Aktualʹnì Pitannâ Farmacevtičnoï ì Medičnoï Nauki ta Praktiki (Aug 2018)
Energy-structural status in perioperative sedoanalgesia
Abstract
The use of minimally invasive surgical techniques and sedoanalgesia contributes to significant progress in reducing perioperative complications, as well as in reducing the length of stay for in-patients, but the problem of the violation of energy-structural interactions in the patient's organism, which subsequently leads to disturbances of higher cortical functions, remains topical. The energy-structural status (ESS) of the organism and the central nervous system specialized cells vital activity disorders are still unexplored. Aim. Improving treatment outcomes for patients with acute intra-abdominal diseases by giving energy-protective capacity to sedoanalgesia and perioperative management. Materials and methods. The research was performed on the results of the perioperative energy-structural activity (ESA) audit, its reserves, properties, and the effectiveness of autoregulation in 84 patients with acute intra-abdominal diseases. According to the initial level of energy-structural activity, all patients were divided into three groups: with dysfunction of the energy-structural status, with damage and insufficiency. Each group was randomly subdivided into treatment and control groups. Patients of the control group underwent standard sedoanalgesia, and patients of the treatment group underwent sedoanalgesia with the use of energy-protective techniques. At all perioperative stages a deep picture of the oxygen regime, acid-base, water-electrolyte balance, hemodynamic and microcirculation indices, basal metabolic rate were studied. Additionally, markers of early signs of neuronal damage were determined in 10 patients: neuroglial protein S100 and neuron-specific enolase NSE. Results. The close relationship between early manifestation of structural microdamages of brain cells and energy-structural changes in the patients' body was proved. The study of the neurospecific proteins level and dynamics of energy-structural activity parameters confirms that the use of energy-protective techniques significantly increases the perioperative energy-protective capacity of sedoanalgesia (p<0,05). Conclusions. Supplementation of standard sedoanalgesia with energy-protective techniques allows to supply anesthetic management of urgent abdominal surgery with energy-protective properties, providing the necessary energy-structural interaction, which makes it possible to reduce the severity of energy-structural status damage, that leads to decreased severity of neurons and neuroglia intracellular damage.
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