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THE USE OF INHALATION ANAESTHETIC ISOFLURAN AT ONCOLOGICAL PATIENTS OF HIGH CARDIOLOGICAL RISK Mutagirov V.V.1, Baibussinova S.K2, Umurzakov КО.3, Shomansurov Sh.Sh.4, Abdimutalip Ye.Ye.5, Turdaliyev Ye.M.6 (Republic of Kazakhstan) Email: [email protected]
1Mutagirov Vladimir Vladimirovich - Candidate of Medical Sciences, Senior Resident, DEPARTMENT OF ANESTHESIOLOGY AND INTENSIVE CARE, NATIONAL SCIENTIFIC CENTER OF SURGERY; 2Baibussinova Sabina Kairatovna - Resident;
3Umurzakov Rabat Omanovich - Resident; 4Shomansurov Sherzot Shakirovich - Resident; 5Abdimutalip Yeldos Yermekovich - Resident; 6Turdaliyev Yerbol Missakhmetovich - Resident, DEPARTMENT OF ANESTHESIOLOGY AND INTENSIVE CARE MEDICINE, ASFENDIYAROVKAZAKH NATIONAL MEDICAL UNIVERSITY, ALMATY, REPUBLIC OF KAZAKHSTAN
Abstract: in the given research the comparative estimation inhalation of anaesthetic isoflurane at oncological patients of high cardiological risk was spent. In the first group, total intravenous anaesthesia was spent to the second inhalation anaesthesia on a basis of isoflurane. Comparison of haemodynamic effects at two kinds of anaesthesia, has shown that at total intravenous anaesthesia there is a hyperdynamic type of blood circulation in comparison with inhalation anaesthesia on a basis isoflurane.
Keywords: inhaled anesthesia, isoflurane, hemodynamics.
ИСПОЛЬЗОВАНИЕ ИНГАЛЯЦИОННОГО АНЕСТЕТИКА ИЗОФЛУРАНА У ОНКОЛОГИЧЕСКИХ БОЛЬНЫХ ВЫСОКОГО КАРДИОЛОГИЧЕСКОГО РИСКА
1 2 3
Мутагиров В.В. , Байбусинова С.К. , Умурзаков Р.О. , Шомансуров Ш.Ш.4, Абдимуталип Е.Е.5, Турдалиев Е.М.6 (Республика Казахстан)
1Мутагиров Владимир Владимирович - кандидат медицинских наук, старший ординатор, отделение анестезиологии и реаниматологии,
Национальный научный центр хирургии; 2Байбусинова Сабина Кайратовна - резидент;
3Умурзаков Рабат Оманович - резидент; 4Шомансуров Шерзот Шакирович - резидент; 5Абдимуталип Елдос Ермекулы - резидент; 6Турдалиев Ербол Мисахметович - резидент, кафедра анестезиологии и реаниматологии, Казахский национальный медицинский университет им. С.Д. Асфендиярова, г. Алматы, Республика Казахстан
Аннотация: в данном исследовании проводилась сравнительная оценка ингаляционного анестетика изофлурана у онкологических больных высокого кардиологического риска. В первой группе проводилась тотальная внутривенная анестезия, во второй ингаляционная анестезия на основе изофлурана. Сравнение гемодинамических эффектов при двух видах анестезии показало, что при ТВА имеется гипердинамический тип кровообращения по сравнению с ингаляционной анестезией на основе изофлурана. Ключевые слова: ингаляционная анестезия, изофлуран, гемодинамика.
UDC 616-14.0-4568+4514.0
Relevance: Elderly patients with an oncological profile, as a rule, have a variety of comorbidities, including the cardiovascular system. An anesthetic treatment in these patients remains an urgent problem. The use of a modern halogen-containing anesthetic of the second generation - isoflurane - is a great help for solving this problem. Isoflurane is non-toxic and has favorable pharmacodynamic and pharmacokinetic properties. The cardioprotective effect of the latter deserves special attention [1, 2, 3]. Reports on the effects of isoflurane in cancer patients with compromised cardiovascular systems are few and contradictory.
Purpose of the work: to study the hemodynamic features of inhalation anesthesia based on isoflurane during operations in cancer patients with concomitant cardiac pathology.
Material and Methods: The features of the course of anesthesia were studied in 36 male patients aged 60 to 80 years, suffering from essential hypertension stage 3-4, functional class 2-3 and chronic heart failure of the 1st degree, who underwent gastrectomy with lymphadenectomy under conditions various anesthesia options: total intravenous anesthesia using fentanyl, ketamine, diazepam, propofol for 17 people (group 1) and inhalation anesthesia based on isoflurane and fentanyl for 19 people (group 2). All patients received standard sedation. In all patients, induction was carried out by sequential administration of fentanyl (4.4 ^g / kg), ketamine (2-4 mg / kg) and propofol (4 mg / kg). The myoplegic effect was achieved by administering pipcuronium bromide (0.1 mg / kg). There were no significant differences in weight, height, age, severity of the initial state. Maintenance of anesthesia in group 1: fentanyl 3.3-12 ^g / kg / h, ketamine 1.98 ± 0.9 mg / kg / h, propofol at a dose of 3-6 mg / kg / h. In group 2, fentanyl is administered at a dose of 5.1 ± 2 ^g / kg / hour, isoflurane 2 - 2.5 MAC.
Hemodynamic monitoring was performed using a NIHON KODHEN monitor. For the convenience of analysis and statistical processing, 5 stages were identified: 1) stable anesthesia; 2) after the incision; 3) gastrectomy; 4) stage of lymph node dissection; 5) sealing the skin wound. The calculation of hemodynamic parameters and oxygen transport function of blood circulation was carried out according to the Fick principle. The data were processed by statistical methods using the t-test for quantitative data in Microsoft Excel 2019. Differences were considered significant at p <0.05. Data were expressed as mean ± standard deviation (M ± c).
Research results and their discussion. The study revealed the relative stability of the indicators of systemic hemodynamics during surgery and anesthesia in two groups (Table 1).
Table 1. Changes in indicators of central hemodynamics and oxygen transport in groups
Indicators Stages
1 2 3 4 5
Heart rate, min-1 1 66,3±13,4 70,2±13,2* 74,3±15,1* 86,1±14,4* 88,1±11,5*
2 64±10 64±12# 70±11 * 87±11* 85±16*
Mean arterial pressure (mm Hg) 1 83,6±10,2 89,5±12,5 75,7±10,1* 70,1±10,1* 69,6±10,7*
2 88±16 87±14 77±17* 71±13* 72±18*
Central venous pressure (mm Hg) 1 6±1 5±1 5±1 8±1* 8±3*
2 4±1 5±2* 5±1 6±2* 8±2*
Cardiac index (l/min/m2) 1 2,4±0,5 2,6±0,8 3,8±0,7* 3,8±1* 3,6±2*
2 2,3±0,2 2,3±0,7 3,5±0,6* 3±0,7*# 2,8±1* #
Index of vascular resistance (din/s/sm5) 1 1648±531 1700±722 2488±645 1376±335* 2301±299*
2 1414±516 1682±470 1400±333# 1233±301* 1254±673*#
Left ventricular stroke index(gm/m2) 1 41±15 39±12 28±18* 35±11* 33±16*
2 47±14 43±11 31±12* 34±12 36±13 #
Notes: 1) * - significant differences compared with stage 1; 2) # - significant differences between groups 1 and 2 at the stages of treatment (p <0.05).
In all groups, there is a clear tendency for the heart rate to increase by 7-21 min -1 (p <0.05) compared to the initial values. At stage 2, the heart rate in the isoflurane group was 7% lower than in the TBA (p <0.05), which was due to the negative chronotropic effect of the inhalation anesthetic. In two groups SBP at 3, 4 and 5 stages decreases by 6-16 mm Hg. (17%) compared with baseline values (p <0.05). There were no significant intergroup differences in CVP; the preload on the right heart was identical. The cardiac index was 33% higher in the TIVA group compared with isoflurane (p <0.05) at stages 4 and 5. IOPSS in the TIVA group at the same stages is 1.5 times more than in the group with isoflurane (p <0.05). These hemodynamic changes demonstrate a hyperdynamic type of blood circulation in the propofol-ketamine-based TIVA group compared with isoflurane-based inhalation anesthesia. Circulatory hyperdynamism is undesirable in patients with high cardiac risk, since it negatively affects the oxygen delivery / consumption ratio in the myocardium.
Conclusion: The use of isoflurane-based inhalation anesthesia during operations in cancer patients of high cardiac risk is characterized by more favorable hemodynamic parameters as compared with total intravenous anesthesia.
References / Список литературы
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3. Conzen P.E., Vollmar B., Habazetti H. et al. Systemic and regional hemodynamics of isoflurane and sevoflurane in rats // Anesth. Analg., 1992. Vol. 74. № 1. P. 79-88.
