Patologìâ (Dec 2020)
Non-invasive control of oxygen consumption during inhalation anesthesia of antireflux laparoscopic interventions by the method of Minimal flow
Abstract
Aim: to study the features of the general anesthesia of antireflux laparoscopic interventions in abdominal surgery using sevoflurane by the method of Low flow, Minimal flow from the standpoint of the ERAS protocol. Materials and methods. The study was conducted at State Institution of Science “Research and Practical Centre of Preventive and Clinical Medicine” of State Administrative Department, it was prospective and not randomized. Forty patients with esophageal hernia of the diaphragm, who underwent laparoscopic crurorraphy and Nissen fundoplication were examined. The age of patients ranged from 21 to 76 years. There were 10 men (25 %) and 30 women (75 %). Patients enrolled in the study had informed consent to be examined, tested, and processed. All patients underwent combined low-flow inhalation anesthesia with sevoflurane in combination with perioperative multimodal analgesia during surgery. Patients were divided into 2 groups. The first group – Low flow anesthesia (n = 20) included patients who underwent combined inhalation anesthesia with sevoflurane with a flow of fresh gas mixture (FGF) 1.0 l/min, the second group – Minimal flow anesthesia (n = 20 ) included patients who underwent combined inhalation anesthesia with sevoflurane with a fresh gas mixture (FGF) flow of 0.5 l/min. In the study, we analyzed monitoring indicators, which included registration of non-invasive blood pressure, heart rate, 5-lead electrocardiography, registration of peripheral oxygen saturation (SrO2) + plethysmogram, depth of anesthesia according to BIS, working pressure in the operating space. Gas exchange indicators – capnography, oxygen and sevoflurane concentration in the mixture during inhalation and exhalation, ventilation parameters were constantly monitored. The monitoring is supplemented by our developed and patented method of intraoperative non-invasive control of oxygen consumption by the patient during inhalation anesthesia in the operating room. Formation, storage, analysis of electronic database, statistical data processing and visualization of research results were performed in license packages: MedStat v. 4. and Microsoft Office. Results. In the study of oxygen consumption by patients of the first and second groups, it was found that at stages 3 and 4 of surgery VO2 was higher compared to stages 1, 2, 5, 6. Statistically significant differences in VO2 in the study periods in the first and second groups were not detected. In both subgroups, there was no significant statistical difference between the indicators of BIS at the stages of surgery during 2–6 stages of the study, which were at the level of the surgical stage of anesthesia. Conclusions. Monitoring of oxygen consumption by the patient is one of the criteria of intraoperative safety of the patient and adequacy of anesthesia. Oxygen consumption by the patient at all the stages of surgery makes it possible to claim that use of the method of Minimal flow anesthesia is safe for the patient.
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