COMPARISON OF ANESTHESIA AND PERIOPERATIVE ANALGESIA OPTIONS IN ENDOSCOPIC SLEEVE GASTRECTOMY IN PATIENTS WITH MORBID OBESITY


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Abstract

Patients with morbid obesity have an increased sensitivity of the respiratory center to opioids, which leads to an increased incidence of respiratory diseases, which dictates the need to limit the use of opioids in the structure of anesthesia. Purpose of the trial. Comparison of the impact of anesthesia options with minimal use of opioids during the perioperative period. Materials and methods. A randomized trial of 59 patients with a body mass index > 35 kg/m2, which was performed endoscopic sleeve gastectomy. Depending on the type of anesthesia, patients are divided into two groups. In the 1st group (n-30), the operation was performed under conditions of combined anesthesia based on low-flow inhalation of desflurane in combination with prolonged epidural analgesia (PEA) with of ropivacaine in group 2 (n-29), the operation was performed under conditions of combined anesthesia based on low flow inhalation of desflurane in combination with a combination with an infusion of the analgesic-sympatholytic solution. The indicators of the adequacy of anesthesia, central and peripheral hemodynamics, monitoring of neuromuscular conduction, the efficiency of postanesthesia recovery and the quality of postoperative analgesia were studied. Results and Conclusion. It was revealed that surgical intervention in conditions of low-flow inhalation anesthesia on the basis of desflurane in combination with PEA ropivacaine promotes faster postnanaesthesia recovery and effective postoperative analgesia.

About the authors

M. I Neimark

Altai State Medical University of the Ministry of Health of the Russian Federation

656038, Barnaul, Russian Federation

Roman V. Kiselev

Altai State Medical University of the Ministry of Health of the Russian Federation

Email: fincher-75@mail.ru
MD, Ph.D. Аssistant of the Department of Anesthesiology, Intensive Care and Clinical Pharmacology with Additional Postgraduate Education University Course and Intensive Care, Altai State Medical University of the Ministry of Health of the Russian Federation, 656038, Barnaul, Russian Federation 656038, Barnaul, Russian Federation

References

  1. Kaur A., Jain A.K., Sehgal R., Sood J. Hemodynamics and early recovery characteristics of desflurane versus sevoflurane in bariatric surgery. Journal Anaesthesiology & Clinical Pharmacology. 2013; 29 (1): 36-40.
  2. Лихванцев В.В., Скрипкин Ю.В., Гребенников О.А., Ильин Ю.В., Шапошников Б.А., Мироненко А.В. Механизмы действия и основные эффекты галогенсодержащих анестетиков. Часть 2. Вестник интенсивной терапии. 2013; 4: 53-7.
  3. Лихванцев В.В., Мироненко А.В., Габитов М.В., Скрипкин Ю.В., Исаев О.В., Данилов М.П. Ускоренное ведение послеоперационного периода у пациента с морбидным ожирением после десятичасовой анестезии. Анестезиология и реаниматология. 2014; 3: 77-9.
  4. Zoremba M., Dette F., Hunecke T., Eberhart L., Braunecker S., Wulf H.A. Comparison of desflurane versus propofol: the effects on early postoperative lung function in overweight patients. Anesthesia & Analgesia. 2011; 113 (1): 63-9.
  5. Norum H.M., Breivik H. Thoracic paravertebral blockade and thoracic epidural analgesia: two extremes of a continuum. Anesth. Analg. 2011; 112 (4): 990-1.
  6. Mansour M.A., Mahmoud A.A., Geddawy M. Nonopioid versus opioid based general anesthesia technique for bariatric surgery: A randomized double-blind study. Saudi. J. Anaesth. 2013; 7 (4): 387-91.
  7. Aantaa R., Tonner P., Conti G., Longrois D., Mantz J. Mulie J.P. Sedation options for the morbidly obese intensive care unit patient: a concise survey andan agenda for development. Multidisciplinary Respiratory Medicine. 2015; 10 (1): 8.
  8. Ginosar Y., Weiniger C.F., Meroz Y., Kurz V., Bdolah-Abram T., Babchenko A., Nitzan M., Davidson E.M. Pulse oximeter perfusion index as an early indicator of sympathectomy after epidural anesthesia. Acta Anaesthesiol. Scand. 2009; 53 (8): 1018-26.
  9. Белоярцев Ф.Ф. Компоненты общей анестезии. М.: 1997; 262 с
  10. Эпштейн С. А. Периоперационное анестезиологическое обеспечение больных с морбидным ожирением. Регионарная анестезия и лечение острой боли. 2012; 4 (3): 5-27.
  11. Aldrete J., Kroulik D. Post-anesthesia recovery score. Anesth. Analg. 1970; 49: 924-9.
  12. Alvarez A., Singh P. M., Sinha A. C. Postoperative Analgesia in Morbid Obesity. Obesity Surgery. 2014; 24 (4): 652-9.
  13. Gaston-Johanson F., Albert M., Fagan E., Zimmerman L. Similarities in pain description of four different ethnic-culture groups. J. Pain Symptom Manage. 1990; 5 (2): 94-100.
  14. Овечкин А. М. Влияние регионарной анестезии и анальгезии на результаты хирургического лечения. Регионарная анестезия и лечение острой боли. 2015; 9 (1): 45-54.
  15. Анисимов М.А., Горобец Е.С., Якушина И.А. Эффективная анестезия при выполнении онкогинекологических операций у пациенток с сопутствующим морбидным ожирением. Вестник анестезиологии и реаниматологии. 2015; 6: 46-52
  16. Vadivelu N., Mitra S., Narayan D. Recent advances in postoperative pain management. Yale J. Biol. Med. 2010; 83 (1): 11-25.
  17. Mulier J.P: Perioperative opioids aggravate obstructive breathing in sleep apnea syndrome: mechanisms and alternative anesthesia strategies. Curr. Opin. Anaesthesiol. 2016; 29 (1): 129-33.

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