Vol 10, No 3 (2016)

Presented paper reviews up-to-date often contradictive concepts about the role of epidural anesthesia in anesthesiological support of patients undergone major surgery. The author performed critical analysis of the arguments of the opponents of the wide use of epidural analgesia who propose to substitute the epidural anesthesia with minimally invasive techniques in particular infiltration analgesia with local anesthetics. The article includes convincing evidence in favour of continuous epidural anesthesia remains the method of choice for open major thoracic and abdominal surgery especially in patients from high risk groups.

Introduction: It is assumed that one of the factors of high incidence of postoperative complications in postpartum women with obesity is intra-abdominal hypertension (IAH). The aim of the work was to evaluate the dynamics of intra-abdominal pressure (IAP) in postpartum women with obesity, depending on the method of postoperative analgesia. The study involved 136 patients divided into 4 groups: control group - initial BMI of 18.5 to 24.9 kg / m2, II of group - patients with obesity I degree (n = 40); Group III - obesity II degree (n = 35); Group IV - III degree obesity (n = 21). All patients were divided into two subgroups - postoperative analgesia with opioids and epidural analgesia (EA). We investigated the timing of reversal of intestinal motility, passage of gas, nausea severity, dynamics IAP and compliance of the anterior abdominal wall. Postoperative dynamics IAP is associated with motor function of the intestine, which is dependent on the initial level of IAP. Paresis intestine often diagnosed at a rate of more than 95% of IAP percentile - for the control group of patients more than 20 mm Hg for patients with obesity more than 23 mm Hg., recorded before the operation. With the development of paresis bowel IAP dynamics within three postoperative days it was practically absent (Δ IAP = 2,55 ± 1,28 mm Hg). Postoperative EA, compared with the use of narcotic analgesics, significantly reduces IAP during the first postoperative day, which prevented the development of their intestinal paresis (RR 0.47; 95% CI: 0,24-0,83), reduced incidence of postoperative nausea (RR 0.47; 95% CI: 0,18-1,21), allows you to quickly reduce the level of IAP in the subsequent days of the postoperative period (59.7%, compared with the effect of opioids). The method of postoperative analgesia affects the dynamics of IAP. EA is the method of choice for postoperative analgesia in postpartum women with obesity and the initially high level of IAP.

The influence of perioperative analgesia modes on the prevalence of postoperative nausea and vomiting in day-case surgery patients is investigated in the article. The study involved 100 cases of unilateral phlebectomy under propofol and nitrous oxide anaesthesia, randomized by 4 groups with different perioperative analgesia modes of 25 patients each. In the first group fentanyl IV infusion was provided during surgery, in the second group it was amplified with ketoprofen 100 mg IV. In the third group sodium adenosintriphosphate IV infusion was provided for the whole surgery time, whereas the patients in the fourth group received 100 mg ketoprofen IV before it. Analgesic efficacy of all the four modes was equal, while ketoprofen administration aggravated and prolonged postoperative nausea and vomiting without influence on PONV morbidity.

Development of the systemic toxicity of local anesthetics can quickly lead to severe bradycardia and hypotension, up to cardiac arrest. The presented clinical recommendations designed to optimize medical care and are included in the list of mandatory clinical protocols according to the Helsinki Declaration on Patient Safety in Anaesthesiology. This review summarizes the main mechanisms of toxicity when using local anesthetics. The guidelines set out criteria and signs of systemic toxicity, recommendations for its prevention. The algorithm of action and recommended dosage of drugs. An intensive care protocol systemic toxicity of local anesthetics including the use of lipid emulsion.