Vol 12, No 2 (2018)

The article is devoted to the questions of epidural analgesia with the use of opioid analgesics. The work analyzes the clinical effectiveness of epidural use of opioids, lists possible complications and cautions of this method of anesthesia. Bioavailability of morphine and fentanyl for the spinal cord with epidural administration allows to achieve analgesic effects at a certain block level more effectively than with systemic administration. However, the side effects of opioids in the form of respiratory depression are also found with epidural administration (3%), so patient safety monitoring is necessary.

Objective: to evaluate the possibility of the cortisol control in patients with lower limb surgery of various degrees of trauma, as a criterion for achieving an absolutely effective analgesia. Materials and methods. In 15 patients of both sexes aged between 29 and 68 years (57 (53; 61)), 15 operations were performed on the lower extremities (knee replacement - 2, hip replacement - 3, metal osteosynthesis - 4, knee arthroscopy - 6). For analgesia was used spinal anesthesia with 0.5% solution of bupivacaine and levobupivacaine 2.5-3.0 ml. In all patients, effective anesthesia was achieved. The control of the cortisol level was carried out by the method of radioimmune analysis at 4 stages of the study: 1 stage - before surgery, on the operating table; Stage 2 - 30-40 minutes after the beginning of the operation; Stage 3 - the end of the operation, suturing of the skin; Stage 4 - 2 hours after the operation. The obtained data were processed quantitatively using nonparametric analysis. Results. Before the operation, the cortisol in the blood serum was 747.6 (507.4; 807.1) nmol/l. After 30-40 minutes after the beginning of the operation, the cortisol level decreased to 655.5 (512.2; 876.8) nmol/l, but no significant differences were found compared to the level of cortisol before the operation. At the end of the operation, the level of cortisol in the study group was 686.5 (470.1; 856.6) nmol/l and did not differ significantly with the stages before and during the operation. Two hours after the operation, there was an increase in cortisol to 760.4 (517.6; 842.1) nmol/l, but there was no significant differences compared to serum cortisol before and during surgery. Conclusion. Control of cortisol level shows the effectiveness of anesthesia in operations of varying severity.

Objective. To assess the effect of infusion of lidocaine solution in patients after extensive abdominal operations. Material and methods. Were examined 42 patients with cancer of the pancreas, which is made pancreatoduodenal resections. The patients were divided into two comparable groups. Patients of the first group (n=21) before surgery injected bolus 1.5 mg/kg lidocaine, followed by infusion at a rate of 1.5 mg/kg*h during the first 24 hours after surgery. Patients of the second group (n=21) started epidural infusion of 0.2 % ropivacaine solution at a rate of 5 ml/h. The intensity of pain syndrome was evaluated on VAS at rest and during mobilization, bowel actions, the time of first flatus and first stool, the need for additional analgesics and lenght of stay in the intensive care unit. Results. The intensity of pain in the first day was significantly (p <0.05) lower in the 2nd group than in the 1st group. The bowel actions, the time of first flatus and first stool between the groups did not differ significantly. The need for additional analgesics in the 2nd group was lower than in the 1st group, 4 (19%) and 17 (80.9%) patients respectively (p<0.05). The length of stay in ICU was 4.1±1.66 bed days in patients of the first group, 3.4±1.25 bed days in patients of the second group (p<0.05). Conclusion. Perioperative intravenous lidocaine is an effective and safe method of postoperative analgesia, which by its characteristics is comparable to epidural analgesia.

The aim of the study was to evaluate the nature of the development of the sensory block and the frequency of occurrence of critical incidents during anesthesia, in the immediate postoperative period using levobupivacaine and ropivacaine in patients with an oncogynecological profile. Materials and methods. The study included 48 women who were randomized into two groups of 24 patients each, depending on the anesthetic used: group 1 - ropivacaine, group 2 - levobupivacaine. The latent period of the sensory block, the motor block, the maximum level of development of the sensory block after 15 minutes, critical incidents at the stages of anesthesia, the level of the pain syndrome after extubation and coughing were analyzed in the groups. Results. The sensory response to the cold sample, after the administration of local anesthetics in the groups, differed: in the first group, 300 (241.25, 314.75) s, in the second group 54.5 (45.75, 60.25) s. The maximum level of the sensory block in the groups was different. During the induction and maintenance of anesthesia, the most common critical incident was hypotension. Reduction of systolic blood pressure for the induction of anesthesia in group 1 was detected in 6 (25%) cases, in group 2 in 7 (29%). After extubation, the pain syndrome in the first group was 1.7 (1; 6), in the second group 1.7 (1; 4). With a cough, the assessment of the pain syndrome had the same intensity of pain, both in the first and in the second group 2 (1; 3). Conclusions. Levobupivacaine with epidural anesthesia accelerates the development of the sensory block. The maximum level of the sensory block does not differ with the use of levobupivacaine and ropivacaine. Hypotension in the stages of anesthesia is a frequent critical incident in epidural anesthesia. The severity of the pain syndrome during extubation and in the immediate postoperative period does not depend on the selected anesthetic.

Achilles Mario Dogliotti, the surgeon station wagon, the author a set of new interventions in neuro, onko-and a heart surgery performed the first-ever successful operation with use of the cardiopulmonary bypass on August 7, 1951. Dogliotti paid special attention and fruitfully was engaged in surgery of a liver and biliary tract. He developed a way of removal of bile in cases when it is impossible to use the general bilious channel with a resection of a part of the left share of a liver (Dogliotti’s way); operation at damage of outside bilious ways with sewing together of a channel on a rubber tube and removal of its disteel end through a front wall of a stomach and a front belly wall outside (Dogliotti’s operation); a way of drainage of biliary tract with carrying out a drainage tube with several side openings outside through the general bilious channel in a duodenum (Dogliotti’s way). A number of interesting innovations offered Dogliotti in cardiovascular surgery. So, it possesses a way of prosthetics of the mitralny valve the pericardium rag on a leg entered into a heart cavity through its wall and attached between the papillary muscles (Dogliotti’s method). He offered some modifications of operations at the inborn and acquired heart diseases. For partial compression of large vessels of Dogliotti developed the tool having three working bransh (a surgical clip of Dogliotti-Vishnevsky), I developed the device for artificial blood circulation and some other original tools for cardiovascular surgery. One of first-ever it made operation with use of extracorporal blood circulation in clinic. Also its researches and clinical application of a moderate and deep hypothermia in heart surgery are known. A. Dogliotti “The treatise on anesthesiology” (1952), “The operational equipment” (1956), “Surgery of bilious ways” (1958) published about 300 scientific works on surgery, including the monograph “Surgical Semiotics and Diagnostics” (1948). I created a number of original tools for cardiovascular surgery, I designed the device for artificial blood circulation, I offered some modifications of operations at the inborn and acquired heart diseases. One of first-ever I made operation in the conditions of extracorporal blood circulation.