Kraĭnik V M, Kozlov S P, Deshko Iu V
Anesteziol Reanimatol. 2012 May-Jun(3):22-5.
77 anaesthesia protocols during a. carotis interna (ACI) operations were analyzed. All the patients were divided into 3 groups. In the 1-st group a total intravenous anaesthesia - TIV4 (propofol and fentanyl) was used. In the 2nd and 3rd groups was used combined anaesthesia: in the 2nd - TIVA + superficial CPB, in the 3rd - combined anesthesia (sevortane+fentanyl+CPB). When analyzing the results, BP, BIS data, anaesthetic doses and the need for opioid analgesics were evaluated. Assessment of the postoperative pain quality was conducted within 48 hours of the postoperative period on a verbal assessment scale (VAS).
The need for fentanyl was considerably higher in the 1st group. The analysis of the BP data dynamics showed better stability in the 2nd and 3rd groups.
TIVA + CPB provides better analgesia and reduces the need for opioid analgesics; greater stability of hemodynamic parameters during operation stages, as well as the best brain perfusion during a. carotis interna occlusion; postoperative analgesia and allows to avoid the early appointment of systemic analgesics.
分析了77例颈内动脉（ACI）手术期间的麻醉方案。所有患者分为3组。第1组采用全静脉麻醉——TIV4（丙泊酚和芬太尼）。第2组和第3组采用联合麻醉：第2组——全静脉麻醉+浅低温体外循环，第3组——联合麻醉（七氟烷+芬太尼+体外循环）。分析结果时，评估了血压、脑电双频指数（BIS）数据、麻醉剂量以及对阿片类镇痛药的需求。术后48小时内采用语言评估量表（VAS）对术后疼痛质量进行评估。
第1组对芬太尼的需求明显更高。对血压数据动态的分析显示，第2组和第3组的稳定性更好。
全静脉麻醉+体外循环提供了更好的镇痛效果，减少了对阿片类镇痛药的需求；在手术阶段血流动力学参数更稳定，以及在颈内动脉闭塞期间脑灌注最佳；术后镇痛并可避免早期使用全身性镇痛药。
