The choice of the method of anesthetic management of gynecological operations in patients with different sensitivity of peripheral chemoreflex

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Abstract

Objective — comparative assessment of spinal and epidural anesthesia during gynecological operations in patients with different sensitivity of peripheral chemoreflex.

Material and Methods. Prospective observational blind study, 152 gynecological patients, elective surgery. The day before the surgery, the sensitivity of peripheral chemoreflex was determined by the duration of an arbitrary threshold apnea in a test with a delayed respiration. According to the duration of the test, the patients were divided into groups: high risk of developing complications (group “1”) and low risk of developing complications (group “2”). Each group contains subgroups depending on the type of anesthesia: spinal or epidural. During the operation and in the early postoperative period, critical incidents were recorded.

Results and Conclusion(s). During anesthesia in gynecological patients from intraoperative critical incidents is revealed hypotension. The use of epidural anesthesia in patients with a high risk of developing complications can reduce the incidence of hypotension and postoperative complications. In patients with a low risk of developing complications, both epidural and spinal anesthesia can be used.

About the authors

M. V. Golovataya

The academician S.N. Fyodorov ISTC NRMC «Eye Microsurgery» of the Ministry of Public Health of the Russian Federation Krasnodar Branch

Email: trembachnv@mail.ru
ORCID iD: 0000-0002-1546-9560
Russian Federation, Krasnodar

N. V. Trembach

FSBEI «Kuban state medical university»

Author for correspondence.
Email: trembachnv@mail.ru
ORCID iD: 0000-0002-0061-0496

assistant of anesthesiology and critical care medicine department

Russian Federation, Krasnodar

K. A. Soghomonyan

FSBEI «Kuban state medical university»

Email: trembachnv@mail.ru
ORCID iD: 0000-0003-3872-2001
Russian Federation, Krasnodar

A. A. Dmitriev

FSBEI «Kuban state medical university»

Email: trembachnv@mail.ru
ORCID iD: 0000-0002-5195-3149
Russian Federation, Krasnodar

References

  1. Zabolotskikh IB, Trembach NV. Features of Isoflurane-based balanced multicomponent anesthesia in patients with different tolerance to transient hypoxia and hypercapnia. Anesteziologija i reanimatologija. 2011;5:27–31. (In Russ).
  2. Zabolotskikh IB, Trembach NV. High Perioperative Risk Patients: Two Approaches to Stratification. Vestnik intensivnoj terapii im. A.I. Saltanova. 2019;4:34–46. doi: 10.21320/1818-474X-2019-4-34-46. (In Russ).
  3. Irzhak LI, Polyakov PV, Oskolkova EM. Functional tests of pulmonary respiration. Fiziologija cheloveka. 2001;27(3):95–9. (In Russ).
  4. Trembach NV, Zabolotskikh IB. Breath-holding test in evaluation of peripheral chemoreflex sensitivity in healthy subjects. Respiratory Physiology & Neurobiology. 2017;235:79–82. doi: 10.1016/j.resp.2016.10.005.
  5. Trembach N, Zabolotskikh I. The Influence of age on interaction between breath-holding test and single-breath carbon dioxide test. BioMed. Research International. 2017; 1010289. doi: 10.1155/2017/1010289. (In Russ).
  6. Zabolotskikh IB, Golovataya MV, Trembach NV. Method for predicting cardiovascular complications during spinal anesthesia in gynecological patients. Patent RF N 2609061;2017. (In Russ).
  7. Bromage PR. Epidural Analgesia. Philadelphia, Pennsylvania: WB Saunders, 1978. P.40–42.
  8. Klasen J, Junger A, Hartmann B, Benson M, Jost A et al. Differing incidences of relevant hypotension with combined spinal-epidural anesthesia and spinal anesthesia. Anesthesia & Analgesia. 2003;96:1491–5.
  9. Paix AD, Runciman WB, Horan BF et al. Crisis management during anaesthesia: hypertension. Qual. Saf. Health Care. 2005;14(12):17.
  10. Cheung CC, Martyn A, Campbell N et al. Predictors of intraoperative hypotension and bradycardia. Am. J. Med. 2015;128(5):532–8. doi: 10.1016/j.amjmed.2014.11.030.
  11. Heintz KM, Hollenberg SM. Perioperative cardiac issues: Postoperative arrhythmias. Surg. Clin. North Am. 2005;85:1103–14.
  12. David M Gaba, Kevin J Fish, Steven K Howard. Crisis Management in Anesthesiology, 2nd Edition. Elsevier. 2015:117–21.
  13. Barone JE, Tucker JB, Cecere J et al. Hypothermia does not result in more complications after colon surgery. Am. Surg. 1999;65(4):356–9.
  14. Yamada T, Tsutsui M, Sugo Y, Sato T, Akazawa T, Sato N et al. Multicenter study verifying a method of noninvasive continuous cardiac output measurement using pulse wave transit time: a comparison with intermittent bolus thermodilution cardiac output. Anesth. Analg. 2012;115(1):82–7. doi: 10.1213/ANE. 0b013e31824e2b6c.
  15. Gelfand BR. Anesthesiology and Intensive Care: A Practical Guide. Moscow: Litterra, 2006. 60p. (In Russ).
  16. Ovechkin AM, Bayalieva AZh, Ezhevskaya AA, Eremenko AA, Zabolotskij DV, Zabolotskikh IB et al. Postoperative pain relief. Clinical guidelines. Vestnik intensivnoj terapii im. A.I. Saltanova. 2019;4:9–33. doi: 10.21320/1818-474X-2019-4-9-33. (In Russ).
  17. Garyaev RV. Long-term epidural analgesia and arterial hypotension. Regionarnaja anestezija i lechenie ostroj boli. 2011;5(1):25–34. (In Russ).
  18. Ezri T, Zahalka I, Zabeeda D, Feldbrin Z, Eidelman A et al. Similar incidence of hypotension with combined spinal-epidural or epidural alone for knee arthroplasty. Canadian Journal of Anesthesia. 2006;53(2):139–45.
  19. Vricella LK, Louis JM, Mercer BM, Bolden N. Impact of morbid obesity on epidural anesthesia complications in labor. American Journal of Obstetrics and Gynecology. 2011;205(4):370.e1–370.e6. doi: 10.1016/j.ajog.2011.06.085.
  20. Brenck F, Hartmann B, Katzer C, Obaid R, Brüggmann D, Benson M et al. Hypotension after spinal anesthesia for cesarean section: identification of risk factors using an anesthesia information management system. J. Clin. Monit. Comput. 2009;23:85–92.
  21. Hartmann B, Junger A, Klasen J, Benson M, Jost A, Banzhaf A et al. The incidence and risk factors for hypotension after spinal anesthesia induction: an analysis with automated data collection. Anesthesia & Analgesia. 2002;94:1521–29.
  22. Mojica JL, Meléndez HJ, Bautista LE. The timing of intravenous crystalloid administration and incidence of cardiovascular side effects during spinal anesthesia: the results from a randomized controlled trial. Anesthesia & Analgesia. 2002;94:432–7.
  23. Ilyukhina VA, Zabolotskikh IB. Physiological basis of differences in the body tolerance to submaximal physical load to capacity in healthy young individuals. Human Physiology. 2000;26(3):330–6.
  24. Gonzalez C, Nurse CA, Peers C, eds. Arterial Chemoreceptors (Advances in Experimental Medicine and Biology. Book 648). Springer; 2009:34–336.
  25. Cooper VL, Bowker CM, Pearson SB, Elliott MW, Hains-worth R. Effects of simulated obstructive sleep apnoea on the human carotid baroreceptor-vascular resistance reflex. The Journal of Physiology. 2004;557(3):1055–65.
  26. Kara T, Narkiewicz K, Somers VK. Chemoreflexes — physiology and clinical implications. Acta Physiol. Scand. 2003;177:377–84.
  27. Zabolotskikh IB, Trembach NV. Predictive role of baroreflex sensitivity in assessing perioperative risk. Vestnik intensivnoj terapii im. A.I. Saltanova. 2020;2:49–62. doi: 10.21320/1818-474X-2020-2-49-62. (In Russ).
  28. Sikhondze WL, Madiba TE, Naidoo NM, Muckart DJ. Predictors of outcome in patients requiring surgery for liver trauma. Injury. 2007;38(1):65–70.
  29. Leonova EA, Moroz GB, Shmyrev VA, Lomivorotov VV. Intraoperative hypotension. Vestnik intensivnoj terapii im. A.I. Saltanova. 2018;3:87–96. doi: 10.21320/1818-474X-2018-3-87-96. (In Russ).
  30. Holcomb HH, Lahti AC, Medoff DR, Weiler M, Tamminga CA. Sequental regional cerebral blood flow brain scans using pet with H2(15)O demonstrate ketamine actions in CNS dynamically. Neuropsychopharmacology. 2001;25(2):165–72.
  31. Svetlov VA. Chapter 30: Complications of regional anesthesia. In: Bunyatyan A.A., Mizikov V.M., eds. Anesthesiology: national guide. Moscow: GEOTAR–Media. 2011:561–574. (In Russian)
  32. Zabolotskikh IB. Postoperative nausea and vomiting: Mechanisms, risk factors, prognosis and prevention. Moscow: Prakticheskaya Meditsina. 2009;24–29. (In Russ).
  33. Finucane BT, ed. Complications of regional anesthesia. Springer; 2007:149–97.

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