Journal «Angiology and Vascular Surgery» • 

2014 • VOLUME 20 • №2

Combined anaesthesia in reconstructive operations on carotid arteries

Krainik V.M.1, Kozlov S.P.1,2, Deshko Yu.V.1, Gavrilenko A.V.1,2, Kouklin A.V.1

1) B.V. Petrovsky Russian Research Centre of Surgery under the Russian Academy of Medical Sciences,
2) First Moscow State Medical University named after I.M. Sechenov, Moscow, Russia

Materials and methods. The authors analysed the protocols of anaesthesia in a total of 100 patients operated on carotid arteries. Depending upon the method of anaesthesiological management, the patients were subdivided into 4 groups comparable by age, gender, physical status, and the scope of the intervention. Group One patients received only propofol-fentanyl total intravenous anaesthesia (TIVA). Group Two, Three and Four patients received combined anaesthesia which was as follows: in Group Two – TIVA based on propofol and fentanyl with superficial cervical plexus block (SCPB), in Group Three – combined anaesthesia based on sevoflurane in a combination with SCPB, and in Group Four – combined anaesthesia based on isoflurane and fentanyl in a combination with SCPB. Analysing the results, we assessed the parameters of arterial pressure, BIS values, also calculating the doses of the anaesthetics and demand for narcotic analgesics during anaesthesia. The quality of the postoperative period was evaluated according to the 5-point vertebral rating scale (VRS).

Results. Comparing the need in fentanyl for maintaining general anaesthesia revealed considerably higher doses thereof in Group One patients. Analysing the dynamics of the parameters of mean arterial pressure showed their higher stability in Groups 2, 3 and 4, which was conditioned by better antinociceptive protection with SCPB added. The degree of the postoperative pain syndrome within 48 hours according to the VRS in Group One patients was higher as compared with that in Groups Two, Three and Four patients who additionally received SCPB.

Conclusions. TIVA based on propofol and fentanyl combined with SCPB provides better analgesia in the area of the operation and decreases the demand for narcotic analgesics. Combined anaesthesia provides better stability of the haemodynamic parameters at the stages of surgery, also decreasing the degree of postoperative pain.

KEY WORDS: carotid endarterectomy, combined anaesthesia.

P. 117

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