Loskutov Oleg, Danchyna Taisiia, Dzuba Dmitryi, Druzina Oleksandr
Department of Anesthesiology and Intensive Care, Shupyk National Medical Academy of Postgraduate Education, Kyiv, Ukraine.
Department of Anaesthesiology and Perfusiology, SE "Heart Institute" of MOH, Kyiv, Ukraine.
Kardiochir Torakochirurgia Pol. 2020 Sep;17(3):111-116. doi: 10.5114/kitp.2020.99072. Epub 2020 Sep 23.
Cardiovascular diseases (CVD) are the main cause of death worldwide, and according to experts, they will continue to dominate the structure of global mortality.
The effectiveness of the multimodal low-opioid anesthesia technique in performing coronary artery bypass graft operations with artificial blood circulation.
Ninety-six patients aged 61.8 ±10.4 years underwent coronary artery bypass grafting under artificial blood circulation. Group I: propofol, sevoflurane, fentanyl, pipecuronium bromide (standard doses). Group II: dexketoprofen trometamol (50 mg), intravenous lidocaine (1% - 1 mg/kg bolus) and continuous lidocaine infusion (1.5-2 mg/kg/h), propofol, ketamine (0.5 mg/kg), magnesia sulfate, minimal doses of fentanyl.
Average duration of anesthesia - 257.4 ±19.1 min; assisted blood circulation - 55 ±10 min. Mean dose of fentanyl in group I - 4.66 ±1.58 µg/kg/h, in group II - 1.29 ±0.32 µg/kg/h.Standard lab values and stress hormonal changes were within the normal range (mean cortisol: 479.3 ±26.4 nmol/l, lactate 1.61 ±0.2 mmol/l, glucose 6.42 ±0.9 mmol/l). Changes in heart rate within group I had a significant amplitude of dynamics, while in group II, these values were relatively at the same level throughout the entire anesthetic provision. Mean arterial pressure changes in group I were characterized by a significant reduction at the stage of induction, support and sternum reduction, whereas in group II it was relatively at the same level during the entire anesthetic management and significantly differed from baseline only at the stage of induction.
Multimodal low-opioid anesthesia during coronary artery bypass surgery with artificial blood circulation allows one to ensure adequate analgesia and avoid the intraoperative usage of routine doses of fentanyl, as indicated by the absence of hemodynamic and endocrine-metabolic changes.
心血管疾病（CVD）是全球主要的死亡原因，据专家称，它们将继续主导全球死亡率结构。
多模式低阿片类麻醉技术在体外循环冠状动脉搭桥手术中的有效性。
96例年龄为61.8±10.4岁的患者在体外循环下接受冠状动脉搭桥术。第一组：丙泊酚、七氟醚、芬太尼、哌库溴铵（标准剂量）。第二组：右酮洛芬氨丁三醇（50mg）、静脉注射利多卡因（1% - 1mg/kg推注）和持续利多卡因输注（1.5 - 2mg/kg/h）、丙泊酚、氯胺酮（0.5mg/kg）、硫酸镁、最小剂量的芬太尼。
平均麻醉持续时间 - 257.4±19.1分钟；体外循环 - 55±10分钟。第一组芬太尼平均剂量 - 4.66±1.58μg/kg/h，第二组 - 1.29±0.32μg/kg/h。标准实验室值和应激激素变化在正常范围内（平均皮质醇：479.3±26.4nmol/l，乳酸1.61±0.2mmol/l，葡萄糖6.42±0.9mmol/l）。第一组心率变化具有显著的动态幅度，而在第二组中，这些值在整个麻醉过程中相对处于同一水平。第一组平均动脉压变化的特点是在诱导、维持和胸骨切开阶段显著降低，而在第二组中，在整个麻醉管理过程中相对处于同一水平，仅在诱导阶段与基线有显著差异。
体外循环冠状动脉搭桥手术期间的多模式低阿片类麻醉能够确保充分镇痛，并避免术中使用常规剂量的芬太尼，血流动力学和内分泌代谢变化未出现即表明了这一点。
