ANESTHESIA FOR ENDOSCOPIC INTRA-ABDOMINAL INTERVENTIONS
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Abstract
Aim of the present study was to optimize the anesthesia aid for endoscopic manipulations based on the determination of the patient's functional change index (IFI).
Materials and methods. We examined 34 patients who underwent colonoscopy with polypectomy or biopsy, the average age was 45.7 ± 5.9 years, the degree of anesthetic risk was consistent with ASA I-II, the duration of the procedure was 20.3 ± 7.1 minutes. IFI (in conventional units-points) was calculated immediately before endoscopic manipulation. To calculate it, we determined the pulse rate( PE), blood pressure (ADp-systolic, ADp-diastolic), height (P), body weight (MT) and age (B): IFI = 0.011PE + 0.014ADp + 0.008ADp + 0.014B + 0.009MT – 0.009P – 0.27.
During the anesthesia support, the opinion of not only the doctor who conducted the study, but also the patients about the comfort during the EVPV was taken into account.
Results. Based on the obtained index value, each subject was assigned to one of four groups according to the degree of adaptation: satisfactory adaptation (IFI less than 2.59), stress of adaptation mechanisms (IFI from 2.6 to 3.09), unsatisfactory adaptation (IFI from 3.1 to 3.49), failure of adaptation (IFI more than 3.5).
In the first group of patients, dexmedetomidine sedation was sufficient to achieve comfortable conditions for both the patient and the endoscopist. In the second group, the recommended dosages of dexmedetomidine were insufficient, which required additional administration of propofol. At the same time, there was a decrease in the average blood pressure below 70 mm hg. In this regard, the second group was divided into two subgroups: patients who were sedated with dexmedetomidine in combination with propofol (n = 10) and patients (n = 10) who were sedated only with propofol, which allowed them to achieve the necessary level of sedation for high-quality manipulation without significant arterial hypotension.
Conclusion. The calculation of the IFI and the determination of the patient's adaptive potential before endoscopic intervention allows us to optimize the anesthetic manual and make a rational choice of the drug for sedation. Thus, when the adaptation mechanisms are stressed, it is sufficient to achieve the required level of dexmedetomidine sedation in the recommended dosages. When identifying a state of unsatisfactory adaptation, the drug of choice is propofol.
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