Bosenko K. V., Sobytniak L. O.

ULTRASOUND-GUIDED ASSESSMENT OF VOLEMIC STATUS OF ANESTHESIA IN SURGICAL DEBRIDEMENT OF GUNSHOT WOUNDS

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About the author:

Bosenko K. V., Sobytniak L. O.

Heading:

CLINICAL AND EXPERIMENTAL MEDICINE

Type of article:

Scientific article

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The choice of anesthetic technique in wounded patients with blast injuries of the lower extremities remains controversial due to the risk of occult hypovolemia and the development of hemodynamic disturbances during neuraxial blocks. The aim of the study is to assess the volemic status of patients with blast injuries of the lower extremities using ultrasound techniques and to investigate the safety of spinal anesthesia. The study was conducted in 46 patients with blast injuries to one of the lower extremities admitted within 18–28 hours after injury. Ultrasound assessment of volemic status was performed, including evaluation of dynamic changes in inferior vena cava diameter, the passive leg raise test, and the rapid fluid challenge test. Patients in Group I underwent spinal anesthesia, whereas patients in Group II received regional nerve blocks. Prior to surgery, all patients demonstrated stable hemodynamic parameters and no signs of hypovolemia. Following anesthesia administration, as well as throughout the surgical intervention, patients in the spinal anesthesia group exhibited a significant decrease in arterial blood pressure and heart rate compared with the regional anesthesia group (p < 0.05). Vasopressor support was required in 5 patients of Group I and 1 patient of Group II. Three hours after surgery, no intergroup differences in hemodynamic parameters were detected. Regional anesthesia was associated with greater hemodynamic stability; however, spinal anesthesia may be used in carefully selected patients without signs of hypovolemia. Ultrasound assessment of volemic status is advisable prior to selecting the anesthetic technique in patients with gunshot injuries. Regional anesthesia provided greater hemodynamic stability. The choice of anesthetic technique requires an individualized approach.

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Publication of the article:

«Bulletin of problems biology and medicine», 2026 Issue 3, 182, 222-228 pages, index UDC 616.08;616.71

DOI:

10.29254/2077-4214-2026-3-182-222-228