Influence of multimodal anesthesia and analgesia on mechanisms of blood circulation adaptation of oncogynecologic patients in the postoperative period

Abstract

Objective: to assess the influence and eff ectiveness of multimodal anesthesia and analgesia from the standpoint of personalization of compensatory mechanisms of blood circulation adaptation in oncogynecologic patients in the postoperative period. Materials and methods: a study was conducted in patients who underwent surgical interventions on pelvic organs for oncogynecological diseases. The total number of patients was 39 people. Based on anesthesia with sevoflurane at low concentrations and spinal analgesia, all patients underwent multimodal anesthesia. To determine the nature of the functioning of the circulatory system, the adaptive potential was determined by the index of functional changes. For the relief of pain syndrome in patients in the postoperative period, the administration of ketoprofen and nefopam hydrochloride, used according to the doctor’s prescription or in the patient-controlled analgesia mode, as well as the regional blockade of the nerves innervating the anterior abdominal wall (Transversus Abdominis Plane block) was provided. Results: it was revealed that multimodal anesthesia and analgesia, depending on the level of the adaptation potential, differently affects the adaptation and regulatory mechanisms of the systemic circulation of patients, and its vegetative tone, which can cause the risk of complications in the postoperative period. Conclusions: multimodal anesthesia and analgesia, including a combination of central, regional non-narcotic analgesics and blockades, allows to preserve the reserves of systemic circulation and optimize its vegetative component, is effective and safe in oncogynecologic patients with the stress of regulatory mechanisms of adaptation. The use of multimodal anesthesia and analgesia in oncogynecologic patients with unsatisfactory adaptation is a risk factor for the disruption of the regulatory and compensatory mechanisms of hemodynamics and the vegetative tone of the systemic circulation, contributing to the limitation of its work in the first 24 hours of the postoperative period.