FIELD: medicine.
SUBSTANCE: invention refers to medicine specifically to anaesthesiology and blood-saving techniques in anaesthesiology and resuscitation science, and can be used as anaesthetic management within adrenalectomy caused by epinephros pheochromocytoma. For this purpose operation is preceded with complex patient examination. Preanesthetic medication applied one day before and in the morning prior to operation implies introduction of tableted phenozepam dosed 0.0005-0.001 g, and 30 min before operation sybazone is injected intramuscularly in dosage 10 mg combined with Dimedrol in dose 10 mg. In operating theatre monitoring, puncture and catheterisation of central vein are performed. Then epidural cavity is punctured at height Th7-L1, catheterised so that catheter cap is being placed at height Th5-Th11 to provide following postoperative anaesthesia. Unassisted breathing is accompanied with oxygen inhalation through anaesthesia apparatus mask at rate 5-8 l/minute. Preanaesthetic medication is completed with intravenous bolus dosing of 0.1% atropine solution dosed 0.005-0.007 mg/kg. 5-10 minutes prior to surgical intervention patient blood is exfused in volume 1.0 litres in case arterial pressure is reduced lower than 140/90 mm m.c., and in volume 1.5 litres in case arterial pressure is reduced higher than 140/90 mm m.c. followed by drop-by-drop intravenous introduction of warmed to 37-42°C crystalloid solution either acesol, or trisol, or lactasol or Ringer's solution. Afterwards anaesthesia is added with intravenous bolus dosing to central vein of 2% thiopental sodium solution in dosage 4-5 mg/kg, 0.005% fentanyl solution dosed 0.0025-0.0035 mg/kg followed by intubation of trachea accompanied with precurarisation by introduction of either pipecuronium bromide (arduan) in dosage 1-2 mg or rocuronium bromide (esmerone) in dosage 10-20 mg and against muscular relaxation introduction of 2% suxamethonium iodide solution (dithylinum) in dosage 1.5-2 mg/kg, then patient is transferred to artificial pulmonary ventilation. Within epinephros central vein clipping and crossing for separation of pathologically modified epinephros complete or partial autoblood is reinfused until patient arterial pressure is completely stabilised at level 100-110/60-70 with following infusion crystalloids warmed up to 37-42°C. In case of partial autoblood reinfusion, repeated reinfusion of the rest autoblood volume is performed within the first days of early postoperative period. Anaesthesia management within all stages of surgical intervention is carried under artificial pulmonary ventilation by inhalation of mixed nitrogen monoxide and oxygen at ratio 2:1 to 3:1 using reversive breathing circuit of ventilation respiratory capacity 7-8 ml/kg at minute ventilation 100-120 ml/kg, intravenous introduction of fentanyl dosed 5-6 mkg/kg/h, as well as introduction of arduan in dosage 2-4 mg every 40-60 minutes of operation procedure or introduction of esmerone in dosage 10-20 mg every 25-35 minutes of operation procedure. Anaesthesia is completed at stage of operation termination by termination of intravenous introduction of fentanyl and relaxing agents against continuation of artificial pulmonary ventilation by oxygen-air mix with FiO2 equal to 0.4-0.6. Method provides stabilisation of haemodynamics and cardiac activity during adrenalectomy without vasopressor application.
EFFECT: provided possibility of stabilisation of hemodynamics and cardiac activity during adrenalectomy without vasopressor application.
3 ex, 4 cl
