In the dissertation the effective and safe method of preventive intraoperative anesthesia of small endouteral surgical interventions is determined on the example of curettage of the uterine cavity (CUC) on the basis of the study of hemodynamic, temporal, economic, socio-psychological changes, as well as stress response of patients in early postoperative period.
Using "blind envelopes" method, women were divided into 4 groups of 32 patients each, depending on the method of general anesthesia. Difference between the groups was the difference in drug combinations and dosages of anesthetic management. Group I — anesthesia was performed by the combination of propofol (2 mg/kg), fentanyl 0.2 (μg/kg) and ketamine (0.2 mg/kg). Difference of group II is using of dexketoprofen at the dose of 50 mg, of group III – reduction in the dosage of ketamine to 0.1 μg/kg and fentanyl to 0.1 μg/kg. Group IV was different for intraoperative preventive anesthesia, the application treatment of the wound surface was performed, which caused the removal of the endometrium from the uterine cavity by 5.0 ml of 0.25% bupivacaine solution.
The general analysis of dynamic changes in the parameters of vital functions confirmed the development of postoperative PS within 5 hours after the end of the CUC.
The obtained data indicate the lack of development of postoperative PS with the use of bupivacaine as the preventive intraoperative anesthetic.
Serum glucose, cortisol, insulin and calculation of cortisol-insulin index were selected for research as the stress marker that confirms the significant difference in pain levels in patients of group IV and group I, II, III for 5 hours in favor of group IV. The significant improvement of their indicators is possible by preventive anesthesia of the postoperative period by application treatment of the wound surface, which was formed after removal of the endometrium, with bupivacaine solution.
For the comprehensive study of the problem of pain in the postoperative period in patients of the gynecological hospital after the CUC, they are surveyed at the same control points where vital signs and biochemical parameters were studied. The results of the subjective evaluation of pain were obtained by questioning patients on the visual-analog scale (VAS) in points. The results of VAS testing at the 3rd control point in groups I-III indicate the presence of pain requiring medication correction, namely 4 points or more on the VAS scale. Such indicator was never recorded in group IV in patients who underwent preventive intraoperative application anesthesia, that is, the development of PS in the postoperative period was prevented. The analysis of the obtained results of the assessment of the quality of life (QL) was also carried out on the sum of points on the concretizing questions of the questionnaire EQ-5D, which in the complex reflected all spheres of life of patients. So, the psycho-emotional state of most patients of groups I-III was defined as depressed, in contrast to patients of group IV, who gave the impression of vigorous and active women, eagerly made contact, took a lively part in conversations with relatives and medical staff. Active behavior of patients of group IV is associated with the absence of PS. Assessment of QL in the early postoperative period on the basis of the second questionnaire, namely, “QL Questionnaire for One Day Surgical Hospital Patients in the Early Postoperative Period”, also proved the advantage of the analgesia technique using intraoperative preventive anesthesia with 5.0 ml of 0.25% bupivacaine solution.
We evaluated and calculated the pharmacoeconomic effectiveness of the studied combinations of anesthetic management of the CUC at all stages of the procedure of CUC, namely premedication, surgical intervention and postoperative period.
By recalculation of total cost of the anesthesiology of CUC, the minimum savings (against the cost of anesthesia in groups I and IV) on the scale of the state may reach 11 914 413.3 UAH per year with a help of using method of intraoperative application anesthesia.
In the dissertation the selection of preventive intraoperative anesthesia of the CUC on the basis of interrelations of changes in hemodynamic, temporal, economic, socio-psychological characteristics, and stress response of patients in the early postoperative period, which is based on the concept of effective anesthesia, short rehabilitation period, high level of QL, which proved its medical, social and economic feasibility.
