RU2006139800A - METHOD OF ANESTHESIA FOR ADRENALECTOMY ON THE ADRENAL PHEOCHROMOCYTOMA - Google Patents

Claims (4)

1. The method of anesthesia during adrenalectomy for adrenal pheochromocytoma, including conducting a preoperative comprehensive examination of the patient, premedication of the patient by administering tabletenosepam at a dose of 0.0005-0.001 g on the day before and morning of the operation, administering sibazon 10 times intramuscularly 30 minutes before surgery mg and diphenhydramine in an amount of 10 mg, patient monitoring, puncture and catheterization of the central vein, puncture of the epidural space at the level of Th ₇ -L ₁ , catheterization of the epidural space with the location of the catheter tip at the level of Th ₅ -Th ₁₁ for subsequent postoperative analgesia, inhalation of oxygen against the background of the patient’s own breathing through the mask of the anesthesia apparatus at a rate of 5-8 l / min, completion of premedication with the introduction of an intravenous bolus of 0.1% atropine in a dose 0.005-0.007 mg / kg, induction of anesthesia by intravenous injection into the central vein of a 2% sodium thiopental solution at a dose of 4-5 mg / kg, as well as a 0.005% fentanyl solution at a dose of 0.0025-0.0035 mg / kg, tracheal intubation on the background of pre-injection with pipecuronium bromide (arduana) in an amount of 1-2 mg or rocuronium bromide (esmeron) in an amount of 10-20 mg and against the background of muscle relaxation by the introduction of a 2% solution of suxamethonium iodide (dithylin) in a dose of 1.5-2 mg / kg transferring the patient to artificial lung ventilation, performing 5–1 min prior to the start of surgical intervention, exfusion of the patient’s blood in a volume of 1.0–1.5 l, followed by simultaneous infusion of crystalloids in a volume of 1.0–1.5 l, then stage of clipping the central adrenal vein and its intersection to isolate pathologically altered adrenal gland, complete or partial reinfusion of autologous blood to the patient until the patient's blood pressure is completely stabilized at a level of 100-110 / 60-70, followed by crystalloid infusion, and when partial autologous blood is infused, the remaining autologous volume is reinfused to the patient during the first day of the early postoperative period , implementation of maintenance anesthesia at all stages of surgical intervention in conditions of mechanical ventilation by inh a mixture of nitrous oxide and oxygen at a ratio of 2: 1 to 3: 1 using a reversible respiratory circuit with parameters of the respiratory volume of ventilation of 7-8 ml / kg with minute ventilation of 100-120 ml / kg, intravenous administration of fentanyl at a dose of 5- 6 μg / kg / h, as well as the introduction of 2–4 mg of pipecuronium bromide (arduan) every 40–60 min or 10–20 mg of rocuronium bromide (esmeron) every 25–35 min; completion of anesthesia at the stage of completion of the operation by termination of intravenous injection eniya fentanyl relaxants and against the background of continued mechanical ventilation oxygen-air mixture with FiO ₂ ratio _of 0.4-0.6. 2. The method according to claim 1, comprising performing exfusion of the patient’s blood in a volume of 1.0 L while lowering the patient’s blood pressure to a level below 140/90 mm Hg. Art. and in a volume of 1.5 l with a decrease in blood pressure in a patient to a level above 140/90 mm RT. Art. 3. The method according to claim 1, comprising administering to the patient, after exfusion of autologous blood, an intravenous drip heated to a temperature of 37-42 ° C of a crystalline solution of Acesol, or Trisol, or Lactasol, or Ringer's solution. 4. The method according to claim 1, comprising administering to the patient, after partial or complete reinfusion of autologous blood, an intravenous drip heated to a temperature of 37-42 ° C of a crystalline solution of Acesol, or Trisol, or lactasol, or Ringer's solution.