FEATURES OF HEMODYNAMIC INDICATORS IN PATIENTS WITH INCREASED BODY MASS INDEX DURING LAPAROSCOPIC CHOLECYSTECTOMY USING DIFFERENT ANESTHESIA METHODS

Abstract

Summary. Objective. To evaluate the safe energy efficiency of blood circulation in different variants of anaesthetic support for laparoscopic cholecystectomy based on the study of basic haemodynamic parameters in patients in the perioperative period. Material and Methods. We examined 84 patients with grade II obesity with acute cholecystitis. The effectiveness of the proposed methods of anaesthetic support was evaluated in a cohort prospective randomised simple open clinical trial. The control points were premedication, induction, intubation, CO2 insufflation, CO2 desufflation, extubation, 3 hours after the end of the operation. The average age of the patients (women) was (58.4±6.1) years, and the level of surgical risk according to ASA was grade II. Patients were divided into 2 groups: Group I, 42 patients, who received total intravenous anaesthesia based on propofol through a perfuser and fentanyl; Group II, 42 patients, inhalation anaesthesia based on sevoflurane using a low-flow method and fentanyl. The effectiveness of anaesthetic protection in all groups was assessed based on the analysis of clinical symptoms and changes in the main hemodynamic parameters: heart rate, mean arterial pressure, arterial blood saturation, perfusion index using the Mindray ePM15 monitor. The target level of anaesthetic depth was 60 on the BIS monitor. Results and discussion. The study showed that the groups of patients were randomised according to anthropometric and gender parameters, duration of surgery and anaesthesia, and baseline somatic status: the average body weight was (98.6±8.2) kg, the average height was (168.2±9.6) cm, the average body mass index was 37.1±1.8, the average duration of anaesthesia was 49.32.6 min, the average Charlson comorbidity index was 1.6±0.2 (the prognosis of survival after surgery was high, >90%). In patients of groups I and II, there were significantly significant differences between the perfusion index at the time of intubation, CO2 insufflation, CO2 desufflation and 3 hours after surgery, which were (3.6±0.2) % and (4.2±0.2) %, (3.9+0.1) % and (4.4+0.2) %, (3.9+0.2) % and (4.6+0.1) %, and (4.1±02) % and 4.7±0.2%, respectively. Conclusions. During laparoscopic surgery, it is important to maintain the energy efficiency of blood circulation at the reference functional level, since microcirculatory disorders and its slow recovery contribute to the occurrence of complications in the postoperative period.In patients with an increased body mass index during laparoscopic cholecystectomy, the choice of anaesthetic support is in favour of inhalation anaesthesia based on sevoflurane using the low-flow method and fentanyl.