The dissertation identifies an effective method of anesthesia in surgical interventions in patients with injuries of the lower extremities on the basis of changes in hemodynamics, stress markers, heart rate variability, pain intensity, psychoemotional state in the perioperative period.
According to the goal, methods were used: anamnestic, instrumental, laboratory, scale, psychological, mathematical and statistical, which allowed to obtain sufficiently complete information to assess the object of study.
The clinical base of the study was the Department of Anesthesiology and Intensive Care and the Department of Traumatology of the Regional Clinical Traumatology Hospital. To achieve this goal, 125 patients with injuries of the lower extremities were examined, who were shown to perform metal osteosynthesis operations. The mean age of patients was 43,72 ± 1,02 years.
All patients were divided into groups depending on the method of anesthesia.
Group I (n = 33) - patients operated under conduction anesthesia; nerve blockade was performed with 1% lidocaine solution at a dose of 800 mg with the addition of epinephrine solution adjuvant (1: 200000).
Group II (n = 31) - patients operated under conduction anesthesia with sedation with 1% propofol solution at a dose at a rate of 1,0 to 4,0 mg / kg / h; nerve blockade was performed with 1% lidocaine solution, 800 mg dose with the addition of epinephrine solution adjuvant (1: 200000).
It was found that most patients of all groups had a high level of anxiety: more than 45 points - situational anxiety 88 (70%) patients, personal anxiety ‒ 80 (64%). During the questionnaire at stage 3 of the study in patients of all groups, the level of anxiety was significantly reduced compared with stage 1 of the study (p < 0,05). But in patients of groups II and IV these changes were more pronounced. The number of patients depending on the level of anxiety during the study was significantly reduced compared to stage 1 (p < 0,05). Significant differences were observed in patients of groups II and IV (p < 0,05). Most patients had a moderate level of anxiety ‒ 31 - 44 points. In patients of group II moderate level of situational anxiety was in 16 (51,6%) patients, the level of personal anxiety was in 17 (54,8%) patients. Patients in group IV had similar indicators, a moderate level of situational anxiety was in 16 (53,3%) patients, personal anxiety ‒ in 14 (46,7%) patients.
Data on changes in hemodynamic parameters, laboratory markers of stress, pain intensity, heart rate variability at different stages of the study during surgery on the lower extremities under different types of anesthesia. Analysis of the dynamics of the main indicators revealed more pronounced changes in patients of groups II and IV at 2 and 3 stages of the study. These changes were due to additional sedation with propofol.
When planning conduction anesthesia for anesthesiological support of metal osteosynthesis operations for injuries of the lower extremities in the tibia, the results of the study established the most significant criteria, based on which an algorithm for selecting anesthesia support was developed, namely conduction anesthesia with sedation and sedation.
During the examination of patients before surgery, a list of criteria was determined, on the basis of which one or another method of anesthesia is chosen: 1 - anamnestic data; 2 - clinical data; 3 - scale data; 4 - psychological data.
Anamnestic criterion: the presence of injury to the lower extremities, which requires metal osteosynthesis.
Clinical criterion: BMI < 25,0 kg / m2;
Scale criterion: VAS ≤ 5 points;
Psychological criterion: assessment of anxiety on the Spielberger-Khanin scale (PA < 45 points and SA <45 points).
When planning spinal anesthesia for anesthesiological support of metal osteosynthesis operations for injuries of the lower extremities in the area, the results of the study established the most important criteria on the basis of which the algorithm for selecting anesthesia was developed, namely spinal anesthesia without sedation and spina bifida.
During the examination of patients before surgery, a list of criteria was determined, on the basis of which one or another method of anesthesia is chosen: 1 - anamnestic data; 2 - clinical data 3 - instrumental data; 3 - scale data, 4 - psychological data.
Anamnestic criterion: the presence of injury to the lower extremities in the thigh, which will be performed metal osteosynthesis.
Clinical criterion: BMI < 25,0 kg / m2;
Instrumental criterion: MAP 80-90 mm Hg;
Scale criterion: VAS ≤ 5 points;
Psychological criterion: assessment of anxiety on the Spielberger-Khanin scale (PA <45 points and SA <45 points).
