[Intraoperative monitoring of abdominal organs under combined general anesthesia].
The authors analyse the early components of somatosensory evoked potentials (SSEP) during anesthesia in prolonged and traumatic operations on the abdominal organs (gastrectomy, hemihepatectomy, pancreatoduodenal resection, etc.). A total of 69 patients were examined, among them 32 underwent operations under conditions of classical NLA, 16 with the narcotic analgetics replaced by moradol, and 21 under modified NLA with dalargin. The results of the study and analysis of literature data allow monitoring of the early components of somatosensory evoked potentials to be considered a highly sensitive test for appraising the depth and adequacy of the modern methods of general anesthesia and to be recommended for use, at least in particularly difficult and venturesome operations. It is shown that most significant in the discussed plan is not the absolute value, but changes of the N19-P23 amplitude in the stages of the operation. Increase of the studied SSEP component by 20% and more in relation to the basal level (SSEP amplitude in the patient after adequate preanesthesia) is evidence of insufficient analgesia. Change of N19-P23 latency is less demonstrative. Monitoring of the early components (N19-P23) of SSEP showed that to ensure effective analgesia in prolonged concurrent and combined operations, if the NLA method is chosen, administration of fentanyl in a dose of no less than 12 micrograms/kg/hour is necessary. It is shown that replacement of narcotic analgesics, within the limits of the conducted NLA, by moradol, an agent of the group of agonists-antagonists is poorly effective.(ABSTRACT TRUNCATED AT 250 WORDS)
Likhvantsev
V V
VV
Smirnova
V I
VI
Grebenchikov
O A
OA
Moroz
V V
VV
Subbotin
V V
VV
D000005:Abdomen / Q000503:physiopathology / Q000601:surgery*; D000701:Analgesics, Opioid; D000768:Anesthesia, General; D000777:Anesthetics; D002077:Butorphanol; D016308:Enkephalin, Leucine-2-Alanine / Q000031:analogs & derivatives; D005073:Evoked Potentials, Somatosensory; D005283:Fentanyl; D006801:Humans; D016343:Monitoring, Intraoperative; D009458:Neuroleptanalgesia; D013565:Sympatholytics; D013997:Time Factors
D000701:Analgesics, Opioid; D000777:Anesthetics; D013565:Sympatholytics; D016308:Enkephalin, Leucine-2-Alanine; D002077:Butorphanol; D005283:Fentanyl; C040996:enkephalin-Leu, Ala(2)-Arg(6)-
Monitoring vo vremia operatsiĭ na organakh briushnoĭ polosti v usloviiakh kombinirovannoĭ obshcheĭ anestezii.