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40DOI: 10.24411/2181-0443/2021-10005 АНАЛИЗ ЭТАПОВ КОМБИНИРОВАННОЙ ИНГАЛЯЦИОННОЙ АНЕСТЕЗИИ НА ОСНОВЕ ОЦЕНКИ BIS- ИНДЕКСА ПРИ КАРДИОХИРУРГИЧЕСКИХ ВМЕШАТЕЛЬСТВАХ У ДЕТЕЙ
Усманова Дурдона Джурабаевна Хайдаров Камбарали Имомалиевич
Ташкентский педиатрический медицинский институт
Данное исследование посвящено разработке оптимального варианта методики ингаляции севофлюрана и его дозы, что позволило удерживать значение BIS-индекса между 40 и 60 (диапазон, позволяющий провести адекватную анестезию). Целью исследования было определить оптимальный способ ингаляции и дозировки севофлюрана на этапах анестезиологического пособия для проведения адекватной анестезии на основании BIS-мониторинга.
Ключевые слова: анестезия, BIS-мониторинг, комбинированная ингаляционная анестезия, кардиохирургия.
БОЛАЛАРДА КАРДИОЖАРРОХЛИК АРАЛАШУВЛАРИДА BIS- ИНДЕКСИНИ БАХ.ОЛАШГА АСОСЛАНГАН БИРГАЛИКДАГИ ИНГАЛЯЦИОН АНЕСТЕЗИЯ
БОСЦИЧЛАРИНИНГ ТАХДИЛИ
Ушбу тадКиКот севофлюран билан ингаляция техникасининг оптимал вариантини ва унинг дозасини ишлаб чи^ишга баГишланган булиб, бу BIS-индекс Кийматини 40 дан 60 гача ушлаб туришга имкон берди (етарли даражадаги беХуштлик чаКириш имкониятини яратди). ТадКиКот маКсади BIS-мониторинг асосида етарли даражадаги беХуштликни чаКириш учун беХуштлик босКичларида севофлюран билан ингаляция утказиш ва унинг дозаланиш оптимал усулини аниКлашдан иборат булди.
Калит сузлар: анестезия, BIS-мониторинг, биргаликдаги ингаляцион анестезия, кардиожарроХдик.
ANALYSIS OF THE STAGES OF COMBINED INHALATION ANESTHESIA BASED ON THE ASSESSMENT BIS-INDEX FOR CARDIAC SURGERY IN CHILDREN
This study is devoted to the development of the optimal variant of the inhalation technique for sevoflurane and its dose, which allowed maintaining the BIS-index value between 40 and 60 (the range that allows for adequate anesthesia). The aim of the study was to determine the optimal way of inhalation and dosage of sevoflurane at the stages of anesthetic management for adequate anesthesia based on BISmonitoring.
Key words: anesthesia, BIS -monitoring, combined inhalation anesthesia, cardiac surgery.
Relevance. In the practice of anesthesia in children, the issue of assessing the level of depression of consciousness or the adequacy of sedation is quite acute and significant from the point of view of the psychoemotional perception of the methods of treatment. A significant number of publications by specialists are currently devoted to this important
component of monitoring the patient's condition. [1-5-9].
The use of BIS monitoring enables us to control the depth of anesthesia and reduce episodes of intranarcotic recovery of consciousness or excessive deep anesthesia [2]. According to the literature, BIS monitoring reduces the incidence of intranarcotic recovery
of consciousness by 80% [6-8]. But the problem is that not all operating rooms are equipped with this equipment. In our work, we tried to develop the optimal variant of the method of inhalation of sevoflurane and its dose, which allowed us to keep the BIS-index value between 40 and 60 (the range allowing for adequate anesthesia).
The aim of the study was to determine the optimal way of inhalation and dosage of sevoflurane at the stages of anesthetic management for adequate anesthesia based on BIS monitoring.
Materials and research methods. The study was carried out on the basis of the department of cardiac surgery of the TashPMI clinic. The study included 36 children with the diagnosis (Atrial septal defect-12, Ventricular septal defect-16, Partial abnormal drainage of pulmonary veins-3, Opening of the atrioventricular canal-2, Ventricular septal defect with pulmonary artery stenosis-3). The patients were divided into two groups: in group 1 (13 children), anesthesia was carried out under the control of BIS monitoring; and in group 2 (13 children) before inhalation anesthetic was determined by hemodynamic parameters and other clinical signs. The study did not include children with pathology of the central nervous system. The examination included collection of complaints and anamnesis, physical examination data, as well as laboratory and instrumental research. Pre-operative premedication included atropine sulfate 0.1% -0.01mg / kg, sibazone 0.5% -0.3mg / kg, ketamine 5% 3-5mg / kg. All patients underwent standard perioperative monitoring, including continuous pulse oximetry, capnography (Vamos, Drager, German), ECG recording, heart rate, invasive arterial and central venous pressure (Vista 120, Drager, German). Prior to induction into anesthesia, all patients underwent peripheral vein catheterization (KDM, B | Braun, Germany). Anesthesia was induced with sibazone 0.25 mg / kg and fentanyl 5-7 ^g / kg. Before tracheal intubation, myorelaxation was performed with 0.1 mg / kg pipcuronium bromide and was subsequently maintained by bolus administration of 0.015 mg / kg. Anesthesia was maintained with an inhalation anesthetic sevoflurane and fractional administration of fentanyl to provide a depth of
anesthesia at the surgical level of 40—60 points under the control of a cardiac monitor module (UTAS 300TM, Ukraine). After induction of anesthesia, the internal jugular vein was catheterized with a three-lumen catheter (Certofix, B. Braun) into one of the ports connected to a transducer for continuous monitoring of central venous pressure. Artificial ventilation of the lungs in the operating room was performed with a Fabius XL apparatus (Drager, German) with parameters, tidal volume 10—12 ml / kg, respiratory rate 20—22 / min, LFA. Infusion therapy during the operation was carried out with isoosmolar solutions in the early postoperative period, with a balanced solution, and in the case of hypovolemia, with 6% solution of HES "Volustim" 130 / 0.42 in a balanced solution (in group 1, depending on BIS parameters, and in group 2, in according to the recommended doses - 2 V%). The recovery of the patient's consciousness after the operation was determined by spontaneous opening of the eyes, full restoration of reflexes and the execution of commands such as "show your tongue", "squeeze my hand", "raise your head".
Research results and discussion In group 1, the BIS value after premedication fluctuated between 70 and 80. During the induction of anesthesia, the BIS value dropped sharply to an average of 32, which means that the sevoflurane we used at an average dose of 1.5 ± 0.7 V% is quite sufficient. This level of anesthesia was maintained for an average of 6 minutes, after which we began inhalation of Sevoflurane at a rate that allowed us to keep the BIS value between 40-60. On average, the concentration of sevoflurane was 2.1 ± 0.7 V%, and only three patients needed inhalation of sevoflurane to increase 3.5 V%. After that, the average flow of inhalation to maintain averaged 2.4 ± 0.9 V% before and after perfusion, inhalation of sevoflurane was stopped on average 5 minutes before the end of the operation, taking into account the BIS parameters. Thus, BIS- monitoring not only allowed us to save anesthetics, but also led to a reduction in the percentage of surface anesthesia and excessively deep anesthesia, which was reflected in the rate of consciousness recovery, which was 35 ± 4.6 minutes in group 1, which is significantly lower than in 2 nd group - 44 ± 3.7
minutes. Based on our results, we can say that the dose of sevoflurane 2 V% for the induction of anesthesia is quite sufficient. For the first half hour, the flow of sevoflurane, sufficient to maintain an adequate depth of anesthesia, is 2.5 V%.
Conclusions. Conducting anesthesia using BIS-monitoring allows to reduce the doses of drugs used, reduce the number of episodes of
excessively deep and superficial anesthesia, and shorten the recovery time after the end of the operation.
Based on our data, we can recommend the following scheme for anesthesia with sevoflurane: 2 V% for induction; 2.5 V% before and after the perfusion period, allows maintaining the required level of sedation.
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