RU2773274C1 - Method for restoring microcirculation outside of the area of skin anaesthesia in the course of prolonged epidural anaesthesia - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: invention relates to medicine, namely, to anaesthesiology, and can be used in the course of prolonged epidural anaesthesia. For this purpose, epidural anaesthesia is performed at the lumbar level. A solution of sibazon at a dose of 0.18 mg/kg and a solution of sodium oxybate at a dose of 36 mg/kg are then administered.

EFFECT: method restores microcirculation outside the area of skin anaesthesia in the course of prolonged epidural anaesthesia and reduces the risk of complications in the circulatory system outside the area of skin anaesthesia due to the dosed administration of the selected products in certain doses.

1 cl, 1 ex

Description

The invention relates to anesthesiology and resuscitation and can be used in the practice of an anesthesiologist-resuscitator in abdominal surgery, in intensive care units and intensive care units.

Lumbar epidural anesthesia is widely used in various surgical options for the surgical treatment of inguinal hernias (Surek A. et al., 2020). Lumbar epidural anesthesia K.T. Delis et al. (2004) increases blood flow in the deep veins of the lower extremities. In the zone of development of epidural anesthesia, vasodilatation and blood flow acceleration occur, outside this zone - vasoconstriction and slowing of blood flow (Sessler D.I., 2000). Pulse oximetry data confirm that epidural anesthesia causes vasodilation in the "blocked" area and opposite reactions in the "unblocked" area due to compensatory vasoconstriction (Kawana, S. et al., 1994). Lumbar epidural anesthesia with bupivacaine reduces the Pi index [(pulse oximetric perfusion index (pulse modulation)] fixed by the pulse oximeter sensor on the finger of the upper limb (Ginosar Y. et al., 2009). Pi is individual and ranges from 0.3% to 20 % depending on the location of the measurement and the physical condition of the patient.A value of this parameter less than 4% indicates hypothermia of the finger, the presence of vascular disease, a shock process.A value of more than 7% indicates overperfusion (Choosing the best pulse oximeter. Which one is right for you? - Academy Health Beurer (beurer-belarus.by).

Disadvantage: in elderly patients operated on an emergency basis, the risk of developing acute myocardial ischemia after surgery is 19%, and after planned surgical interventions - 0.2% (Ovechkin A.M., 2007; Sekiya Y., TakahashiH., TanakaM., 2010 ). A preoperative spasm of the coronary artery with the primary genesis of an acute coronary syndrome attack (synchronous ECG manifestations and clinical symptoms) was described during lumbar epidural anesthesia due to activation of the sympathetic innervation of the heart (Hoka S. et al., 1995). These data support the hypothesis of a vicious association of post-stenotic coronary vasoconstriction caused by sympathetic activation leading to severe myocardial ischemia (Heusch G., Deussen A., Thämer V., 1985).

A method is proposed for restoring microcirculation outside the area of skin anesthesia when performing prolonged epidural anesthesia.

The technical result consists in restoring microcirculation outside the zone of skin anesthesia when performing prolonged epidural anesthesia. It is achieved by the fact that to restore microcirculation outside the zone of skin anesthesia under conditions of prolonged epidural anesthesia, a solution of sibazon is used, which causes dilation of peripheral vessels. At the same time, a solution of sodium oxybate is administered, leading to a hypnotic effect, stimulation of the circulatory system, "absence of the patient for own anesthesia and surgery" at the peak of the development of prolonged epidural anesthesia. The named pharmacological effect of restoring microcirculation outside the area of skin anesthesia during prolonged epidural anesthesia is confirmed by a study of the Pi index of a pulse oximeter (OXIMETER, Chine) against the background of the Harvard monitoring standard in a patient with prolonged epidural anesthesia. Prior to the start of extended lumbar epidural anesthesia performed at the level of L _ii -L _iii index Pi pulse oximetry sensor, fixed on the second finger of the left hand, was 8.5. 30 minutes after the introduction of a full dose of 2% lidocaine solution (at the peak of the development of prolonged epidural anesthesia), the Pi index decreased and became equal to 3.0. At this time, a solution of sibazon at a dose of 0.18 mg/kg and sodium oxybate at a dose of 36 mg/kg were slowly injected intravenously. After 60 minutes against the background of effective prolonged epidural anesthesia and 30 minutes after the introduction of a solution of sibazon and sodium oxybate in the above dosages, the Pi index increased and amounted to 7.1.

Thus, it was found that with the development of the full effect of prolonged epidural anesthesia at the lumbar level, intravenous strictly dosed application of the sibazon solution causes the expansion of peripheral vessels outside the zone of skin anesthesia, and the sodium oxybate solution causes a hypnotic effect, stimulation of the circulatory system, the effect of "absence of the patient" on own anesthesia and surgery. Based on the data obtained, it becomes possible to restore microcirculation outside the area of skin anesthesia with prolonged epidural anesthesia. With the proposed method, prolonged epidural anesthesia is performed at the lumbar level, microcirculation is restored outside the area of skin anesthesia by intravenous administration of a solution of sibazon, sedation is achieved by intravenous administration of a solution of sodium oxybate, which reduces the risk of complications from the circulatory system outside the area of skin anesthesia.

Similar signs of restoration of microcirculation caused by intravenous administration of a solution of sibazon at a dose of 0.18 mg/kg and sedation of sodium oxybate at a dose of 36 mg/kg during prolonged epidural anesthesia at the lumbar level were not found in the known methods for performing prolonged epidural anesthesia at the lumbar level . Therefore, the proposed method for restoring microcirculation outside the area of skin anesthesia when performing prolonged epidural anesthesia has a novelty of significant features and practical significance.

The proposed method for restoring microcirculation outside the area of skin anesthesia when performing prolonged epidural anesthesia at the lumbar level is performed as follows. After the catheter is installed, a local anesthetic solution is injected into the epidural space according to the standard method. The test dose is 3 ml of a 2% lidocaine solution. With stable hemodynamics, the absence of critical incidents and complications, every 5 minutes add 4 ml of a 2% lidocaine solution into the epidural space, achieving the development of a skin anesthesia zone 2 segments above and below the surgical intervention zone. After that, a solution of sibazon is administered at a dose of 0.18 mg/kg and sodium oxybate at a dose of 36 mg/kg. The effect of restoring microcirculation above the zone of skin anesthesia and sedation is obtained against the background of the full effect of prolonged epidural anesthesia under the control of pulse oximetric parameters, in particular the Pi index, the Harvard monitoring standard.

Clinical example.

Patient R. Height 174 cm. Body weight 55 kg. Diagnosis: right inguinal hernia (K40.9). Operation: inguinal hernia repair according to Liechtenstein. Anesthesia time 9.20 - 10.45 min. Operation time 9.40 - 10.40 min. The volume of intravenous infusion is 600 ml. Diuresis 100 ml/hour. Surgical, anesthesiology and resuscitation complications: none. Features: 1) 9.00 start of prolonged epidural anesthesia at the level of L _ii -L _iii . 2) 9.30 peak of prolonged epidural anesthesia. Area of skin anesthesia Thvii-Sjj. 3) 9:30 introduced Sol. Sibasoni at a dose of 0.18 mg/kg and Natrii oxibaty at a dose of 36 mg/kg. Before the start of extended lumbar epidural anesthesia, performed at the level of L _ii -L _iii index Pi pulse oximetry sensor, fixed on the second finger of the left hand) was 8.5. At the peak of the development of epidural anesthesia (30 minutes after the introduction of a full dose of 2% lidocaine solution) - 3.0. 60 minutes after the administration of a full dose of 2% lidocaine solution with the full clinical effect of prolonged epidural anesthesia against the background of restoration of microcirculation due to the administration of sibazon solution and sedation induced by sodium oxybate, the Pi index was 7.1.

With the proposed method of maintaining microcirculation outside the area of skin anesthesia, when performing prolonged epidural anesthesia, the risk of complications from the circulatory system above the area of skin anesthesia is reduced.

Bibliography

Ovechkin A.M. Review of selected materials on the problems of regional anesthesia and pain treatment and published in foreign journals in the 1st half of 2007 // Regional anesthesia and treatment of acute pain. - 2007. - Volume 1. - No. 4. - With. 8, 13.

Delis K.T., Knaggs A.L., Mason P., Macleod K.G. Effects of epidural-and-general anesthesia combined versus general anesthesia on the venous hemodynamics jf the lower limb. A randomized study // Thromb. haemost. 2004; 92(5): 1003-1011. PMID: 15543327 DOI: 10.1160/TH04-04-0233.

Ginosar, Y., Weiniger, C.F., Kurz, V., Babchenko, A., Nitzan, M., & Davidson, E. (2009). Sympathectomy-mediated vasodilatation: a randomized concentration ranging study of epidural bupivacaine. Canadian Journal of Anesthesia/Journal Canadien D'anesthesie, 56(3), 213-221. PMID: 19247742 DOI: 10.1007/sl 2630-008-9036-z.

Heusch, G. Cardiac sympathetic nerve activity and progressive vasoconstriction distal to coronary stenoses: feed-back aggravation of myocardial ischemia / G. Heusch, A. Deussen, V. Thamer // J Auton Nerv Syst. 1985 Aug; 13(4):311-326. PMID: 4031366 DOI: 10.1016/0165-1838(85)90020-7.

Hoka, S. Coronary artery spasm induced under lumbar epidural anaesthesia / S. Hoka, K. Izumi, T. Matsukado, K. Matsuda, S. Takahashi // Eur J Anaesthesiol. Nov 1995; 12(6):609-12. PMID: 8665885

Sekiya Y., Takahashi H., Tanaka M. [Patient who developed acute myocardial infarction after total-gastrectomy] // Masui. Feb 2010; 59(2):210-2. Japanese. PMID: 20169960.

Sessler D.I. Perioperative heat balance // Anesthesiology. February 2000; 92(2):578-96. review. PMID: 10691247 DOI: 10.1097/00000542-200002000-00042

Kawana, S., Watanabe, H., Namiki, A., & Kokita, N. (1994). Epidural anesthesia affects pulse oximeter readings and response time. Journal of Anesthesia, 8(2), 159-162. PMID: 28921136 DOI: 10.1007/BF02514705.

Surek, A., Bozkurt, M.A., Ferahman, S., Gemici, E., & Donmez, T. (2020). Laparoscopic Total Extraperitoneal Inguinal Hernia Repair Under Epidural Anesthesia Versus General Anesthesia. Surgical Laparoscopy, Endoscopy & Percutaneous Techniques, 30(5), 471-475. doi:10.1097/sle.0000000000000817.

Choosing the best pulse oximeter Which one is right for you? - Beurer Health Academy (beurer-belarus.by

List of abbreviations

Extended epidural anesthesia - PEA

Area of skin anesthesia - ZKA

Pulse oximetric perfusion index (pulse modulation) - Pi

Claims (1)

A method for restoring microcirculation outside the zone of skin anesthesia when performing prolonged epidural anesthesia, including performing prolonged epidural anesthesia at the lumbar level, characterized in that after epidural anesthesia, a solution of sibazon is administered at a dose of 0.18 mg/kg and a solution of sodium oxybate at a dose of 36 mg/kg kg.