Safe anesthesia, analgesic and sedation in the surgery of head and neck tumors

Abstract

Highly traumatic surgical interventions for head and neck tumors were performed in 62 adult patients under conditions of multimodal opioid-free general anesthesia, which included dexmedetomidine, lidocaine, nefopam, and sevoflurane. In 18 cases, due to trismus II – IV degree, fibro optic nasotracheal intubation was used, in 10 patients with laryngeal stenosis, the operation was started with tracheotomy under local anesthesia. In all 28 cases, local anesthesia was supplemented by sedation with intravenous (IV) administration of dexmedetomidine and lidocaine, which was enhanced by the addition of sub-drug doses (10–20 mg) of ketamine. Consciousness and spontaneous breathing were preserved in all observations. Before intubation, propofol and rocuronium were added, and at the stage of the main operation, against the background of intravenous infusion of dexmedetomidine and lidocaine, inhalation of sevoflurane vapors (1–1.5 MAC). In 62 cases, the course of the operation and anesthesia was smooth, awakening and restoration of spontaneous breathing occurred after the end of the operation. Postoperative pain relief for the first two days was in the form of a continuous iv infusion of a 3-component mixture of 1% lidocaine and two non-opioid analgesics (nefopam and tenoxicam) using a disposable elastomeric pump. In the next 3-4 days, they switched to intramuscular administration of nefopam and tenoxicam. The quality of pain relief was high, without clinically significant complications. Only in three cases, at the beginning of mastering the technique, it was necessary to resort to an additional single injection of promedol or tramadol.