Improving the effectiveness of anesthesia support during surgery in trauma patients

The article presents a view on the ways to improve the effectiveness of anesthetic care in traumatological patients.
The aim of the study is to theoretically substantiate, develop and introduce into clinical practice schemes of premedication and anesthesia during arthroscopic surgeries, by using clonidine, nefopam and ketorolac.
Materials and methods of the study. Clinical observations were performed in 280 patients undergoing arthroscopic surgery. The comparison group consisted of 100 traumatological patients who received intramuscular premedication of atropine 0,014 mg/kg; diphenhydramine 0,14 mg/kg; trimeperidine 0,28 mg/kg 30–40 minutes before surgery. In 80 patients, clonidine 1.5 mcg/kg was additionally included in preacute drug treatment — the main group No. 1. In 100 patients, premedication was used with ketorolac 0,4 mg/kg, atropine 0,014 mg / kg and nefopam 0,27 mg/kg — the main group No. 2. All patients underwent intravenous anesthesia using propofol, ketamine, and fentanyl. The inclusion criteria were: male and female gender; age 18 years and older; presence of intra-articular knee joint injuries.
Results. A detailed analysis of the immediate preoperative period showed that 25% of patients in all groups had a negative reaction to the upcoming surgery and anesthesia. Although 52,5% of the patients were calm, only 22,5% of the patients were indifferent to the upcoming surgery. The use of premedication with atropine, diphenhydramine and trimeperidine did not correct disorders from the psycho-emotional sphere, moreover, all patients experienced fear and tension, which were relieved by drugs for introductory anesthesia. Inadequate preoperative mental preparation was accompanied by a hemodynamic reaction. Our studies have shown that patients in the comparison group had a significant decrease in SaO2 after delivery to the operating room. However, the inclusion of clonidine in the premedication significantly changed the above picture. All patients did not experience negative emotions after being taken to the operating room, and 9 of them (22,5%) were sleepy. The stabilization of hemodynamics in patients of the main group No. 1 made it possible to maintain HDD and SaO2 in optimal condition at all stages of the study. After premedication with ketorolac and nefopam, all patients experienced a significant sedative effect — 36 patients entered the operating room in a drowsy state, and 3 were even asleep. Our studies have shown that the combined use of ketorolac and nefopam significantly optimized hemodynamic parameters.
Conclusion. The inclusion of clonidine in premedication or the prescription of ketoralac with nefopam (instead of a narcotic analgesic) in premedication for patients undergoing arthroscopic operations may be promising for wide practical use, because takes into account specific clinical and physiological disorders present in the patient.

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