[Anesthesia and infusion-transfusion therapy in extensive combined surgeries].
The article discusses 434 one-stage concurrent and combined surgical interventions in the cavities. The type of anesthesia and the volume of infusion-transfusion therapy were determined for each type of combinations. A concurrent-combined method, i. e. combined endotracheal (NLA with Kalipsol) and epidural anaesthesia is advisable in supertraumatic interventions (evisceration of the organs of the true pelvis, hemicorporectomy). The method of dissociative total intravenous anesthesia must be used for patients with heart diseases, especially in patients with various disorders of the conduction system. The specific features of this method is exclusion of nitrous oxide and reduction of the doses of Phentanyl, (which produce a negative effect on the conduction system of the heart) and increase of the doses of Kalipsol and droperidol, which allows the operation to be conducted in full volume in these patients. Agents for NLA with Dalargin are preferable for general anesthesia in patients undergoing operations on the hepatopancreatoduodenal zone. In other concurrent and combined operations on patients without concomitant heart diseases, NLA and NLA in combination with Kalipsol may be used; the last-named is particularly valuable in massive blood loss, when the hemodynamics are insufficiently stable. Particular attention is given to extensive, traumatic interventions attended by massive blood loss. The performance of hypervolemic hemodilution to the main stage of the operation is suggested, which makes it possible to stabilize hemodynamics at the peak of the hemorrhage. With the chosen tactics of anesthesia and infusion-transfusion therapy the incidence of complications and the lethality rate in such extensive operations were significantly reduced.
Smirnova
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D000701:Analgesics, Opioid; D000770:Anesthesia, Endotracheal; D000767:Anesthesia, Epidural; D000771:Anesthesia, Intravenous; D003131:Combined Modality Therapy; D004329:Droperidol; D016308:Enkephalin, Leucine-2-Alanine / Q000031:analogs & derivatives; D005283:Fentanyl; D006331:Heart Diseases / Q000150:complications; D006438:Hemodilution; D006801:Humans; D007410:Intestinal Diseases / Q000150:complications / Q000628:therapy*; D007649:Ketamine; D013514:Surgical Procedures, Operative / Q000379:methods; D013565:Sympatholytics
D000701:Analgesics, Opioid; D013565:Sympatholytics; D016308:Enkephalin, Leucine-2-Alanine; D007649:Ketamine; D004329:Droperidol; D005283:Fentanyl; C040996:enkephalin-Leu, Ala(2)-Arg(6)-
Anesteziia i infuzionno-transfuzionnaia terapiia pri obshirnykh sochetannykh i kombinirovannykh polostnykh khirurgicheskikh vmeshatelśtvakh.