The first results of the application of multimodal anesthesia during surgical interventions on the chest organs

Abstract

The aim of the work: to show one of the variants of balanced anesthesia in performing surgical interventions on the organs of the chest.

Materials and Methods. The study analyzed 152 cases of analgesia, divided into three groups: the main 85 patients (proposed method) and two groups of comparison 37 and 30 cases, respectively. Operative intervention on the organs of the chest is performed with onesided mechanical ventilation (intubation of the right or left major bronchi), which was achieved by intubation with the endotracheal tube number 7 – number 7.5 on a usb-SMART camera attached to electronic visualization devices (in our case, a laptop). The ventilators were controlled by Blizar apparatus in controlled ventilation mode (CMV). After the completion of major surgical manipulations, ETT was transfused into the trachea, and mechanical ventilation was performed in the usual manner. In the period from 01.01.19. to 22.05.19 85 surgical interventions were performed according to this methodology (main group). In the comparison group, 30 patients were assigned, the surgical intervention was performed according to the common method of endotracheal analgesia with artificial ventilation (standard on fentanyl), the third group - fentanyl + paracetamol + lidocaine (37 cases). There were no complications in each of the groups.

Results and Discussion. The modern development of anesthesiology makes it possible to use different methods of analgesia. Most surgical interventions on the chest organs are complex, dangerous, and highly traumatic. To ensure better conditions for operative intervention, 80–90 % of cases are performed by one-sided incubation of one of the major bronchi, which requires more careful control of the depth of analgesia and vital signs from the anesthesiologist. Recently, there is a lot of information about multimodal analgesia, but the vast majority of publications is the use of it for the reduction of postoperative pain. In the literature available to us, we did not find information on the use of multimodal analgesia during surgical intervention. In addition, one should take into account, in modern conditions, the financial aspect – since one ampoule of narcotic analgesics (for example, fentanyl) is 2.5–3 times more expensive than one ampoule of NSAIDs (for example, nalbuphin 10 mg). This makes it possible to actively and prolonged use of it in conjunction with paracetamol for the purchase of pain in the postoperative period.