SU950334A1 - Method of foreoperation preparation of patients for orthopedic-traumatologic operations - Google Patents

Description

(54) METHOD OF PRE-OPERATING PREPARATION OF PATIENTS WITH ORTHOPEDIO-TRAUMATOLOGICAL OPERATIONS

one

The invention relates to medicine, primarily to anesthesiology, and may find application in the anesthetic management of orthopedic and trauma operations.

There is a method of preoperative preparation of patients with orthopedic and traumatologic operations by prior sensory examination and premedication 1.

However, this method does not take into account the possibility of using various methods of anesthesia on the basis of a preliminary study of the thresholds of tactile and pain sensitivity.

The aim of the presentation is an individual approach to the choice of anesthesia.

The goal is achieved by the fact that during the implementation of the method of preoperative preparation of patients during orthopedic and traumatologic operations by preliminary sensometric examination and premedication, thresholds of tactile and pain sensitivity are determined before and after sedation and when thresholds are increased by 9-11 and 19-21% surgery performed under intraosseous anesthesia in combination with neutroleptoanalgesia (NLA), with an increase in thresholds of 19-21 ° / o and 39 41 / o operation is performed under intraosseous anesthesia, and with a decrease and tactile sensitivity by 9-11% and pain by 19-21%, the operation is performed under anesthesia. The method is carried out as follows.

In the preoperative period, tactile and pain thresholds are determined in patients with a special device (sensor), which with the help of a voltage divider provides a 5 V stepped increase in the latter and sends AC pulses with a duration of 1 s at 3 s intervals. If they are respectively equal to 45-50 V and 55-60 V, and 30 minutes after the premedication, consisting of intramuscular administration of droperidol and promedolum in a dose of u, J mg / kg

Claims (3)

20 each and atropine 0.008 mg / kg body weight, the thresholds of tactile sensitivity are in the range of 60-70 V (increased by 19-210 / o) and pain - 80-90 V (increased by 39-41%), then for performing these operations in such patients can be limited to intraosseous anesthesia without the use of NLA. Both at the main stage of the operation and in the immediate postoperative period, this group of patients is characterized by stability of the pulse, arterial and venous pressure, external respiration, stability of the concentration of catecholamines, sugar and blood lithium. The degree of anesthesia using the Gologorsky-Dale scale is assessed as good. If the thresholds of tactile and pain sensitivity before sedation are 35–40 and 50–60 V, respectively, and after sedation, the thresholds of tactile sensitivity change to 40–50 V and pain thresholds increase by 19–21%, i.e. up to 60-75 V, then one intraosseous anesthesia without the use of NLA cannot provide effective pain relief. Patients begin to react relatively early to pain from the compression of tissues at the site of the tourniquet, moderate pain at the puncture site of the bone is noted when the first portions of novocaine are administered intracutaneously. At the same time, tachycardia, an increase in arterial and venous pressure are observed, the concentration of sugar, lithium, catecholamines increases in the blood. The degree of anesthesia is rated as poor. In such cases, a high quality of anesthesia is provided by the combination of intraosseous anesthesia with NLA according to the following procedure: on the operating table, intravenous administration of fluid is adjusted by drip to the patient and 10 min before intraosseous anesthesia, droperidol is administered intravenously at a dose of 0.1 mg / mg and fentanyl at a dose of 0.001. mg / kg body weight. Subsequently, the same dose of fentanyl is administered every 10 minutes during the whole operation and the administration of the drug is stopped 20 minutes before the end of the intervention. If the thresholds of tactile and pain sensitivity before sedation are 25-40 V and 50-60 V, respectively, and after sedation, the thresholds of tactile sensitivity decrease by 9-11%, i.e. equal to 20–35 V, and the thresholds for pain sensitivity decrease by 19–21%, i.e. equal to 40-55 V, even the combination of intraosseous anesthesia with NLA does not provide reliable protection from operative aggression, and with the help of clinical and laboratory signs, the anesthesia is inadequate (tachycardia, increased arterial and venous pressure, sweating, and an increase in the concentration of sugar of latecholamines in the blood ). In such cases, only anesthesia (sodium hydroxybutyrate with hexenal or sodium thiopental) in combination with intraosseous anesthesia reliably protects the body from operating aggression. Example I. Patient S., 33, body weight 75 kg. Prior to the sedation, the sensorometry was made: the threshold of tactile sensitivity was 45 V, painful 55 V. For 40 minutes before the operation, premedication was performed with a 0.1% atropine solution in an amount of 0.6 ml, with a 1% solution of promedol in an amount of 2.5 ml and droperidol in a dose of 8 ml. Surgery: arthrotomy, removal of the inner. Replacement of the left knee joint. After pre-medication, the threshold of tactile sensitivity is 60 V, painful 90 V, which is 33% and 63%, respectively. The operation was performed under intraosseous anesthesia. Anesthesia was monitored by clinical indicators of the adequacy of anesthesia (at the height of the operation, arterial pressure (BP) of 120/80 mm Hg, pulse 90 beats per 1 minute, peripheral venous pressure 120 cm aq. Art.) And laboratory tests (blood sugar 130 mg%, adrenaline 0.5 µg / l, noradrenaline 0.7 µg. / l, lithium 0.5 mmol / l). The degree of pain relief is rated as good. Example 2. Patient H., 35 l., Body weight 80 kg. The results of sensometry before sedation: the threshold of tactile sensitivity of 45 V, painful 50 V. For 40 minutes before the operation, the premedication was performed: atropine at a dose of 0.7 ml of a 0.1% solution, delayed 2.5 ml of 1% solution and droperidol at a dose of 9.5 ml of a 2.5% solution. Surgery: open reposition, osteosynthesis for necrosis of the external ankle fracture. After sedation for 10 minutes before the operation, the sensor data is as follows: the threshold of tactile sensitivity is 50 V, pain 60 V, which is 11% and 20%, respectively. The operation was performed under combined anesthesia: intraosseous anesthesia with NLA with a single injection before performing intraosseous anesthesia of droperidol at a dose of 2 ml and subsequent fractional administration of fentanyl at a dose of 2 ml of 0.05% solution every 10 minutes of surgery. Anesthesia was monitored by clinical indicators (BP 110/80 mm Hg pulse 92 beats per 1 minute, peripheral venous pressure 115 cm water column) and laboratory tests (blood sugar 115 mg%, adrenaline 0.4 µg / l, norepinephrine 0.8 µg / l and lithium 0.7 mmol / l). The degree of pain relief is rated as good. Example 3. Ill M., 58 l., Body weight 70 kg. Sensometry was performed prior to sedation: the threshold for tactile sensitivity was 40 V, the pain threshold was 60 V. Premedication was administered intramuscularly 40 min before the operation: atropine at a dose of 0.5 ml of a 0.1% solution, promedol at a dose of 2 ml of 1%. solution and droperidol in a dose of 7.5. ml. Operation: osteoplasty according to Khakhutov in connection with a transversely comminuted fracture of the bones of the left tibia. 10 minutes before the operation, after sedation, the threshold of tactile sensitivity is 35 V, the pain threshold decreased to 50 V, indicating a decrease of 13% and 23 %% respectively. The operation was performed under intraosseous anesthesia with intravenous anesthesia with sodium hydroxybutyrate (4 g) and a 1% solution of hexanal injected by fractions to 1 g of dry matter. Anesthesia was evaluated on the basis of clinical signs (BP 110/80 mm Hg, pulse 88 beats per 1 minute, peripheral venous pressure 110 cm. Water.) And laboratory tests (blood sugar 90 mg%, adrenaline 0.4 µg / l, norepinephrine 0.7 μg / l and lithium 0.5 mmol / l). The degree of anesthesia is estimated as good. The proposed method makes it possible in advance of the preoperative period to strictly individualize the type of anesthesia of orthopedic and trauma operations, depending on the results of preliminary determination of tactile and pain sensitivity thresholds. The invention The method of preoperative preparation of patients with orthopedic and traumatological operations by means of a preliminary sensory examination and premedication, characterized in that, with the aim of an individual approach to the choice of anesthesia, thresholds of tactile and pain sensitivity are determined before and after sedation and when thresholds are increased 9-11% and 19-21% operation is performed under intraosseous anesthesia in combination with neuroleptanalgesia, with an increase in the thresholds of 19-21% and 39-41%, the operation is performed under intra ostnoy anesthesia, while reducing tactile sensitivity to 9-11% and 19-21% pain on operation is performed under anesthesia, information sources, the received note in the examination Sangaylo AK 1. On Principles controlled analgesia in anesthesiology. In the book: "Questions of anesthesiology, Sverdlovsk, 1964, p. 3-17.