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options balanced general anesthesia, be based on mechanisms
of new dasgs and, in particular, to study the influence of combined
forms of anesthesia on pain and analgesic system. Spending total intravenous anesthesia
, selecting a set of dasgs for its implementation, should be considered
pharmacodynamics of various anesthetics. Achieving reliable antinociceptive
protect patient is only possible when blocking pathological impulses in
afferent and efferent stasctures in the CNS. The problem adekvatnoti
general anesthesia remains the focus of Anesthesiologists. Itself
adequacy means the level of protection needed for a particular
surgery, it is not always constant and determined
degree of trauma surgery. When deciding on the degree of protection of the patient,
must take into account the body's response not only to the injury, but also used
anesthesia, so far adequate anesthesia can be considered as a complex individual
anesthetic protection, preduprezhdayushey
impact operative stress in the first place, not only by blockade
nociceptive information, but also the stimulation of Pain, the action
which aims to eliminate energostaskturnogo deficit.
We made an attempt to develop a version of the TBA using Stadol in
as a central analgesic and assess its adequacy.
Butorphanol tartrate (Stadol) is a synthetic opioid analgesic
fenantrenovogo series, which has agonist / antagonist
activity. Butorphanol and its major metabolites are agonists
opioid receptor class eland - are mixed and antagonists of mu -
opioid receptors. Onset of action of the dasg depends on the route of administration: when
/ in the introduction the action begins almost immediately, the maximum effect
develops within 5-8 minutes.
Stadol is used during the TBA in patients with tuberculous lesion
upper urinary tract. Patients suffering from this disease, characterized by
initially severe condition, a variety of concomitant diseases and a large volume of
defeat. Operations have a high degree of trauma, often
are repeated or carried out in several stages.
Completed 15 operations in patients with tuberculosis of the urinary system: 8 nephrectomy, 2
nephrostomy, 3 kavernotomii, 2 resection of the ureter. Age composition of patients
ranged from 33 to 64 years. All operations were performed routinely.
duration of anesthesia based on Stadol - from 2 to 4 hours. The most common concomitant diseases
: nephrogenic hypertension 2 and 3 tbsp. - V5 patients,
HPN0-1 tbsp. - 5 men, coronary heart disease - 3, obesity - 2, diabetes mellitus type 1 -4,
varicose veins of the lower extremities -2 patient.
We developed and applied the following method of anesthesia:
Premedication is carried out by BM Stadol injection at a dose of 0.01 mg / kg per 30
minutes before surgery, when indicated, combined with a dose of droperidolom 0,1-0,15 mgkg.
A few minutes later developed severe sedation, stabilized blood pressure and heart rate
. Effect on lung function was expressed in the slowing of respiratory rate to 10-12 in
min, which may be associated with a decrease in activity of central stasctures of the brain,
responsible for the regulation of breathing, and can be caused by analgesic and tranquilizing effects
premedication and, quite possibly, the direct
action on neurons of the respiratory center, of course, having
opiate receptors. All patients were assessed sedation as "very good". After the first administration of Stadol
noted coming rise in blood pressure
compared to baseline, was fixed tachycardia, which can be explained
pharmacological characteristics of the dasg.
Before induction cc injected atropine 0.1% - 0,3-0 , 4 mL and diphenhydramine 1% -1.0 ml.
then administered at a dose of Stadol 0.13 mgkg. After exposure of 5-8 minutes (including
availability period before the development of maximum effect) to prekurarizatsii
arduan injected a dose of 1-2 mg, then used one of the following: a) sibazon in
dose of 0,5 mgkg, b) 1% thiopental sodium at a dose of 4.5 mgkg, and then injected
ditilin at a dose of 100-200 mg, was performed endotracheal intubation and mechanical ventilation was carried out.
average dose of sodium thiopental, injected before intubation, was 150-200 mg,
dose of Stadol from 8 to 12 mg. Under option a) during induction of anesthesia
noted marked reduction ADsist.diast. from 15 to 20% of the original, with
variant b) using sibazona we fixed
pronounced stability of hemodynamic parameters at all stages of induction.
main stage of general anesthesia in all cases combined
induction was similar in both groups. Conducted periodic introduction of fractional dose of Stadol
0.02 mgkgchas and thiopental sodium 50 mg every 25-30 minutes. Analyzing
flow entered the dasg, it should be noted that 90% of anesthesia used
additional dose of analgesic after induction was not required. In both versions
induction (a, b) even in traumatic stages of the operation (nefroliz,
selection renal feet), while continuing to maintain the analgesic component of anesthesia
fractional introduction Stadol adequacy of anesthesia
of sound central hemodynamics . Changes
hemodynamics during induction with the use of thiopental sodium tended to
normalize within 10 minutes. By the end of surgery and anesthesia was noted
gradual recovery of spontaneous breathing and a rapid awakening of the patient at
satisfactory muscle tone. Sedative and antitussive
pronounced effects of the dasg can leave the tracheal tube (if necessary) and
produce extubation of the trachea without any sign of discomfort was at
patient. We should also note a pronounced analgesic background for
6-8 hours after general anesthesia.
According to the literature, increasing the pain threshold when administered Stadol
accompanied by activation of antinociceptive systems, specific action,
manifested in the suppression of pain reaction in the VPL of the thalamus, as well as
nonspecific action, reflected in the shortening of the reaction of desynchronization in
cortex. The dasg has a predominantly inhibitory effect on
associative and nonspecific stasctures of the brain, as well as slightly easier
conduct impulses along specific afferent paths with somatic pain.
analgesic effect of Stadol due mainly opiatomimeticheskim
mechanism, implemented through