The dissertation is devoted to improving the effectiveness of anesthesia in the perioperative period of Caesarean Section (CS) on the basis of studying hemodynamic changes, stress response and the level of pain (PS) of women in labor, the main side effects and complications in the perioperative period.
The study involved 127 pregnant women with a mean age of 29.8 ± 0.5 years, who were surgically delivered by surgery. Depending on the method of anesthesia, women in labor were divided into 2 groups. СS section for group 1 (n = 62) was performed under multicomponent general intravenous anesthesia on the background of total myoplegia with mechanical ventilation, analgesia was provided by fractional administration of 0.005% fentanyl solution at a dose of 1-2 μg/kg every 15-30 minutes. Patients were divided into two subgroups depending on the general anesthetic used: induction and maintenance of anesthesia for subgroup 1a (n = 31) was performed with 5% ketamine solution at a dose of 1-1.5 mg/kg and 1 mg/kg, respectively, and the induction and maintenance of anesthesia for subgroup 1b (n = 31) was performed with 1% solution of sodium thiopental at a dose of 4 mg/kg and 1-2 mg/kg, respectively. Cesarean section for group 2 (n = 65) was performed under conditions of spinal anesthesia (SA), which was divided into two subgroups depending on the access of the spinal puncture (SP): SA for group 2a (n = 31) was performed by central access; SA for group 2b (n = 34) was performed by paramedian access. Ondansetron at a dose of 8 mg was administered intravenously 5 min before its implementation to prevent the development of hypotension.
For postoperative analgesia in patients of all subgroups 1 g of paracetamol was used intravenously 3 times a day, 30 mg of ketorolac intramuscularly 3 times a day. The study included the following stages: 1st stage - the initial examination by the anesthesiologist; 2nd stage - the beginning of the operation; 3rd stage - fetal retrieval; 4th stage - end of operation; 5th stage - 30 minutes after the operation; 6th stage - 6 hours after the operation; stage 7 - 12 hours after the operation.
Changes in hemodynamic parameters at different stages of the perioperative period of cesarean section operation have been demonstrated in terms of different methods of anesthesia.The general analysis of the dynamics of the main indicators proved that the greatest changes occur in group 1 at the traumatic stage of the study (the beginning of the operation), in group 2 after spinal punction.A significant increase in systolic arterial pressure in 16.1 %, diastolic arterial pressure in 12.2 %, average arterial pressure in 13.9 %, pulse arterial pressure in 20.2 %, respectively, from initial level in subgroup 1a, and an increase of systolic arterial pressurein in 11.7 %, diastolic barometric pressure in 9.5 %, systolic barometric pressure in 10.5 %, pulse arterial pressure in 15.3 % from initial level, respectively, in subgroup 1b (p < 0,001), pressor response to intubation, activation of the sympathoadrenal system in response to operating stress.The decrease in the main indicators of hemodynamics was mostly observed in subgroup 2a in 77.4 ± 7.5 % of cases and required correction by vasopressors. In subgroup 2b, hypotension was recorded only in 14.7 ± 6.1 % (p < 0.001).The use of ondansetron intravenously 5 minutes before SP at a dose of 8 mg provides stable hemodynamic parameters.
When comparing the dynamics of stress markers, it was found that the greatest changes occur at the beginning of the operation. Increased levels of glucose, cortisol, prolactin, K/I, and decreased insulin were registered in group 1, namely in subgroup 1b, compared with group 2. The maximum increase in prolactin levels on the second stage in patients of subgroups 1a and 1b in 51.4 % (from 3482.1 ± 183.2 to 5271.04 ± 242.7 ng/ml) and in 47.0 % (from 3402.9 ± 100.2 to 5003.5 ± 193.6 ng/ml), respectively (p < 0.001; p < 0.001), while the increase in prolactin levels in patients of subgroups 2a and 2b remained statistically insignificant (p> 0, 05). The K/I value had higher indicators in group 1 on the 2nd and 6th stage compared with group 2 (p < 0,001; p < 0,05). The highest K/I values were observed in subgroup 1 using a 1% solution of thiopental sodium compared to 2a and 2b subgroup. 12 h after the end of the operation, a decrease in K/I was recorded in all subgroups.
