The dissertation presents a comparative analysis of hemodynamics and gas exchange, the severity of surgical stress response, perioperative pain and the incidence of postoperative nausea and vomiting (PONV) in ophthalmic patients depending on the scheme of anesthesia.
The study included 136 patients. Patients were randomly divided into 4 groups: group K: multicomponent anesthesia, n = 45; group B: multicomponent anesthesia, supplemented by blockade of the pterygopalatine fossa, n = 28; group D: multicomponent anesthesia, supplemented by the dexmedetomidine, n = 32; group DB: multicomponent anesthesia, supplemented by blockade and the dexmedetomidine, n = 31.
In the study of surgical stress response in control group, it was found that glycemia in patients increased at all stages of the study, the dynamics of leukocyte counts and CRP were unidirectional and showed a decrease compared with preoperative levels.
To study the pain intraoperatively, we used the ANI index. The data obtained indicate a lack of analgesia during the first four minutes of the most traumatic stage of transplantation. A numerical rating scale (NRS) was used to characterize postoperative pain. The findings suggest that analgesia may be considered adequate in three of the four stages of the study, but 6 hours after surgery, the pain score was 6, which could not be considered.
Examining the dynamics of glycemia in group B, it was found that glucose levels increase at all stages of the study, but do not exceed the norm. Leukocytes in the blockade group at stage 6 did not show a statistically significant increase. Similar dynamics of indicators of operative stress response can testify to stress-protective influence of blockade.
Pain during the most traumatic phase of the operation never exceeded the lower limit of normal.
Postoperative pain in the group B was assessed by us as statistically significantly lower than pain in the group K at all stages of the study except stage 5a. PONV occurred in 4 patients, which was 14.3%.
When assessing the dynamics of glycemia, it was found that the level of glucose in group D increased in stages 4 and 5 of the study, without going beyond normal. Leukocytes in patients of group D did not show statistically significant growth after surgery. Similar changes occurred in the study of CRP. Similar dynamics of indicators of both links of the operative stress response may indicate a stress-limiting effect of the dexmedetomidine during transplantation.
Intraoperative analgesia in patients of the group D can be considered adequate throughout the most traumatic stage of intrusion. When assessing the severity of postoperative pain, it was found that pain in patients of group D was statistically significantly lower than in patients of group K during three of the four stages of evaluation.
The incidence of PONV in patients of the dexmedetomidine group was 12.5%.
When analyzing the glycemia in patients of the group DB, we found a tendency to a gradual increase in the rate without approaching the figures of hyperglycemia. Analyzing the dynamics of leukocytosis in the group DB, we noted that leukocytes in stage 6 in the DB group did not increase, and even showed a tendency to decrease. CRP in the group DB showed a stable value relative. Such dynamics of the above indicators may indicate a stress-limiting effect of the modified scheme of anesthesia in corneal transplantation.
Examining the quality of anesthesia in DB patients during corneal transplantation, we concluded that analgesia can be considered adequate throughout the “open sky” stage. Analyzing postoperative pain, we concluded that the modified scheme (used in the group DB) allows better control of pain in patients after transplantation.
When comparing the three modified anesthesia schemes we made the following conclusions:
• all three proposed schemes have a stress-limiting effect on patients during corneal transplantation;
• all three modified anesthesia regimens allow quality control of pain intraoperatively, as evidenced by ANI-index values exceeding 50 during the most traumatic stage of corneal transplantation (stage of “open sky”);
• the best control of postoperative pain and frequency of PONV can be obtained by using blockade of the pterygopalatine fossa in combination with dexmedetomidine.
Scientific novelty of the materials. For the first time, the efficacy and safety of the use of blockade of the pterygopalatine fossa and / or the drug dexmedetomidine in the perioperative period in patients with ophthalmic surgery during surgery through keratoplasty as stress-limiting factors were substantiated and proved.
The practical significance results. The paper proposed 3 schemes of anesthesia for surgical intervention, which have stress-limiting properties, allow to achieve adequate pain control during and after surgery and reduce the frequency of episodes of PONV without the use of additional pharmacological drugs.
