OPTIONS OF GENERAL ANESTHESIA FROM THE POINTS OF CLINICAL EFFICIENCY AND COMPLIANCE OF PATIENTS IN MINOR GYNECOLOGICAL SURGERY
DOI:
https://doi.org/10.11603/1811-2471.2024.v.i3.14906Keywords:
hysteroscopy, general anesthesia, inhalation analgesia, VAS scaleAbstract
SUMMARY. Hysteroscopy has become the main method of diagnosis and treatment of endometrial pathology in gynecology. There are few studies on the analgesic effect of techniques without the use of opioids in the concept of "Accelerated recovery after surgery", especially in the field of ambulatory gynecological surgery.
The aim – to evaluate the clinical effectiveness and frequency of adverse events in different options of general anesthesia for minor gynecological operations.
Material and Methods. The research was conducted on the basis of "AVIDA Medical Clinic" LLC during 2022–2023. To achieve the goal of the work, a prospective, randomized, open study was conducted, during which 72 patients with endometrial pathology who underwent hysteroscopic polypectomy were examined. All patients were divided into two groups depending on the anesthesia performed. The first (control) group included 37 patients who underwent standard opioid-based general anesthesia with the use of fentanyl 2–4 μg/kg/h and propofol 1.5–2.5 mg/kg/h intravenously. To ensure adequate blood saturation against the background of spontaneous breathing, oxygen therapy (3-6 l/min) was used. The second group (main) was formed from 35 patients who were given inhalation analgesia using methoxyflurane (2 ml) and dexketoprofen 50 mg intravenously.
The level of pain sensitivity was assessed using an algesimeter. The examination was carried out dynamically in 5 stages: I – before the operation, II – before the operation after the patients enter the operating room, III – after the induction of anesthesia, IV – within 10 minutes after the transfer of the patients to the postoperative ward, V – 2 hours after the operation.
Evaluated criteria: anesthesia time, hemodynamic response, mean arterial pressure (MAP), heart rate (HR), assessment of the level of pain according to the visual analog scale (VAS), assessment of the intensity of pain according to the modified Scott scale (from 0 to 10 points ), determination of the frequency of negative reactions associated with anesthesia.
Results. The average age of the examined patients was 37.5±10.5 years in the 1-st group and 36.9±9.8 in the 2-nd group. The body mass index (BMI) was 22.4±3.1 kg/m2 in the 1-st group, and 23.1±2.9 kg/m2 in the 2-nd group. The average duration of the operation in the first group was 21±5 minutes, in the second group it was 20±4 minutes. Immediately before the operation at the 1st and 2nd stages of the study, a moderate increase in MAP and heart rate was observed in the 1st and 2nd groups. At the III stage of the study, a significant decrease in the average blood pressure values was found in the 1st group by 21.4 % (р<0.05), in the 2nd group – by 11.3 % (р<0.05). The heart rate in the most traumatic stage of the operation increased by 16.5 % (p<0.05) in the 1st group and by 12.1 % (p<0.05) in the 2nd and by 9.1 % in the 3rd group, these changes also indicated hyperdynamic reactions of the cardiovascular system, activation of the neurovegetative system. A significant difference was observed at the IV stage for the 1-st group (10±4) mm, and in the 2-nd group – (32±7) mm (p<0.05). The average indicator according to the VAS scale at the V stage in the patients of the 2-nd group was (10±5) mm, which corresponds to the level of slight discomfort in the intervention area, and in the 1-st group, the patients did not notice any pain.
The frequency of manifestations of nausea at the IV stage in the 1-st group was 24 %, in the 2-nd group 13 %, and at the V stage in the first group 4 %, and in the second group there were no such manifestations. That is, in the group where opioids were used, such side effects as nausea occurred significantly more often.
Conclusions. Therefore, when performing hysteroscopic polypectomy, it is advisable to use general anesthesia based on opioids, since the subjective result of analgesia according to (VAS) is significantly better. Non-opioid inhalation analgesia is accompanied by a significantly lower rate of nausea. Therefore, non-opioid inhalation analgesia can be considered as an option for analgesia during diagnostic inspection hysteroscopy.
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