Dynamic of myocardial ischemic events in different periods of general anesthesia during abdominal surgery and possible methods of their profilactics

Abstract


Relevance Perioperative myocardial ischemia is often the result of operation stress development particularly in presence of cardiovascular pathology, in this connection the development of new methods for myocardium defence at surgical intervtntion is the important problem for anesthesiology and cardiology. The purpose of the study Investigation of ischemic episodes length, their quantity and value of ischemic index at different stages of perioperative period during open cholecystectomy under intravenous multi-component anaesthesia and possibility for their correction by cardioprotectors. Materials and methods There were examined 98 patients divided into three subgroups according to one of the pathologies: ischemic heart disease (IHD), hypertensive disease (HD) and without cardiovascular disease. In each subgroups there was a group of comparison (n=34), received traditional therapy and two main groups: the 1st - (n=34) received, additionally, Mexicorum – 3 times/a day, 200 mg, intravenous (a day before the operation, during premedication, during the operation, during early postanesthetic period, and for 2 days after the operation – 600 mg (a day); the 2nd - (n=30) (a day before the operation, received Мildronat 2 times/a day, 500 mg, intravenous ( a day before the operation, during premedication, during early postanesthetic period, and for 2 days after the operation – 1000 mg (a day). Registration of ischemic episodes was carried out by the way ofdaily Holter monitoring ECG. The monitoring was divided into 6 time intervals: 1 – the day before the operation, 2 – 6 hours period before the operation, 3 – leading in anesthesia, 4 – maintenance of anesthesia, 5 – leading out of anesthesia, 6 – on the 2nd day after operation. Results and their discussion There has been revealed reduction of the ischemia time in Mexicorum and Мildronat groups among the patients with IHD and HD during the periods of leading into, leading out of anesthesia and on the2nd day after the operation (p≤0,05), among the patients without pathology - during leading into (p=0,003). The namber of ischemic episodes reduced in groups with cardioprotectors among the patients with IHD during leading into and out of anesthesia (p≤0,05). Value of ischemic index reduced after cardioprotectors prescription among the patients with IHD during leading into and out; among the patients with HD – during leading out, and among the patients without pathology during leading into anesthesia and the 2nd day after operation (p≤0,05). Conclusiou Ischemic episodes are registrated not ouly among the patients with IHD and HD, but among the patients without cardiologic pathology. Use of cytoprotectors reduced the number, duration of ischemic episodes and the value of ischemic index at differeut stages of anesthesia.

Kursk State Medical University, Kursk, Russian Federation

Author for correspondence.
Email: ser-sumin@ya.ru
MD, prof., Head of the department of anesthesiology, reanimatology and intensive therapy of the Kursk state medical university

Kursk State Medical University, Kursk, Russian Federation

Email: mikhinvp@yandex.ru
MD, prof., Head of the department of Internal Diseases No.2 of the Kursk state medical university

Kursk State Medical University, Kursk, Russian Federation

Email: volkova-nataly@yandex.ru
academic teachers of the department of anesthesiology, reanimatology and intensive therapy of the Kursk state medical university

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