SU1639661A1 - Method of anesthesia in surgery on the abdominal viscera - Google Patents

Abstract

The invention relates to the field of medicine, primarily anesthesiology, and can be used in abdominal abdominal operations as an anesthetic aid. The purpose of the invention is to provide adequate anesthesia with extensive surgeries on the abdominal organs with preservation of spontaneous breathing, sufficient postoperative anesthesia and a reduction in the level of complications associated with anesthesia. The patient is punctured and catheterized in the epidural space at two different levels: during stomach operations in the 7-8 thoracic and 1-2 in the lumbar regions, in the intestine, including peritonitis and intestinal obstruction, in the 8-9 thoracic and 2-3 in the lumbar, in renal pathology and uterine surgeries in the 7-8 thoracic and 2-3 in the lumbar divisions. An anesthetic, a 2% solution of lidocaine or trimecain, is administered to each catheter, half of the total dose calculated, based on 3-5 ml per 10 kg of patient weight. Repeated administrations are carried out every 50-70 minutes. $ (L

Description

This invention relates to the field of medicine, namely anesthesiology.

The purpose of the invention is to provide adequate analgesia during the operation with preserved spontaneous breathing.

The method is carried out as follows.

The patient in the lateral position is subjected to a sequential puncture and catheterization of the epidural canal (using any conventional method) at levels corresponding to the planned volume of surgical intervention. The sequence of catheterization of the upper or lower segments is irrelevant. The catheters are fixed to the skin with a patch according to conventionally used techniques.

The levels of puncture of the epidural canal, depending on the type of surgical intervention, are given below.

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with so

About O5

Type of surgery Surgery on the stomach, incl. resections on various

Puncture levels

Level x, Gastr-1

ectomy Th7-8, L1-2

Surgery of intestinal obstruction, peritonitis Th8-9, L2-3

Surgery for renal pathology Th7-8, L2-3 Uterine extirpation Th7-8, L2-3 A 2% solution of trimecain or lidocaine is used as an anesthetic. Each catheter is injected with half of the total dose calculated by patient weight, 3-5 ml per 10 kg of weight. The use of lower dosages does not provide the necessary zone of analgesia, and the use of higher doses causes serious hemodynamic disturbances,

In order to prevent a critical decrease in blood pressure indices, a fractional administration of anesthetic is carried out: 1/3 of the dose with an interval of 5 minutes, starting with a test dose of 5 ml.

With a drop in blood pressure of more than 20% of the baseline, 12.5 mg of a 5% ephedrine solution is administered intravenously.

After determining the boundaries of the loss of skin sensitivity and the degree of muscle relaxation begin surgery. A repeated dose of local anesthetics is administered in 50 to 70 minutes, since it is by this time that the conductivity in the anesthetized segments begins to gradually recover. Depending on the stage of the operation (on the upper or lower parts of the abdominal cavity), the drug is administered mainly in the upper or lower catheter.

The qualitative and quantitative composition of the infusion intraoperative therapy is usual.

Examples of specific performance. Example 1. Patient G., 46 years old, weight 71 kg.

Diagnosis: gastric cancer. Operation:

GASTRECTOMY.

On the operating table, puncture and catheterization of the epidural space were made at the levels of Th7-8 and in the lumbar section at the level of 1-2 vertebrae, catheters were inserted to a depth of 3 cm, fixed with a plaster along the entire length of the back. The introduction of the test dose in 5 ml of a 2% lidocaine solution was not accompanied by any hemorrhage disorders.

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d d

five

g

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speakers. Into the upper and lower catheters 15 ml of 2% lidocaine solution are injected (5 ml every 5 min). Skin anesthesia after 10 minutes with borders: from the third intercostal space to the knees, the relaxation of the muscles of the abdominal wall is good (the patient cannot lift his legs without bending at the knees).

An hour after the start of the operation, the patient began to notice dull pains in the surgical wound (stage - mobilization of the stomach). 15 ml of a 2% lidocaine solution was injected into the upper catheter, after which the pain disappeared. During the 3-hour operation, 15 ml of lidocaine was administered two more times into both catheters. Hemodynamic parameters remained relatively stable (baseline: BP 125 / / 80 mm Hg, pulse 88 beats per minute, during operation: Blood pressure 115/70 mm Hg, pulse 78 beats per minute), data spirometry without any changes} baseline - UP TO 350 ml, MOD 7.5 l / min, VC 1.9 l, during surgery - UP 350 ml, MOD 7 l / min, VC 1.7 l. Investigation of acid-base equilibrium: pH 7.37 pCO2 39 mmHg, BE + 2.5 mmol / l, BB 40 mmol / l. Indicators of central hemodynamics: baseline - SI 4.0 l / min / m2, UI 49.1 ml / m2, OPS 900. cm 5, during anesthesia - SI 4.0 l / min / m2, UI 50.0 ml / m2, OPS 870 dyn s-cm.

The postoperative period was uneventful, without complications. Peristalsis of the intestine is clear from the first day. Postoperative analgesia was performed by injecting 5 mg of morphine into the lower catheter, the upper catheter was removed on the second day.

PRI me R 2, Bolna I., 60 years old, weight 95 kg.

Diagnosis: acute ca. cholecystitis. Operations: cholecystitis - ectomy, imposition of choledochoid and duodenal anesthesia.

On the operating table, puncture and catheterization with local anesthesia with novocaine of the epidural canal at the levels: 6-7 vertebra in the thoracic region and 11-12 also in the thoracic region. Fractionally injected with 14 ml of a 2% solution of trimekain (3 ml per 10 kg). After 10 min, a decrease in blood pressure was observed - from 130/90 mm Hg. before. 90/50 mm Hg After intravenous infusion of 1639661 with 0.2 ml of a 5% solution of ephedrine, the AL parameters stabilized at 120/70 mm Hg.

Border skin anesthesia (after 8 min) from the second intercostal space to the inguinal folds. After 40 minutes from the start of the operation, an additional 14 ml of trimecaine was introduced into the upper catheter (suturing of the bed), and by the end of the operation, at the time of revision of the abdominal cavity, another 14 ml of 2% trimekain solution was introduced into the lower catheter. Spirometry: initial data - up to 250 ml, MOD 6.6 l / min, VC

through catheters installed initially.

PRI me R 4. Sick 3., 68 years old, weight 72 kg.

Diagnosis: cancer of the uterus. Operation:

extirpation of the uterus with drinkers.

Peridural punctures and catheterization

foot canal at level 7-8 in the thoracic spine and 2-3 in the lumbar spine.

Fractionally injected 18 ml of 2% lidocaine solution (6 ml every 5 minutes). A moderate decrease is noted.

1.1 l, on the background of anesthesia - up to 230 ml, is the blood pressure with

140 /

/ 80 mmHg up to 115/70 mm Hg

Skin anesthesia after 15 min with the boundaries of the IV intercostal space down. Operation duration 2 hours. After 50 min.

MOD 6.8 l / min, ЖЕЛ 1.2 l.

Example 3. Patient M.ch 70 years old 59 kg

Diagnosis: acute destructive appendicitis, diffuse purulent peritonitis. The operation: appendectomy, abdominal-Yu sanation was additionally injected with 20 ml of the 2% cavity, laparostomy and lidocaine into the lower catheter (at the time of

On the operating table, puncture and catheterization of the epidural space at the levels of Th8-9 and in the lumbar

15

at level 2 and 3, the catheters are set to 3

CALLS

cm, fixed with a plaster on the back along the entire length. Fractionally injected 12 ml of 2% lidocaine solution (4 ml per 10 kg). Five minutes after the first injection, a sharp decrease in blood pressure from 110/60 mm Hg to 80/30 mm Hg was observed. Introduced intravenously with 0.2 ml of 5% ephedrine. After 10 minutes, hemodynamic parameters stabilized in numbers: BP 90 / / 60 mm Hg, pulse 92 beats. in minutes Borderline loss of skin sensitivity from the third intercostal space down all legs. The operation was repeated for 4 hours. 4 times repeated administration of Trimeca-A was performed (12 ml each in both catheters, 60 minutes later); after the second injection, a decrease in blood pressure to 73/30 mm Hg was also observed. St, which required an additional prescription of 12.5 mg ephedrine. Spirometry: baseline - up to 230 ml, MOD 5000 ml / min, VC 900 ml, during surgery - up to 250 ml, MOD 6100 ml / min, VC 1000 ml. Central hemodynamic: baseline. Indicators - SI 3.1 l / min / m3, MD

30 ml / m2, OPS 1455 din-s. Cm-, in. time of anesthesia - SI 3.2 l / min / m2., UI 34 ml / m2, OPS 912 dyn s.

cervical dilution and peritonization), by the end of the operation, another 18 ml of 2% lidocaine solution in both catheters in the revision of the abdominal organs. Spirometry: UP TO 300 ml, MOD 5,4 l / min, VC 2 l, during anesthesia - UP 300 m, MOD 4.8 l / min, VC 1800 ml.

30 The postoperative period without complications, anesthesia in the first two days - morphine 5 mg per day (in the lower catheter, the upper catheter is removed after surgery).

The use of the invention as an anesthetic tool for extensive abdominal surgery helps to ensure adequate, deep analgesia, the level of which, unlike all existing methods, is controlled most objectively, since verbal contact with the patient is maintained throughout the operation. A number of laboratory and instrumental research methods confirm this position: the results of the study of KOS indicators do not reveal a statistically significant difference in the source data.

50 and obtained during anesthesia; hemodynamic parameters are relatively stable throughout the operation, only 8 out of 80 patients had a decrease in blood pressure of more than 30% of the initial

35

40

45

one

through catheters installed initially.

PRI me R 4. Sick 3., 68 years old, weight 72 kg.

Diagnosis: cancer of the uterus. Operation:

extirpation of the uterus with drinkers.

Puncture and catheterization of the epidural canal at levels of 7-8 in the thoracic spine and 2-3 in the lumbar spine.

Fractionally injected 18 ml of 2% lidocaine solution (6 ml every 5 minutes). A moderate decrease is noted.

140 /

blood pressure with

/ 80 mmHg up to 115/70 mm Hg

Skin anesthesia after 15 min with the boundaries of the IV intercostal space down. Operation duration 2 hours. After 50 min.

additionally injected 20 ml of 2% lidocaine into the lower catheter (at the time of

five

cervical dilution and peritonization), by the end of the operation, another 18 ml of 2% lidocaine solution in both catheters in the revision of the abdominal organs. Spirometry: UP TO 300 ml, MOD 5,4 l / min, VC 2 l, during anesthesia - UP 300 m, MOD 4.8 l / min, VC 1800 ml.

0 The postoperative period without complications, analgesia in the first two days - morphine 5 mg per day (in the lower catheter, the upper catheter is removed after surgery).

The use of the invention as an anesthetic tool for extensive abdominal surgery helps to ensure adequate, deep analgesia, the level of which, unlike all existing methods, is controlled most objectively, since verbal contact with the patient is maintained throughout the operation. A number of laboratory and instrumental research methods confirm this position: the results of the study of KOS indicators do not reveal a statistically significant difference in the source data.

0 and obtained during anesthesia; hemodynamic parameters are relatively stable throughout the operation, only 8 out of 80 patients had a decrease in blood pressure of more than 30% of the initial

five

0

five

Subsequently, the patient 4 times the npo-jj data at the beginning of the injection was re-administered with repeated surgical injections; central hemodynamic data

Sounds (revision of the abdominal cavity, show an increase in IC of 5.9 ± 0.2%

replacement of the gauze matrix) with the use of compared with the original (, 02),

A similar anesthesia reduction in OPS is 8.8 o, 4% (, 01).

716

The technical conditions for handling during surgery are improved due to good relaxation. Moreover, the pronounced relaxing effect of the method is combined with a minimal effect on the function of external respiration. Spirometry studies during anesthesia with the proposed method in 80 patients showed an increase in DO by 22t3% compared with baseline data in 67 people, in 13 this indicator did not change, in 72 patients there was an increase in VC (P40.01), MOU values were up to operations and during anesthesia remained almost identical and did not have statistical significance (, 05) during their subsequent analysis.

Reduced the number of pulmonary complications during surgery, especially when

emergency (in patients with a full stomach). With the previously used methods, including and prototype, 6 cases of regurgitation (for 300 anesthesia) and 1 case of aspiration were registered. In one patient, left-sided pneumothorax developed against the background of artificial lung ventilation, in 7 cases partial bronchospasm was observed during induction anesthesia. When using the proposed method, there was not a single case of pulmonary complications during surgery.

In the postoperative period, 4 postoperative pneumonia developed when compared with the methods of anesthesia, using the developed method of anesthesia, as well as when using it as a variant of postoperative analgesia, such complications were not revealed.

Application of previously used anesthetic techniques

eight

nor during operations was accompanied by further development of anastomotic inconsistency in 10 cases (for 800 cases of emergency operations), while this was not the case with the use of the proposed method.

The intestinal motor function was restored more quickly in the postoperative period. Peristalsis when using anesthesia with catheters at two levels was practically preserved from the first hours after the operation, while in other cases the restoration of intestinal motility occurred for 2 ± 1 day using specific means: cerculate, ornid, scanned, etc. ( 100 patients).

The method is simple in its application, does not require any additional equipment (ventilators, anesthetic, etc.) and with proper preparation of the anesthesiologist is the safest for the patient.

F

formula of invention

The method of anesthesia during operations on the abdominal organs, including -. puncture and catheterization of the epidural space and the introduction of local anesthetic solutions, characterized in that, in order to ensure adequate anesthesia during the operation with preserved spontaneous breathing, catheters are introduced into the epidural space at two different levels: during operations on the stomach and intestines TH7-8 and L1-2, with peritonitis and obstruction at the level of TH8-9 and L2-3, with renal pathology and extirpation of the uterus Th7-8 and L2-3 and injected half of the total anesthetic dose of anesthetic into each catheter 3-5 ml 10 kg of patient weight with repeat rhenium administration after 50 to 70 minutes.

Claims (1)

The claims The method of anesthesia during operations on the organs of the abdominal cavity, including. canceling and catheterization of the epidural space and the introduction of local anesthetic solutions, which is due to the fact that, in order to ensure adequate analgesia during the operation while maintaining spontaneous breathing, catheters are inserted into the epidural space at two different levels: during operations on the stomach and intestines of Th7-8 and L1-2, with peritonitis and obstruction at the level of Th8-9 and L2-3, with renal pathology and extirpation of the uterus Th7-8 and L2-3 and half of the total dose of anesthetic is injected into each catheter 3 -5 mp per 10 kg of patient weight with repetition HAND administration through 5070 m.