RU2271815C2 - Method of autoanalgesia with mixture xenon-oxygen - Google Patents

Abstract

FIELD: medicine, anesthesiology, rheanimatology.

SUBSTANCE: method involves independent inhalation the mixture xenon-oxygen by a patient in the ratio of xenon to oxygen, vol. % = from 30:70 to 50:50 up to arresting the pain syndrome. Invention shows the expressed analgesic effect at consciousness condition that, in turn, promotes to normalization of hemodynamics, function of neuroendocrine system, normalization of metabolic processes based on improvement in delivery of oxygen in tissues under condition of xenon vasoplegia.

EFFECT: improved method for autoanalgesia.

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Description

The invention relates to medicine and can be used as a symptomatic therapeutic agent for autoanalgesia.

An analgesic agent is known which is used as an auto-analgesic and is a pharmaceutical composition comprising an antispasmodic component and / or at least one non-narcotic analgesic, purine alkaloid, sedative component barbiturate and at least one compound selected from the group of non-specific anti-inflammatory drugs (NSAIDs). The drug stops pain in almost any etiology (RU 2191605, 2002).

There is a known method of limb electroanalgesia, which can also be used for autoanalgesia, which includes applying a pulsed electric current to nerve trunks, while the active electrode is inserted through the microirrigator using the puncture method, and the passive electrode is fixed on the skin (RU 2000125946, 2002).

There is a known method of electroanalgesia, which can be used to relieve and suppress acute and chronic pains of a post-traumatic and neurological nature, in which modulated stimulating current pulses are used for electroanalgesia, and the pulses are modulated by a transformed patient's breathing signal (RU 2019205, 1994).

A common disadvantage of the above methods is their inability to improve and normalize metabolic processes. Due to its multicomponentity, an analgesic in the form of a pharmaceutical composition can cause allergies, exacerbation of peptic ulcer, gastric bleeding, gastritis, and a sedative component, barbiturate, leads to inhibition of consciousness, drowsiness. Electroanalgesia methods require a special electric device, knowledge of the technique of applying electrodes, sterility for introducing a microirrigator using the puncture method, and searching for optimal current parameters. The period of adaptation to electrical influences and the expectation of an analgesic effect is more than 20 minutes, and the analgesic effect is absent in more than 20% of patients.

There is a method of autoanalgesia with nitrous oxide (N ₂ O) during labor anesthesia using the NAPP-6 anesthesia device, in which a woman in labor can breathe with the mask a gas-narcotic mixture of N ₂ O: O ₂ (50:50) for pain relief during labor . (K.M. Federmesser, in the book: Analgesia with nitrous oxide in obstetric and gynecological practice. M., 1964, p. 27). There are also methods for using nitrous oxide for therapeutic purposes to relieve pain in myocardial infarction (F.R. Chernyakhovsky et al., In the book: Anesthesia and resuscitation in oncology. M., 1968, p.209-210.), In the postoperative period (B.V. Petrovsky, S.N. Efuni, Therapeutic analgesic anesthesia. J. Surgery, 1962, No. 4, pp. 7-11).

However, this method is described for stationary conditions where there is a centralized or balloon gas supply: oxygen and nitrous oxide, and the procedure is monitored by medical personnel. Autoanalgesia with nitrous oxide is often accompanied by nausea, vomiting, psychomotor agitation, which complicates the procedure. In addition, with prolonged sessions of autoanalgesia, the toxic effect of nitrous oxide on the myocardium, erythropoiesis appears, toxic myelopathy develops, the DNA structure changes, which is especially dangerous in the first 12 weeks of pregnancy due to the teratogenic effect of nitrous oxide.

Known portable inhaler (analgesic) for liquid vaporous anesthetic pentran (methoxyflurane). The analgeser is a hollow tube made of fluoroplastic, inside which a felt is rolled up, rolled up into a tube. The distal end of the tube is closed by a cover with openings for air entry. The proximal end is narrowed in the form of a mouthpiece and inserted into the mouth. Pentran in the amount of 15-20 ml is poured through the distal end of the tube, completely absorbed by felt and begins to evaporate slowly (boiling point 104 ° C). The proximal end of the analgesic is inserted into the mouth, pinched by the lips and the patient inhales the pentran vapor. After 2-4 minutes, a state of analgesia occurs with the patient's consciousness preserved. With longer inhalation, a narcotic sleep may occur, the patient’s hand drops, and the analgeser, tied with a ribbon to the patient’s forearm, is automatically removed from the mouth. After waking up, after anesthesia from pain, the patient can again inhale the anesthetic in the autoanalgesia mode. However, pentran autoanalgesia is used exclusively to eliminate pain perception, it is carried out by inhalation of ambient air, and not oxygen, which reduces the effectiveness of the procedure. In addition, pentran, like all halogen-containing substances, has toxicity (hepato-nephro-cardio-toxicity) and is discontinued.

Also known is an analgesic for trichlorethylene called "Trilan". It is a metal tube. The proximal end of the tube is connected to the face mask, the distal end is closed by a perforated cover. Inside the hollow cylinder is a rolled-up felt that absorbs trichlorethylene. In autoanalgesia, the patient applies a mask to his face and inhales trichlorethylene vapor. However, trichlorethylene is discontinued due to toxicity.

A known method for conducting anesthesia with xenon-oxygen (Xe: O ₂ ) mixture according to the masque type, which consists in the fact that after premedication, for example, with atropine and a small tranquilizer, denitrogenation is carried out with pure oxygen on a half-open circuit with a flow of O ₂ in the amount of 6-8 l / min, after switching to a closed circuit, no more than 500 ml of oxygen is left in the breathing bag, xenon is fed into the system of the anesthesia apparatus in an amount equal to 1.3 VC of the patient for 1.5-2 minutes to achieve the drug concentration of Xe (70%) . After anesthesia, the facial mask is removed, the laryngeal mask is injected and, with low gas flow, subsequent anesthesia is performed, maintaining the oxygen concentration not lower than 30%. When the breathing bag is full, the narcotic mixture is removed into a special xenon regeneration device. After the operation, xenon is turned off, and oxygen is supplied to the anesthesia apparatus for 5 minutes to “wash” xenon from the body. When using the proposed method, better denitrogenation is achieved (leaching of alveolar nitrogen), which leads to a decrease in the level of nitrogen to 0.4%. The absence of nitrogen impurities in the closed loop contributes to the correct formation of a gas-narcotic mixture of Xe with O ₂ and adequate anesthesia. Using the proposed method, a reduction in the cost of expensive Xe is achieved by 3-4 times compared with the known methods in which the gas-narcotic mixture is removed from the respiratory circuit into the atmosphere (RU 2102088, 1998).

However, these methods of the mask type or endotracheal type of xenon anesthesia do not belong to the autoanalgesia regimen and are applicable only in the hospital for surgical operations and painful manipulations. They are performed by an anesthetist who has undergone special training in low-flow xenon anesthesia using complex stationary anesthesia techniques.

It is known to use the xenon-oxygen mixture in adults as a gaseous agent for anesthesia for anesthetizing surgical operations, painful manipulations, relieving pain and pain attacks (N.E. Burov et al., In the book "Xenon in anesthesiology. Clinical and experimental studies ", M., Pulse, S. 42-46). However, these options for anesthesia and analgesia are used in stationary conditions using stationary anesthesia machines and do not belong to the autoanalgesia regimen.

The technical result achieved by the invention is to increase the efficiency of autoanalgesia and obtain a therapeutic effect while simplifying the effect.

The essence of the invention is to achieve the specified technical result in a method of autoanalgesia, in which the patient, being conscious, spends the xenon-oxygen mixture independently, achieving a therapeutic effect and relieving pain in the ratio of xenon to oxygen from 30:70 to 50:50.

The invention is illustrated in the drawing, which schematically shows a device for the implementation of autoanalgesia.

The device contains a cylinder (1) with Xe: O ₂ mixture with a capacity of 500 to 1000 cm ³ , a T-shaped connecting tube (2), a breathing bag (3) with a capacity of up to 3 liters, made of polyethylene or rubber, a face mask (4) , L-shaped tube (5) with a standard depressurization valve (not shown in the drawing), a shutter (6) for opening and closing the breathing circuit, a nozzle (7) with a rubber cap for introducing bronchodilators (if necessary), a cap (8) of the valve Xe injection: O ₂ mixture. The T-shaped tube is connected at its ends with a balloon (1), a breathing bag (3) and a face mask (4), the end of the tube for placement in the breathing bag has two unconnected cavities.

A device for implementing the method is used as follows. Before use, all elements should be connected with a connecting T-shaped tube (2): on the one hand with a canister cap (1), and on the other hand with a face mask (4), connect the T-shaped tube with a breathing bag (3). Next, close the T-shaped tube with a shutter (6) and press the cap of the injection valve (8) to fill the Xe: O ₂ breathing bag with the mixture until it is completely expanded. Next, the patient puts the mask on the face and strengthens it with standard rubber straps on the head (the straps are not shown in the drawing), sets the depressurization valve (5) at the level of + 5 cm water column, opens the shutter (6) and takes a few normal breaths in and out in the bag . When it falls (i.e., decreases the volume of Xe: O ₂ mixture), it is necessary to fuel the flow of a new portion of the gas mixture by pressing the injection valve cap (8) again. On the contrary, when the bag is overfilled and the resistance on the exhale increases, the depressurization valve is activated and part of the exhalation is carried out into the atmosphere without having to remove the face mask.

If it is necessary to use a bronchodilator aerosol (salbutamol, terbutaline, berodual, etc.), the aerosol spray can’s tube is connected to the connecting pipe nozzle (7) and the required dose of bronchodilator is administered by pressing the metering valve 2 times. In this case, do not remove the face mask during breathing in order to maintain the tightness of the respiratory circuit.

After 5-7 deep breaths, the pain abruptly abates or completely disappears, while at the same time the feeling of asthmatic suffocation (if it was) disappears.

The capacity of the cylinder with Xe: O ₂ mixture can be designed for 500-1000 ml under a certain pressure, accurately calculated for its strength, which can provide the volume of the gas mixture for breathing for 30-60 minutes. At full consumption of the gas mixture, the cylinder is replaced by another.

Xenon-oxygen mixture in a concentration of xenon: oxygen from 30:70 to 50:50 has a pronounced analgesic effect while maintaining a person’s consciousness, allowing him to carry out the autoanalgesia regimen. The elimination of pain contributes to the normalization of hemodynamic parameters, the function of the neuroendocrine system. On the other hand, inhalation of the xenon-oxygen mixture helps to normalize metabolic processes by improving oxygen delivery to tissues under xenon vasoplegia, improving microcirculation and the favorable molecular interaction of inert gas at the subcellular and cellular levels, has an anti-stress effect, and eliminates the feeling of fear and tension, which contributes to the normalization of neurological processes and vital functions.

To clarify the invention we give the following explanations. Known:

- autoanalgesia with nitrous oxide mask method,

- MAK Xe = 50-71% (minimum alveolar concentration of gas anesthetic in volume% with oxygen, in which 50% of young patients do not respond to pain irritation),

- mask anesthesia (anesthesia) Xe: O ₂ with a mixture in the ratio of 70:30 - 80:20, carried out by an anesthesiologist in a hospital (after premedication) using anesthesia machines,

- the stage of xenon monoanesthesia (Xe: O ₂ mixture in a ratio of 70:30 - 80:20, carried out by an anesthesiologist in a hospital (after premedication) using anesthesia machines):

The first stage is paresthesia and hypoalgesia. Appears from the first 5-6 breaths of the Xe: O ₂ mixture (70:30) and grows within 1-2 minutes. It is characterized by the appearance of peripheral paresthesia, numbness and weakness in the legs, a feeling of pressure in the epigastrium and diffuse severity throughout the body. Tinnitus, compression of the head are noted. There is a feeling of intoxication, discoordination, swaying, like in a boat. Consciousness remains clear, breathing is even, skin is warm, dry, pulse is slightly quickened, hypoalgesia builds up. The threshold of pain increases 2 times from the original.

The second stage is euphoria and psychomotor activity. The stage begins for 3 minutes against the background of already reduced pain and visceral sensitivity. There is a surge of joyful emotions, a feeling of bliss. There is a logorrhea, a desire to talk about your pleasant feelings. Suggestibility persists. Stiffness, lethargy, and dysarthria are gradually increasing. Muscle tone rises. Breathing deepens, becomes uneven. The skin is dry, warm, pink. Blood pressure is slightly increased, heart rate is increased. The pain threshold increases 3 times.

The third stage is analgesia and partial amnesia. Appears on the 4th min. It is characterized by the appearance of severe analgesia. The pain threshold is not determined. The patient does not respond to pain irritations. Consciousness persists, but memory lapses occur, visual images, absurd situations arise, lethargy increases, and (according to the subjects) an apprehension of an early loss of consciousness appears.

The fourth stage is anesthesia (complete analgesia and amnesia). It comes on the 5th minute. Corresponds to level 1 of the surgical stage of ether anesthesia (according to Guidel). Consciousness is lost, pharyngeal and corneal reflexes disappear. Patients do not respond to laryngoscopy and the introduction of a laryngeal mask. The pupils narrow. Rhythmic breathing. Muscle tone decreases, the jaw sinks. Blood pressure and heart rate are normal. The skin is dry, pink, warm. The patient does not respond to surgical manipulation.

Not known:

- analgesia, by inhalation of the xenon-oxygen mixture in the ratio of xenon to oxygen from 30:70 to 50:50 to stop the pain and achieve a therapeutic effect,

- the third stage - analgesia and partial amnesia turned out to be very wide (in terms of the concentration of Xe in the mixture), and it can be divided into two phases (two levels):

Phase 1 - severe analgesia, consciousness preserved,

2 phase - expressed analgesia, consciousness is inhibited, memory lapses occur, visual images, absurd situations arise, a premonition of a loss of consciousness appears;

- inhalation of the xenon-oxygen mixture in the ratio of xenon to oxygen from 30:70 to 50:50 can for hours support the 1st phase of the third stage of xenon anesthesia, providing the analgesic and therapeutic effects described previously for xenon monoanesthesia (Xe: O ₂ mixture in the ratio of 70: 30-80: 20).

Output:

Self-inhalation of the xenon-oxygen mixture in the ratio of xenon to oxygen from 30:70 to 50:50 allows you to achieve relief of the pain syndrome and achieve a therapeutic effect.

The method is illustrated by the following examples.

Example 1. Patient S., 65 years old. Diagnosis: Coronary heart disease, angina pectoris. After emotional stress and scandal in the family, I felt acute pain behind the sternum, it became difficult to breathe, there was a fear of death, taking nitrates in ordinary doses did not give relief. An ambulance crew was called, waiting for her for 30 minutes. The pain was not removed, heart failure increased. The patient is shown more powerful painkillers and oxygen therapy, and the faster the better. (Severe angina pectoris with the failure of nitrates and pharmacological painkillers can go into a heart attack). The use of an inhaler with Xe: O ₂ (40:60) gas mixture after 5-7 breaths eased the pain, and after 1 minute (14 breaths) the pain disappeared. When the ambulance arrived, the patient was taken to a hospital while maintaining the established autoanalgesia regimen during transportation.

Example 2. Patient T., 35 years old, was hit by a car. Diagnosis: Closed leg bone fracture, chest bruise and rib fracture on both sides. The mechanics of breathing, the pain brake of coughing, and respiratory failure are increasing. Upon arrival of the ambulance, the patient was given inhalation Xe: O ₂ (50:50) of the gas mixture. The pain decreased, the chest breathing excursion increased, oxygen therapy relieved hypoxia, and gas exchange rates improved. Affected after 30 minutes. was taken to an emergency hospital. During transportation, the patient himself maintained the autoanalgesia regimen.

Example 3. Patient B., 86 years. Diagnosis: Prostate adenoma, severe pulmonary heart disease. In order to anesthetize with a puncture biopsy of the prostate, a regimen of autoanalgesia Xe: O ₂ gas mixture was prescribed. After 4-5 minutes from the moment of inhalation Xe: O ₂ (30:70) of the mixture, a puncture biopsy was performed. He suffered a painful manipulation well, without worsening the general condition. Consciousness was maintained throughout the entire period of manipulation.

Example 4. In a young miner in the face, the left leg is crushed by a multi-ton metal structure at the level of the upper third of the leg. In the mine, under autoanalgesia with a gas mixture Xe: O ₂ (50:50) in combination with the IM injection of fentanyl (2 ml), the amputation of the left leg was performed at the level of the lower third of the thigh. The miner's life was saved.

Example 5. In a patient after nephrostomy, left drains do not function. Suffers from bronchial asthma. At night there was an attack of suffocation and the patient took the salbutamol aerosol inhalation. In the morning, residual bronchospasm remains. It is urgent to carry out an audit of the wound, to check the patency and correct installation of the drains. Under inhalation Xe: O ₂ (50:50) of the mixture in the autoanalgesia mode, the sutures were removed, the wound was diluted, the kidney was exposed and a precipitated drainage was established in the renal pelvis. During inhalation of Xe: O ₂ (50:50), 2 doses of salbutamol aerosol were introduced into the respiratory circuit. The asthmoid component of respiration disappeared, cyanosis of the lips and nail beds disappeared, the patient's well-being improved significantly. The audit of the wound has ended. Stitches are placed on the skin around the drains. Manipulation tolerated well. Sent to the ward in satisfactory condition.

The method can be used in the following conditions:

angina pectoris, myocardial infarction, pulmonary heart disease, asthma, bronchial asthma, renal and hepatic colic, spastic pain attack, acute pancreatitis, mechanical or burn injury, pain shock, toothache, labor pain relief, surgical delivery (cesarean section), painful manipulations in surgical and gynecological practice (abortion), psycho-emotional stress.

In cases of an attack of bronchial asthma or suffocation from other causes, the Xe: O ₂ inhaler can be used for oxygen therapy and relief of bronchospasm. The bronchodilator effect can be achieved by spraying the appropriate dose of an aerosol bronchodilator into the respiratory circuit of the inhaler.

Inhalation of Xe: O ₂ mixture can be carried out in the form of self-help or mutual assistance in the domestic environment before the arrival of the ambulance team, at the prehospital stage in the ambulance service system, medical aviation, sports medicine, as well as in a sanatorium or dispensary for removal emotional stress and normalization of neurological status, as well as in a surgical hospital with painful dressings, burn surface treatment, punctures, biopsies, during small gynecological examinations eration.

Claims (1)

The method of autoanalgesia, which consists in the fact that the patient is offered to independently inhale the xenon-oxygen mixture in the ratio of xenon and oxygen in vol.% From 30:70 to 50:50 until the pain is stopped.