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Comparative evaluation of anesthesia methods for reconstructive carotid surgery
- Source :
- Вестник анестезиологии и реаниматологии, Vol 17, Iss 5, Pp 15-24 (2020)
- Publication Year :
- 2020
- Publisher :
- NEW TERRA Publishing House, 2020.
-
Abstract
- The objective: to assess the impact of total intravenous and combined anesthesia (consisting of regional block and inhalation anesthesia with sevoflurane) on higher mental functions, frequency and nature of postoperative complications in carotid endarterectomy.Subjects and methods. A total of 190 patients with ipsilateral carotid stenosis exceeding 70%, or with the unstable atheromatous plaque were examined. CE was performed in 140 (73.6%) patients, while 50 (26.4%) patients underwent plasty with the autovenous patch. 60 patients had total intravenous anesthesia. The other 60 patients had combination anesthesia (cervical plexus block as per A. Yu. Paschuk + non-inhalation anesthesia with thiopental sodium). In 70 patients, low-flow inhalation anesthesia with sevoran and potentiation of the analgesic effect by bolus administration of fentanyl was performed. The parameters of central hemodynamics, cerebral blood flow, markers of cerebral damage, and state of higher mental functions were assessed.Results. Inhalation anesthesia with sevoflurane was characterized by decrease of total peripheral resistance index by 20% (p = 0.002) and SBP by 13% (p = 0.004) compared to baseline values. Moderate reduction of afterload was accompanied by normalization of cardiac and stroke indices. Optimization of the central hemodynamic parameters led to high levels of the linear velocity of cerebral blood flow and cerebral perfusion pressure which at the main stages of the operation did not differ from the control values. At the end of the operation, a statistically significant insignificant increase in intracranial pressure was noted (on average, by 4 mm Hg exceeded values at the previous stages, p = 0.014) and levels of markers of ischemic neuronal damage: the levels of antibodies to protein S-100 increased by 14% (p = 0.043), and NSE – by 2.8 μg/L. During inhalation anesthesia with sevoflurane, the lowest number of postoperative neurological and cardiac complications was recorded; they developed only in 6 (8.6%) patients and distributed equally. However, more pronounced postoperative cognitive dysfunction was noted when this method of anesthesia was used.Conclusion. Each method of anesthesia provided an unequal level of cerebral protection from ischemic damage which was manifested by a difference in the severity of disorders of higher mental functions, the number and nature of postoperative neurological complications.
- Subjects :
- 0106 biological sciences
higher mental functions
sevoflurane
Hemodynamics
Critical Care and Intensive Care Medicine
01 natural sciences
Sevoflurane
Fentanyl
03 medical and health sciences
0302 clinical medicine
medicine
Cerebral perfusion pressure
Intracranial pressure
propofol
business.industry
RC86-88.9
010604 marine biology & hydrobiology
030208 emergency & critical care medicine
Medical emergencies. Critical care. Intensive care. First aid
medicine.disease
neuron-specific enolase
Anesthesiology and Pain Medicine
Cerebral blood flow
Anesthesia
Emergency Medicine
Propofol
business
regional anesthesia
Postoperative cognitive dysfunction
carotid endarterectomy
medicine.drug
Subjects
Details
- Language :
- Russian
- ISSN :
- 25418653 and 20785658
- Volume :
- 17
- Issue :
- 5
- Database :
- OpenAIRE
- Journal :
- Вестник анестезиологии и реаниматологии
- Accession number :
- edsair.doi.dedup.....2b9a08362bc5e56c5cfa2f69be7d633f