Improving the effectiveness of anesthesia support during surgery in trauma patients

The article discusses the need for premedication in the preoperative period, and presents its own data on the use of clonidine, nefopam, and ketorolac in premedication in patients to prevent hyperergic reactions of the neuro-endocrine  system during arthroscopic surgery.

The aim of the study was to evaluate the effect of the use of clonidine, the combined use of nefopam and ketorolac in premedication and anesthesia to prevent hyperergic reactions of the neuro- endocrine system in patients undergoing arthroscopic surgery.

Materials and methods. Clinical observations were performed in 280 patients undergoing arthroscopic surgery. The comparison group consisted of 100 traumatological patients who received the usual premedication of atropine 0.014 mg/kg; diphenhydramine 0.14 mg/kg; trimeperidine 0.28 mg/kg intramuscularly 30–40 minutes before surgery. In 80 patients, clonidine 1.5 mcg/kg, the main group No. 1, was additionally included in pre-acute drug treatment. In 100 patients, premedication with ketorolac 0.4 mg/kg, atropine 0.014 mg/kg and nefopam 0.27 mg/kg, the main group No. 2, was used. 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-ar ticular knee joint injuries.

Results. Mathematical analysis of the heart rhythm has shown that under the influence of psycho- emotional stress before surgery, patients experience tension in the sympathetic part of the autonomic nervous system. Premedication with atropine, diphenhydramine and trimeperidine and introductory anesthesia practically did not change the heart rate in the comparison group of patients, who remained at high levels throughout all stages of the study. The dynamics of heart rate indicators in the 2^nd main group differed slightly from the changes in the 1st main group. However, the combined use of ketorolac and nefopam made it possible to maintain AMo and IN within the physiological norm. The current level of knowledge allows us to establish only a general relationship between the wave structure of the heart rhythm and the anatomical and physiological structure of the control system. Although, the levels of humoral, hormonal, autonomic, and central (cortical) regulation correspond to certain anatomical and physiological structures (subcortical nerve centers, higher autonomic centers, and the central nervous system). However, a complete picture of the quantitative and qualitative endocrine response can only be judged by the concentration of hormones in the blood serum. The inclusion of clonidine in the premedication of patients in the main group No. 1 made it possible to remove excessive hormonal reactions by the time they were admitted to the operating room. Thus, the concentration of cortisol and insulin in the subsequent stages did not significantly differ from the norm. The combined use of ketorolac and nefopam in premedication, even without the use of narcotic analgesics, had a similar effect to clonidine and contributed to the normalization of hormones of the adrenal cortex and pancreas.

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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