Comparison of methods of anesthetic management in hysteroscopy

Abstract

The objective: to evaluate and improve the existing methods of anesthetic support during hysteroscopy.Materials and methods. In 2021-2022 years, 40 patients who had operative treatment – hysteroscopy, were examined in the municipal non-commercial enterprise “Kyiv City Center of Reproductive and Perinatal Medicine”. The exclusion criterion was the presence of concomitant diseases (hypertension, type 1 and type 2 diabetes, bronchial asthma, etc.).All patients were randomly divided into two groups depending on the chosen method of anesthesia. In the 1st group, standard total intravenous anesthesia was performed and premedication with nefopam and paracetamol was used for the improvement the anesthetic support and compare the results in the 2nd group.The hemodynamic indicators of heart rate (HR), systolic blood pressure (SBP), diastolic blood pressure (DBP) and mean arterial pressure (MAP) were measured to objectify the level of the pain syndrome, oxygen saturation in the blood was measured also. Pain was assessed using a visual analog scale (VAS) questionnaire.Results. It was established that the anesthetic support of the 1st group of patients was accompanied by a significant (p<0.05) increase of hemodynamic indicators at the stage of the beginning of the operation versus the indicators of the 2nd group: SBP – by 13.77%; DBP – by 11.92%, MAP – by 13.08%. After the end of anesthesia (awakening), an increased blood pressure was registered in the 1st group, which had a significant difference with similar indicators of the 2nd group, namely: SBP by 22.33%, DBP – by 19.05%, MAP – by 20.51%.Heart rate in the 1st group after the installation of a laryngeal mask (induction of anesthesia) was higher by 12.85% (p<0.05) than in the 2nd group. Heart rate was also higher upon awakening in the 1st group – by 16.03% (р<0.05) than in patients of the 2nd group. In the 2nd group, the maximum VAS score in 30 minutes after waking up was 0.9±0.11 points, which did not require additional analgesia, while in the 1st group this score was 3.86±0.20 points.20% of patients who were not premedicated with nefopam and paracetamol, in 30 minutes after surgery had vomiting, which was not present in the group where premedication was performed.Conclusions. Premedication with nefopam and paracetamol as the additional analgesics can prevent the development of pain sensations in the postoperative period and reduce the incidence of vomiting. The use of a laryngeal mask during artificial lung ventilation ensured adequate tightness of the connection of the respiratory tract with the circuit of the anesthesia machine.