Гемодинаміка при корекції лійкоподібної деформації грудної клітки за Nuss

Abstract

Introduction. The hemodynamic parameters during the Nuss procedure for repair of pectus excavatum are under the influence of surgical procedures and anesthetic components especially regional blocks. The aim of the study: analysing the hemodynamic parameters during the Nuss procedure for repair of pectus excavatum under the combination of general anesthesia with different regional analgesia techniques. Materials and methods. The observative prospective study inclueded 60 adolescents (boys/girls=47/13) undergone the Nuss procedure for repair of pectus excavatum under the combination of general anesthesia with different types of regional blocks. The patients were randomized into three groups (n=20 in each) according to the regional analgesia technique: standart epidural anaesthesia in the dermatome of maximal deformity (SEA), high epidural anaesthesia in Th2-Th3 level (HEA) and bilateral paravertebral anaesthesia (PVA). The deformity severity by Haller index in all patients was 3.9 [3.6–4.1]. The blood pressure (BP) and heart rate (HR) were analyzed at different stages of anesthesia and surgery. Results. SEA resulted to significant derease in BP up to 30% compared to initial level before anesthesia. In the HEA group the decrease in BP was moderate and in PVA group the BP did not decrease at all. The sternal elevation and applying capnothorax increased BP without increasing HR. The bar rotation provided a little hemodynamic change in spite of being the most traumatic moment of such surgery. Under PVA HR was moderately increased but BP was almost unchanged, and the intraoperative infusion volume was the smallest in PVA group. HEA provided more stable hemodynamics in comparison to SEA. At the end of surgery hemodynamic parameters almost the same as initial before surgery. Conclusions. During the Nuss procedure for pectus excavatum repair the blood pressure decreased significantly under the standart epidural anaesthesia in the dermatome of maximal deformity, moderately – under the high epidural anaesthesia in Th2-Th3 level and was stable under the bilateral paravertebral anaesthesia. HR decreased under epidural blocks but not under PVA. The sternal elevation and applying capnothorax increased BP. The initial hemodynamic parameters before surgery did not correlate with the severity of deformity according to the Haller index. The study was conducted in accordance with the principles of the Helsinki Declaration. The study protocol was approved by the Local Ethics Committee of the institution. Informed consent of parents and children was obtained for the study. The author declares no conflict of interest. Key words: hemodynamics, pectus excavatum, Nuss procedure, epidural anaesthesia, paravertebral anaesthesia.