Year 2014 Vol. 22 No 6

ANESTHESIOLOGY-REANIMATOLOGY

N.L. GOMON 1, I.P. SHLAPAK 2

MULTIMODAL COMBINED ANASTHESIA / ANALGESIA IN COMPLEX TREATMENT OF SURGICAL PATIENTS WITH ABDOMINAL PROFILE

Vinnitsa National Medical University named after N.I. Pirogov1
National Medical Academy of Postgraduate Education named after P.P. Shupyk, Kiev 2
Ukraine

Objectives. To achieve a minimal impact on hemodynamics of multimodal anesthesia in combination with epidural analgesia with low concentration of bupivacaine as a technique of antinociceptive mechanism during surgery and in the postoperative period by using the hemodynamic index in surgical patients with abdominal profile.
Methods. Depending on the use of anesthesia and postoperative analgesia 45 patients with the operations on the abdominal organs (3-4 degree of risk according to ASA) were divided into two groups. In the first group a balanced general anesthesia with endotraheal mechanical ventilation of the lungs was used; in the second group a prolonged epidural analgesia with bupivacaine (0,1-0,25%) additionally applied.
Results. It was found out that the use of antinociceptive mechanism due to additional application of low concentrations of bupivacaine (0,1% or 0,25%) for the epidural analgesia based on the dynamics of the integral hemodynamic indicator is accompanied by a stable hemodynamics without hypotension and periods of increase of the average arterial pressure as well as by stable indices of the heart rate, low intensity of postoperative pain syndrome, earlier terms of the intestinal motility restoring in comparison with the general multicomponent anesthesia and a pharmacological postoperative analgesia. The use of traditional pharmacological techniques is accompanied by the periods of the arterial pressure increase, expense of large quantities of drugs for anesthesia, analgesia and symptomatic support, longer terms of the intestinal passage restoring that increases the risk of postoperative early and delayed complications.
Conclusion. The conducted study gives an opprtunity to recommend the use of the multimodal anesthesia combined with the epidural analgesia with low concentration of bupivacaine for perioperative providing of surgical patients of the abdominal profile.

Keywords: multimodal anesthesia, epidural analgesia, abdominal surgery
p. 721-726 of the original issue
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Address for correspondence:
21018, Ukraina, g. Vinnitsa, ul Pirogova, d. 56,
Vinnitskiy natsionalnyiy meditsinskiy universitet
im.N.I.Pirogova, kurs
anesteziologii-reanimatologii
kafedryi khirurgii 1,
tel. 380 677 24-31-07,
e-mail: mgomon@meta.ua,
Gomon Nikolay Longinovich
Information about the authors:
Gomon N.L. PhD, an associate professor, a head of the course of anesthesiology- reanimatology of the surgery chair 1, Vinnitsa National Medical University named after N.I. Pirogov.
Shlapak I.P. MD, professor, a head of the anesthesiology chair, National Medical Academy of Postgraduate Education named after P.P. Shupyk.
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