Безопіатна аналгоседація під час стентування коронарних артерій

Abstract

The widespread usage of opioids / opiates in anesthetic practice has highlighted a number of related problems. Therefore, in recent years, the concept of opiate-free anesthesia has been gaining popularity among anesthesiologists around the world. In this context, we are interested in lidocaine as a component of this anesthesia. The attention of anesthesiologists to lidocaine during analgesia is due to its analgesic, anti-inflammatory and antihyperalgesic properties. The basis of the analgesic effect of the drug is that it blocks sodium channels and depolarizes nociceptive peripheral neurons, simultaneously inhibits NMDA receptors, reduces the number of cytokine complexes circulating in the plasma, and dissociates the Gq protein. In general, these properties lead to a decrease in opiate consumption, an acceleration of rehabilitation, a decrease in episodes of nausea and vomiting, a reduction in hospital stay, and even has certain neuroprotective properties. The purpose of our work was to establish the main aspects of non-opiate anesthesia usage that was based on lidocaine during coronary stenting. Material and methods. We studied 60 patients with coronary artery disease who underwent stenting of the coronary arteries in a planned manner. The main diagnosis was exertional angina FC II-III. In terms of the duration of the surgery, it was 38.54±19.3 minutes, and the number of stents was 1.3±0.7. The patients were evenly divided into two study groups, depending on the prescribed drug regimen. The first group included patients who were sedated by slow intravenous administration of diazepam and fentanyl. In the group of non-opiate anesthesia, a lidocaine solution was the main component of analgesia. At the stages before the start of the surgery, during the main stage, namely, the stent placement, and after the end of the surgery, the parameters of hemodynamics, saturation, gas and electrolyte composition of blood, the level of glycemia and cortisol were assessed. Results and discussion. The main complaint of patients in the control group was drowsiness, which was noted by 36.7% of patients. We attribute this feature to the use of diazepam. However, drowsiness was also noted in 33.3% of the experimental group after surgery. This fact can be explained by the use of significant doses of propofol, which were needed to maintain hemodynamics at the appropriate level. Episodes of nausea and vomiting may occur during surgery, especially when using opiates with a high probability. The phenomena of nausea were observed in 13.4% of the 1st group, and in the 2nd group it occurred in 3.3% of cases. According to the recommendations, we administered 4 mg of ondasetron solution after which the nausea disappeared. In the second group, complaints related to the local anesthetic effects of lidocaine came to the fore. 63.3% complained of "crawling ants" or numbness in the hand, the same sensations in the cheek and numbness of the tongue – 33.3%. After the operation, the feeling of numbness in the hand persisted in 16.7%. It should be noted that these sensations did not cause significant discomfort and did not interfere with anesthesia. Conclusion. In the course of the work, we came to the conclusion that the usage of lidocaine at a dose of 1 mg / kg of the patient's body weight is safe for coronary artery stenting operations and, at the same time, there are no negative effects inherent in opiate based anesthesia. At the same time, the local anesthetic effects after using lidocaine do not worsen the course of the postoperative period