Regional Anesthesia and Acute Pain ManagementRegional Anesthesia and Acute Pain ManagementРегионарная анестезия и лечение острой боли1993-65082687-1394Eco-Vector3606710.17816/RA36067ArticlesСтатьиResearch ArticleContinuous spinal anesthesia for aorta-femoral bypass surhery in patients with COPDПродленная спинальная анестезия как метод анестезиологической защиты при реконструктивных операциях на брюшной аорте у пациентов с хроническими обструктивными заболеваниями легкихKosteckyI. V.КостецкийИ. В.DavidovaN. S.ДавыдоваН. С.PenkovaI. K.ПеньковаИ. К.Ural Academy of Medicine Department of Anesthesiology and Intensive CareГОУ ВПО «Уральская государственная медицинская академия»City Clinical Hospital №40. EkaterinburgМУ «Городская клиническая больница №40», Екатеринбург1503201041VOL 4, NO1 (2010)ТОМ 4, №1 (2010)384621072020Copyright ©; 2010, Eco-VectorCopyright ©; 2010, ООО "Эко-Вектор"2010Eco-VectorООО "Эко-Вектор"https://rjraap.com/1993-6508/article/view/36067

Aim of the study was to determine an optimal anesthesia technique for aorta-femoral bypass surgery in patients with chronic obstructive pulmonary disease (COPD). Material and methods. 58 patients with COPD undergoing aorta-femoral (bi-femoral) bypass were enrolled. We investigated oxygen transport and serum level of cortisol during surgery and in the early postoperative period. We also measured PO 2/FiO 2 ratio. The patients were randomized in three groups - general anesthesia (GA) (n=19), total intravenous anesthesia (TIVA) (n=19), continuous spinal anesthesia (CSA) (n=20). Results. PO 2/FiO 2 ratio was significantly higher in CSA group in comparison with GA and TIVA groups. For the patients under CSA cortisol serum level was lower then in GA and TIVA patients but statistically significant difference was reached only between GA and CSA groups at the second day after operation. Conclusions CSA is the most appropriate option in patients with COPD undergoing abdominal aortic surgery.

Целью исследования была оптимизация анестезиологической защиты у пациентов с хронической обструктивной болезнью легких (ХОБЛ) при реконструктивных операциях на брюшной аорте. У пациентов с ХОБЛ, оперированных на брюшной аорте, исследовали транспорт кислорода и уровень кортизола плазмы. 58 пациентов были рандомизированы на 3 группы: 1-я - группа тотальной внутривенной анестезии (ТВА) - 19 пациентов; 2-я - группа ингаляционной общей анестезии (ИА) - 19 пациентов; 3-я - группа продленной спинальной анестезии (СА) - 20 пациентов. Обнаружено большее снижение коэффициента оксигенации (PO 2/FiO 2) в послеоперационном периоде в группе пациентов, оперированных под ОА и ТВА по отношению к пациентам группы СА (р<0,05). Исследование уровня кортизола в крови свидетельствует о большем увеличении уровня кортизола в крови в 1-е и 2-е сут после операции в группах ТВА и ОА в сравнении с СА. Продленную СА можно считать методом выбора анестезии при реконструктивных операциях на брюшной аорте у пациентов с ХОБЛ.

continuous spinal anesthesiatotal intravenous anesthesiageneral anesthesiaпродленная спинальная анестезиятотальная внутривенная анестезияобщая анестезияLittle R. A., Edwards J. D. Applied physiology. In: Edwards JD, Shoemaker WC, Vincent JL, eds. Oxygen transport: principles and practice. London: WB Saunders, 1993: 21-40.Zander R. Calculation of oxygen concentration. In: Zander R, Mertzlufft F, eds. The oxygen status of arterial blood. Basel: Karger, 1991: 203-209.Dreyfuss D., Saumon G. Ventilator-induced lung injury // Am. Rev. Respir. Crit. Care Med. 1998; 157: 294-323.Ranieri V. M., Giunta F., Suter P., Slutsky A. S. Mechanical ventilation as a mediator of multisystem organ failure in acute respiratory distress syndrome // JAMA. 2000; 284: 43-44.Gajic O., Dara S., Mendez J. L. et al. Ventilator-associated lung injury in patients without acute lung injury at the onset of mechanical ventilation // Crit. Care Med. 2004; 32: 18171824.Greene N. M. Physiology of Spinal Anesthesia, 3rd ed. Baltimore, Williams & Wilkins, 1981.Rooke G. A., Freund P R., Jacobson A. F. Hemodynamic response and change in organ blood volume during spinal anesthesia in elderly men with cardiac disease // Anesth. Analg. 1997; 85: 99.Chen T. L., Ueng T. H., Chen S. H et al. Department of Anesthesiology, National Taiwan University Hospital, Taipei, Republic of China.Human cytochrome P450 mono-oxygenase system is suppressed by propofol // Br. J. Anaesth. 1995; 74(5): 558-562 (ISSN: 0007-0912).Godet G., Gossens S., Prayssac P. et al. Département dAnesthésie-Réanimation, Hôpital Pitié-Salpêtrière, Paris, France.Infusion of propofol, sufentanil, or midazolam for sedation after aortic surgery: comparison of oxygen consumption and hemodynamic stability // Anesth. Analg. 1998; 87(2): 272-276 (ISSN: 0003-2999).Hertzer N. R. Cardiac risk factors in peripheral vascular surgery. In Estafanous FG (ed): Anesthesia and the HeartPatient. Oxford, Butterworth-Heinemann, 1989: 173-195.Norris E. J., Beattie C., Perler B. A. et al. Double-masked randomized trial comparing alternate combinations of intraoperative anesthesia and postoperative analgesia in abdominal aortic surgery // Anesthesiology. 2001; 95: 1054-1067.Baron J. F., Bertrand M., Barre E. et al. Combined epidural and general anesthesia versus general anesthesia for abdominal aortic surgery // Anesthesiology. 1991; 75: 611-618.Davies M. J., Silbert B. S., Mooney P. J. et al. Combined epidural and general anaesthesia versus general anaesthesia for abdominal aortic surgery: A prospective randomised trial // Anaesth. Intensive Care. 1993; 21: 790-794.Bois S., Couture P., Boudreault D. et al. Epidural analgesia and intravenous patient-controlled analgesia result in similar rates of postoperative myocardial ischemia after aortic surgery // Anesth. Analg. 1997; 85: 1233-1239.Park W. Y., Thompson J. S., Lee K. K. Effect of epidural anesthesia and analgesia on perioperative outcome: A randomized, controlled Veterans Affairs cooperative study // Ann. Surg. 2001; 234: 560-569, discussion 569-571.Breslow M. J., Jordan D. A., Christopherson R. et al. Epidural morphine decreases postoperative hypertension by attenuating sympathetic nervous system hyperactivity // JAMA. 1989; 261: 3577-3581.Fleron M. H., Weiskopf R. B., Bertrand M. et al. A comparison of intrathecal opioid and intravenous analgesia for the incidence of cardiovascular, respiratory, and renal complications after abdominal aortic surgery // Anesth. Analg. 2003; 97: 2-12.Garnett R. L., MacIntyre A., Lindsay P et al. Perioperative ischaemia in aortic surgery: Combined epidural/general anaesthesia and epidural analgesia vs general anaesthesia and i.v. analgesia // Can. J. Anaesth. 1996; 43: 769-777.Boylan J. F., Katz J., Kavanagh B. P. et al. Epidural bupivacainemorphine analgesia versus patient-controlled analgesia following abdominal aortic surgery: Analgesic, respiratory, and myocardial effects // Anesthesiology. 1998; 89: 585-593.Christopherson R., Beattie C., Fran S. M. et al. Perioperative morbidity in patients randomized to epidural or general anesthesia for lower extremity vascular surgery. Perioperative Ischemia Randomized Anesthesia Trial Study Group.Breslow M. J., Parker S. D., Frank S. M. et al. Determinants of catecholamine and cortisol responses to lower extremity revascularization. The PIRAT Study Group // Anesthesiology. 1993; 79: 1202-1209.Tuman K. J., McCarthy R. J., March R. J. et al. Effects of epidural anesthesia and analgesia on coagulation and outcome after major vascular surgery // Anesth. Analg. 1991; 73: 696-704.Warner D. O. Preventing postoperative pulmonary complications: The role of the anesthesiologist // Anesthesiology. 2000; 92: 1467-1472.Christopherson R., Glavan N. J., Norris E. J. et al. Control of blood pressure and heart rate in patients randomized to epidural or general anesthesia for lower extremity vascular surgery. Perioperative Ischemia Randomized Anesthesia Trial (PIRAT) Study Group // J. Clin. Anesth. 1996; 8: 578-584.Rodgers A., Walker N., Schug S. et al. Reduction of postoperative mortality and morbidity with epidural or spinal anaesthesia: results from overview of randomized trials // BMJ. 2000; 321; 1493 doi:10.1136/bmj.321. 7275.1493.Holst, Dietmar, Möllmann et al. Intrathecal Local Anesthetic Distribution With the New Spinocath Catheter // Regional Anesthesia and Pain Medicine September/October. 1998; 23 (Issue 5): 433-526.Gosch U., Huepp L. M., Hallschmid M., Bor J., Schmucker P., Meier T. Post-dural puncture headache in young adults: comparison of two small-gauge spinal catheters with different needle design // British Journal of Anaesthesia. 2005; 94(5): 657-661; doi:10.1093/bja/aei100.Jaitly V., Kumar C. Continuous spinal anaesthesia for laparotomy. 2009; 20 (Issue 2): 60-64.Chandra M. Kumar, William A. Corbett, Robert G. Wilson. Spinal anaesthesia with a micro-catheter in high-risk patients undergoing colorectal cancer and other major abdominal surgery // Surgical Oncology. 2008; 17(Issue 2): 73-79.Global Initiative for Chronic Obstructive Lung Disease. Global Strategy for Diagnosis, Management, and Prevention of Chronic Obstructive Pulmonary Disease. (Based on the April 1998 NHLBI/WHO Workshop). National Institutes of Health, National Heart. Lung and Blood Institute. April 2001 (Updated 2003).