Vol 11, No 1 (2017)

Rationale. Currently is being actively developed a method for removal of chiasmosellar area tumors by endoscopic endonasal transsphenoidal resection, which is considered to be less traumatic and is well tolerated by patients, resulting in an expanded possibility to operate the elder patients, and patients with clinically localized somatic pathology. Objective. Considering the aforesaid, the issue of choosing the adequate anesthetic method and the problem of reducing the perioperative pharmacological load on the patient are brought to the forefront. Materials and Methods. In order to improve the anesthetic management results 200 patients divided into two subgroups have undergone certain examinations. These two subgroups included: a subgroup of 125 patients with general anesthesia and a subgroup of 75 patients with general anesthesia together with the regional one. By use of the undertaken study, we were able to improve successfully the technique of anesthesia for this type of operations through a combination of general and regional anesthesia (bilateral anesthesia of a pterygopalatine fossa). Results and Discussion. A significant decrease in pharmacological load on a patient and stress reaction has been obtained on the background of more stable intraoperative hemodynamics. In addition, a problem of postsurgical pain syndrome control has been considered. For this purpose two subgroups of 20 patients have been allocated: subgroup where patients only received general anesthesia, and the subgroup where the patients received general anesthesia together with regional one, for the purpose of analizing the severity of postsurgical pain on a visual analog pain scale during the day as well as the consumption of analgesics on the patient’s request. For this purpose patients have been divided into two subgroups of 20 people each (subgroup where only general anesthesia was performed, and the subgroup where general anesthesia combined with regional anesthesia was performed), where the severity of postsurgical pain syndrome on a visual analog pain scale during the day has been analyzed, as well as the consumption of analgesics on a patient’s request. Conclusion. As a result, the subgroup of patients received the concomitant anesthesia has shown the best results: there was a significant decrease in pain syndrome intensity on a background of lower consumption of Lornoxicam.

Objective. The main purpose of the prospective, randomized study was to evaluate the efficiency of the superficial cervical plexus block combined with total intravenous anesthesia by propofol and fentanyl during surgical procedures on carotid arteries. Material and methods. 86 patients were divided in 2 groups depending on the method of anesthesia. There was held a comparative analysis of clinical, instrumental, laboratory parameters, the intensity of pain and the number of perioperative complications. Results and conclusion. It turned out that this option allows you to reduce the dose of anesthetic propofol and fentanyl, to decrease the duration of mechanical ventilation, as well as to provide better antinociceptive protection of patients during surgical procedures on carotid arteries.

Inadvertent perioperative hypothermia (IPH) occurs in many patients, undergoing oncogynecological operations, due to the influence of the spinal anesthesia and sedation. The conventional intraoperative using of forced-air warming is insufficient to counteract thermal redistribution resulting from the peripheral vasodilatation, associated with spinal anesthesia. The objective of the study was to test the efficiency of the preoperative forced-air warming device (Bair Hugger) in combination with intravenous injection of tramadol in preventing IPH. Material and Methods. Eighty adult patients undergoing oncogynecological surgery under spinal anesthesia (SA) were randomized to receive either normal care or prewarming for 30 min, at 43°C, using the Bair Hugger, in combination with the injection of tramadol preoperatively. Results. Forty patients were prewarmed and received tramadol (0,5 mg/kg) and 40 patients were in the control group. There was smaller decrease in mean core temperature in the prewarmed group at 15, 30, 75, 90 min post-induction (p < 0,05). By the end of the operation all patients from the control group remained hypothermic, whereas only 28 patients (70%) remained hypothermic in prewarmed group (P < 0,05). 26 (65%) patients from the control group and 10 (25%) patients in prewarmed group suffered from muscle shivering (P < 0,05). There were no significant differences in vomiting and nausea between the groups. Conclusions. Preoperative warming using the Bair Hugger, combined with preoperative injection of tramadol results in smaller decreases in core temperature intraoperatively and less IPH in patients undergoing oncogynecological surgery under SA.