “1”, satisfactory “2”, dangerous “3”;
9 - pain reaction - no “0”, weak “1”, normal “2”, pronounced “3”;
10 - the condition of the mucous membranes is pale pink, moderately moist “0”, cyanotic, cyanotic, pale “1”;
11 - the position of the animal’s body - tense shrunken - “0”, frozen, semi-conscious - “1”, relaxed, indifferent - “2”
12 - level of intraoperative sedation - unstable with episodes of awakening "0", stable - "1", moderately deep level "2", followed by their total assessment at a score of 5-12 - anesthesia is effective, from 13-18 points - anesthesia at an average level, from 19-23 anesthesia is ineffective.