Abstract
Objective. To analyze the influence of the sequence of anterior and posterior fusion procedures performed under combined anesthesia in a single surgical session on gas exchange and hemodynamics in patients. Material and Methods . The performance of gas exchange and hemodynamic status was analyzed in 125 patients who underwent simultaneous two-stage combined intervention for post-traumatic spine deformity. All operations were performed under combined anesthesia with low flow sevoflurane. Patients were divided into two groups depending on the sequence of anterior and posterior fusion procedures: Group I (posterior-anterior sequence) included 60, and Group II (anterior-posterior sequence) - 65 patients. Results . An open pneumothorax, mechanical compression of the lungs, and hyperextension of the spine are the main factors affecting the degree of deviations in hemodynamics and gas exchange, which require adjustment of mechanical ventilation and infusion rate parameters. The most statistically significant changes in analyzed indicators were registered in patients in Group I. Conclusion . The anterior-posterior sequence of fusion procedure is more physiological treatment of patients comparing to the posterior-anterior one.
Highlights
To analyze the influence of the sequence of anterior and posterior fusion procedures performed under combined anesthesia in a single surgical session on gas exchange and hemodynamics in patients
The performance of gas exchange and hemodynamic status was analyzed in 125 patients who underwent simultaneous two-stage combined intervention for post-traumatic spine deformity
Наук, Новосибирский государственный медицинский университет; Виктор Викторович Рерих, д-р мед
Summary
To analyze the influence of the sequence of anterior and posterior fusion procedures performed under combined anesthesia in a single surgical session on gas exchange and hemodynamics in patients. The performance of gas exchange and hemodynamic status was analyzed in 125 patients who underwent simultaneous two-stage combined intervention for post-traumatic spine deformity. Анестезиологическое обеспечение технологий комбинированных вмешательств при деформациях позвоночника. В настоящее время методом выбора хирургического лечения ригидных посттравматических деформаций позвоночника является тактика двухэтапных комбинированных вмешательств в одну хирургическую сессию [9, 11, 12, 24]. Современный подход к анестезиологическому обеспечению хирургических операций трудно представить без использования галогенсодержащих анестетиков, в частности севофлурана (СФ), в режиме низкопоточной анестезии (LFA – low flow anesthesia) как метода, позволяющего существенно улучшить микроклимат в дыхательном контуре при одновременном снижении расхода кислорода, используемых ингаляционных анестетиков и риска микробной контаминации дыхательных путей. Указанные аргументы предопределили цель исследования – установить влияние последовательности выполнения вентрального и дорсального спондилодезов позвоночника, выполняемых в условиях комбинированной анестезии в одну хирургическую сессию, на состояние газообмена и гемодинамический статус оперируемых
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