多模式低阿片全麻在择期剖宫产中的应用

A. PADALKO, D. DZIUBA
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 Purpose: To compare the \"routine\" technique of total intravenous anaesthesia with artificial lung ventilation for elective caesarean section and multimodal low-opioid general anaesthesia.
 Materials and methods: Our study is based on an examination of 60 patients. All patients were divided into 2 groups. The first group is a \"routine\" method of general anaesthesia, the second group is multimodal low-opioid general anaesthesia. Intravenous forms of medical drugs were used as adjuvants: paracetamol (1000 mg), clonidine (100 μg), 30 minutes before surgery and intravenous infusion of lidocaine (after the childbirth). Perioperative monitoring and treatment were based on the recommendations of the Enhanced Recovery After Caesarean Section and the American Association of Anaesthesiologists, the bispectral index and determination of the stress-induced substances (glucose, cortisol) blood levels were added. The newborns were evaluated with the Apgar scale and umbilical venous blood gas analysis was carried out. In the postoperative period, the intensity of pain, the time of patient activation and transfer from the intensive care unit were evaluated. The two-sided Student's t-test was used for statistical data processing (p value = 0.001; t > ± 3,466).
 Results: The obtained data showed the presence of statistically significant differences between the two groups: mean blood pressure (t = 18.25); heart rate (t = 9.2); bispectral index (t = 5.9); assessment of newborns with the Apgar scale at 1 minute (t = - 4.2); parameters of umbilical venous blood gas analysis (t = - 6,5); glucose (t = 14.5); cortisol (t = 26,2); patient activation time (t = 8.12); the time of transferring from the intensive care unit (t = 8.67); pain assessment on a numerical rating scale (t = 13.4); using of opioids intraoperatively (t = 9.9); using of intravenous anaesthetics (t = 5.25); using of opioids after surgery (t = 8.78). Better indicators were determined in the multimodal low-opioid general anaesthesia group.
 Conclusions: Based on the obtained results, the multimodal low-opioid general anaesthesia has reasonable (statistically significant) advantages over the \"routine\" technique of total intravenous anaesthesia with artificial lung ventilation for elective caesarean section.","PeriodicalId":487491,"journal":{"name":"Bìlʹ, znebolûvannâ ì ìntensivna terapìâ","volume":"9 17 1","pages":"0"},"PeriodicalIF":0.0000,"publicationDate":"2023-09-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"MULTIMODAL LOW-OPIOID GENERAL ANESTHESIA FOR ELECTIVE CAESAREAN SECTION\",\"authors\":\"A. PADALKO, D. DZIUBA\",\"doi\":\"10.25284/2519-2078.3(104).2023.287873\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"Introduction: The frequency of general anaesthesia during caesarean section is up to 15 %. The main disadvantages of general anaesthesia during caesarean section are: a high percentage of consciousness during surgery and a pronounced hemodynamic reaction to surgical trauma. The most dangerous part of this surgical intervention is the period before the birth of a child.
 Purpose: To compare the \\\"routine\\\" technique of total intravenous anaesthesia with artificial lung ventilation for elective caesarean section and multimodal low-opioid general anaesthesia.
 Materials and methods: Our study is based on an examination of 60 patients. All patients were divided into 2 groups. The first group is a \\\"routine\\\" method of general anaesthesia, the second group is multimodal low-opioid general anaesthesia. Intravenous forms of medical drugs were used as adjuvants: paracetamol (1000 mg), clonidine (100 μg), 30 minutes before surgery and intravenous infusion of lidocaine (after the childbirth). Perioperative monitoring and treatment were based on the recommendations of the Enhanced Recovery After Caesarean Section and the American Association of Anaesthesiologists, the bispectral index and determination of the stress-induced substances (glucose, cortisol) blood levels were added. The newborns were evaluated with the Apgar scale and umbilical venous blood gas analysis was carried out. In the postoperative period, the intensity of pain, the time of patient activation and transfer from the intensive care unit were evaluated. The two-sided Student's t-test was used for statistical data processing (p value = 0.001; t > ± 3,466).
 Results: The obtained data showed the presence of statistically significant differences between the two groups: mean blood pressure (t = 18.25); heart rate (t = 9.2); bispectral index (t = 5.9); assessment of newborns with the Apgar scale at 1 minute (t = - 4.2); parameters of umbilical venous blood gas analysis (t = - 6,5); glucose (t = 14.5); cortisol (t = 26,2); patient activation time (t = 8.12); the time of transferring from the intensive care unit (t = 8.67); pain assessment on a numerical rating scale (t = 13.4); using of opioids intraoperatively (t = 9.9); using of intravenous anaesthetics (t = 5.25); using of opioids after surgery (t = 8.78). Better indicators were determined in the multimodal low-opioid general anaesthesia group.
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引用次数: 0

摘要

剖宫产术中全身麻醉的发生率高达15%。剖宫产术中全麻的主要缺点是:术中意识比例高,手术创伤后血流动力学反应明显。这种手术干预最危险的部分是孩子出生前的一段时间。目的:比较择期剖宫产人工肺通气全静脉麻醉与多模式低阿片类药物全麻的“常规”技术。材料和方法:我们的研究基于60例患者的检查。所有患者分为两组。第一组是“常规”全麻方法,第二组是多模式低阿片类药物全麻。使用静脉注射形式的医疗药物作为佐剂:扑热息痛(1000 mg)、可乐定(100 μg)、手术前30分钟和静脉输注利多卡因(分娩后)。围手术期监测和治疗依据美国麻醉医师协会和剖宫产术后增强恢复的建议,增加双谱指数和测定应激诱导物质(葡萄糖、皮质醇)血水平。采用阿普加量表对新生儿进行评分,并进行脐静脉血气分析。术后评估疼痛强度、患者激活时间和从重症监护病房转移的时间。统计学数据处理采用双侧Student’st检验(p值= 0.001;t比;本市±3466)# x0D;结果:所得数据显示两组间存在统计学差异:平均血压(t = 18.25);心率(t = 9.2);双谱指数(t = 5.9);1分钟用Apgar量表对新生儿进行评估(t = - 4.2);脐静脉血气分析参数(t = - 6,5);葡萄糖(t = 14.5);皮质醇(t = 26,2);患者激活时间(t = 8.12);从重症监护病房转出的时间(t = 8.67);采用数值评定量表进行疼痛评估(t = 13.4);术中使用阿片类药物(t = 9.9);静脉麻醉剂使用情况(t = 5.25);术后阿片类药物的使用(t = 8.78)。多模式低阿片类药物全麻组各项指标较好。 结论:基于所获得的结果,多模态低阿片类药物全麻相对于择期剖宫产全静脉麻醉加人工肺通气的“常规”技术具有合理(统计学意义显著)的优势。
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MULTIMODAL LOW-OPIOID GENERAL ANESTHESIA FOR ELECTIVE CAESAREAN SECTION
Introduction: The frequency of general anaesthesia during caesarean section is up to 15 %. The main disadvantages of general anaesthesia during caesarean section are: a high percentage of consciousness during surgery and a pronounced hemodynamic reaction to surgical trauma. The most dangerous part of this surgical intervention is the period before the birth of a child. Purpose: To compare the "routine" technique of total intravenous anaesthesia with artificial lung ventilation for elective caesarean section and multimodal low-opioid general anaesthesia. Materials and methods: Our study is based on an examination of 60 patients. All patients were divided into 2 groups. The first group is a "routine" method of general anaesthesia, the second group is multimodal low-opioid general anaesthesia. Intravenous forms of medical drugs were used as adjuvants: paracetamol (1000 mg), clonidine (100 μg), 30 minutes before surgery and intravenous infusion of lidocaine (after the childbirth). Perioperative monitoring and treatment were based on the recommendations of the Enhanced Recovery After Caesarean Section and the American Association of Anaesthesiologists, the bispectral index and determination of the stress-induced substances (glucose, cortisol) blood levels were added. The newborns were evaluated with the Apgar scale and umbilical venous blood gas analysis was carried out. In the postoperative period, the intensity of pain, the time of patient activation and transfer from the intensive care unit were evaluated. The two-sided Student's t-test was used for statistical data processing (p value = 0.001; t > ± 3,466). Results: The obtained data showed the presence of statistically significant differences between the two groups: mean blood pressure (t = 18.25); heart rate (t = 9.2); bispectral index (t = 5.9); assessment of newborns with the Apgar scale at 1 minute (t = - 4.2); parameters of umbilical venous blood gas analysis (t = - 6,5); glucose (t = 14.5); cortisol (t = 26,2); patient activation time (t = 8.12); the time of transferring from the intensive care unit (t = 8.67); pain assessment on a numerical rating scale (t = 13.4); using of opioids intraoperatively (t = 9.9); using of intravenous anaesthetics (t = 5.25); using of opioids after surgery (t = 8.78). Better indicators were determined in the multimodal low-opioid general anaesthesia group. Conclusions: Based on the obtained results, the multimodal low-opioid general anaesthesia has reasonable (statistically significant) advantages over the "routine" technique of total intravenous anaesthesia with artificial lung ventilation for elective caesarean section.
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