Vorotyntsev S. І.

CLINICAL AND EXPERIMENTAL MEDICINE

Scentific article

Laparoscopy in obese patients has become the main technique during operations on the organs of abdominal cavity because it facilitates the surgery process and reduces the number of postoperative complications. But during pneumoperitoneum stress hemodynamic instabilities that can cause the increase of cardiac ischemia. In general practice to avoid this they use opioid analgesics, benzodiazepines, beta-blockers, calcium channel blockers and vasodilators – drugs that are not always prescribed for patients with obesity. α2-agonists because of their anxiolytic, sedative, sympatholytic and analgesic properties are widely used in bariatric surgery and laparoscopic surgery in patients without obesity. The aim of our work was to evaluate the hemodynamic response, sedative effect and the need for analgesics in obese patients during the first 24 hours after non-bariatric laparoscopic surgery under general anesthesia with dexmedetomidine’s use. The research included 40 patients with a body mass index (BMI) over 30 kg/m2, functional class ASA I-II and age over 18 years who were scheduled to a laparoscopic cholecystectomy or fundoplication under general anesthesia with artificial lung ventilation. Using computer generated table of random numbers patients were divided into two groups: control group (Dex 0, n=20) where total intravenous anesthesia (TIVA) based on propofol, fentanyl and atracurium was conducted; study group (Dex 1/0.5, n=20) where TIVA was complemented by the injection of dexmedetomidine (loading dose – 1 mcg/kg BMI for 10 minutes, maintenance dose – 0.5 mg/kg BMI/h during the surgery. We compared value changes on heart rate and blood pressure immediately after intubation of the trachea, during pneumoperitoneum, immediately after extubation of the trachea. The level according to Ramsay sedation scale (RSS) was determined before the transfer of patients to intensive care ward, 60 min and 120 min after surgery. Evaluation of pain by visual analogue scale (VAS) was performed on the above-mentioned stages and in 6 hours after surgery. The time till the first “saving” injection of analgesic and its quantity during first 24 hours of postoperative period was observed. Incidence of dyspnea in the recovery room was controlled during two hours. Statistical analysis was provided with a program Statistica for Windows version 6.0. Demographic and clinical data of the patients did not significantly differ between two groups (p>0.05). At all the stages of the research in group Dex 1/0.5 AT was 10-15% lower than in group Dex 0 (p<0.05) and values of the heart rate didn’t differ between the groups (p>0.05). For analgesia during surgery fentanyl was used 1.5 times less in group Dex 1/0.5 than in group Dex 0 (p<0.05). For bradycardia and hypotension correction atropine and phenylephrine was used almost with the same frequency both in groups Dex 0 and Dex 1/0.5. After tracheal extubation in group Dex 1/0.5 sedation level of 4 points 15% of patients had and in group Dex 0 – none of patients (p<0.05); after 30 minutes in group Dex 1/0.5 sedation level of 3 points 40% of patients had and in group Dex 0 – 10% of patients (p<0.05); after 60 minutes in group Dex 1/0.5 sedation level of 2 points 80% of patients had and in group Dex 0 – 20% of patients (p<0.05). In group Dex 0 average time for the use of “saving” analgesia was 60 min in 100% of patients, in group Dex 1/0.5 – 360 min appropriately, and it was needed in 85% of patients (p<0.05). Patients of group Dex 0 in the first 2 hours after surgery had 2 times higher incidence of dyspnea than patients from group Dex 1/0.5 (p<0.05). The total dose of trimeperidine during 24 hours in postoperative period also was 1.5 times higher in group Dex 0 than in group Dex 1/0.5 (p<0.05). So we found that infusion of dexmedetomidine in the loading dose 1 μg/kg BMI for 10 min and maintenance dose of 0.5 μg/kg BMI/h intraoperatively control hemodynamic stress response in patients with obesity to whom non-bariatric laparoscopic surgery is provided under general anesthesia. Dexmedetomidine reduces the need for intraoperative opioid analgesics, prolongs a painless period immediately after operation thereby reducing the total demand for analgesics and incidence of postoperative respiratory depression, making it an ideal adjuvant of anesthesia during laparoscopic surgery in obese patients.

obesity, laparoscopic non-bariatric surgery, α2-agonists, dexmedetomidin

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«Bulletin of problems biology and medicine» Issue 4 Part 3 (141), 2017 year, 106-111 pages, index UDK 616.381-072.1-08-036.8-056.257

10.29254/2077–4214–2017–4–3–141–106-111