Abstract
Objective. To prove pathogenically the reasonability of multimodal anesthesia in patients with lung cancer to improve the efficacy of pain management. Materials and methods . 74 patients (59 men and 15 women) aged 46 to 60 years with lung cancer were examined and treated. 42 patients (the main group) underwent surgery under multimodal anesthesia accompanied with epidural blockade, and 32 patients (the comparison group) were subjected to a surgical intervention under inhalation and intravenous anesthesia with mechanical ventilation. The surgeries including atypical lung resection, lobectomy and pneumonectomy were performed. In preoperative, intraoperative and early postoperative periods, the systemic hemodynamics parameters were determined; adrenaline, noradrenaline, dopamine, cortisol, insulin and glucose were measured in plasma, and acidbase balance parameters — in arterial blood. Pain intensity was assessed by the visual analog scale. Data processing was carried out using Microsoft Exсel 2000, STATISTICA6.0 and Biostat software. Normality of distribution was assessed by KolmogorovSmirnov test. Since the ordered sample did not follow the normal distribution law, the data are presented as a median (Me) and interquartile amplitude (25 and 75 percentiles). Results. It has been found that the most significant pathogenic factor in patients being operated due to lung cancer under the standard anesthesia is the expressed activation of the sympathoadrenal system due to the impact of surgical stress. This is manifested by disorders of the central hemodynamic parameters, such as metabolism, nociception and oxygen balance. In surgeries carried out under multimodal anesthesia, the minimal changes of basic homeostasis parameters are registered; these changes are shorttermed, compensated and reversible. Pain syndrome upon completion of surgery and in the early postoperative period is either absent or mild. C onclusion . It is more expedient to perform surgeries to remove malignant tumors in the lungs under the multimodal anesthesia, because these interventions are distinguished by high traumatic rate and having a «fine line» between compensation and decompensation of the basic vital functions in the perioperative period.
Highlights
Заболеваемость злокачественными новооб разованиями легких с каждым годом неуклонно возрастает [1, 2], около 50% всех заболевших — лица трудоспособного и социально активного возраста [3]
The exclusion criteria were the presence of uncompensated concomitant pathology of the liver, kidneys, blood circulation, postinfarction cardioscle rosis, metastatic lesions, diabetes mellitus type 1 and 2, intake of any hormonal drugs, participation in another study, and patient's refusal to participate in the study
The parameters of central hemodynamics in the preoperative period in both groups corresponded to standard values and were not significantly different (Table 1)
Summary
Заболеваемость злокачественными новооб разованиями легких с каждым годом неуклонно возрастает [1, 2], около 50% всех заболевших — лица трудоспособного и социально активного возраста (от 46 до 60 лет) [3]. Методы мультиспи ральной компьютерной томографии, позитронно эмиссионной томографии легких значительно расширяют возможности диагностики злокачест венных новообразований легких [4, 5], что позво ляет выявлять опухоли на ранних стадиях, когда они поддаются радикальному хирургическому лечению [6]. Задача анестезиологического пособия за ключается в максимальной защите оперируемого пациента от хирургического стресса [7, 8]. При неадекватной антиноцицептивной защите происходит выра женная активация симпатоадреналовой системы в рамках стресс реакции [11], что приводит к по вышению содержания в крови основных гормо нов стресса (катехоламинов и кортизола), изме нению параметров центральной гемодинамики, усилению катаболических процессов, выражен ным метаболическим изменениям и нарушению
Sign-in/Register to view highlights & summary Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
