BLAST INJURI. ANESTHESIA AND INTRAOPERATIVE INTENSIVE CARE AT THE EARLY HOSPITAL STAGE (ADVANCE NOTICE)

Abstract

Summary. Explosive injury is a combat multifactorial injury that occurs as a result of the combined damaging effect on the human body of a shock wave, gas jets, fire, toxic products of explosion and combustion, ammunition casing fragments, secondary projectiles. The hostilities taking place in Ukraine present many questions to anesthesiologists regarding the provision of medical care to victims of blast injuries. This type of injury is often associated with damage to 2-4 anatomical sites and sometimes more. Moreover, most of the hospital care is provided in civilian hospitals located close to fighting.
 The aim of study. The choice of anesthesia technology and intraoperative intensive therapy in victims of explosive trauma depending on the severity of the explosive trauma and the condition of the patients.
 Material and method. During the period March-December 2022, 226 (195 men, 31 women) patients of explosive injuries were admitted to the Zaporizhzhya Regional Clinical Hospital and assessed according to the GKO scale (standardized system for assessing the severity of injuries and the condition of patients.
 The results. Before the operation, there was normotension and moderate tachycardia. However, in 25 patients, the systolic blood pressure was less than 90 mm Hg, which required the use of sympathomimetics and infusion therapy with crystalloids and colloids. During the operation, sympathomimetics continued to be used in 42 patients. Norepinephrine was used in 37 patients in a dose of 0.1 to 0.4 μg/kg/min. Phenylephrine – in 5 patients in bolus doses of 20-100 μg.
 The indicators of systolic, diastolic, pulse, mean arterial pressure and heart rate at the stage of completion of the operation did not differ significantly from the initial ones. Before the operation, the patients had subcompensated metabolic and respiratory acidosis, hyperoxemia, and increased lactate concentration. At the stage of the operation, the phenomenon of metabolic acidosis increased, as evidenced by a significant increase in the BE indicator. Respiratory acidosis and hyperoxemia persisted. The concentration of lactate in the blood decreased significantly, on average by 21 %, but on average was (4.1±0.1) mmol/l.
 Conclusion. Assessing the severity of the patients on the GKO scale allows you to choose the anesthesia technology considering the influence of the drugs used for anesthesia on hemodynamics. At the stages of treatment of the patients of the blast trauma, it was possible to maintain normotension. Mixed decompensated acidosis and increased lactate at the end of the operation indicate oxygen debt.