Changes in Hemodynamics Indicators in the Perioperative Period in Patients in Thoracic Surgery

Abstract

Introduction. The covid pandemic has caused a delay in diagnosis and early detection of oncological diseases, which in the future will be accompanied by a short-term decrease in the registration of new cancer cases, and then an increase in the number of surgical interventions, including on the respiratory organs. Anesthesiological support in thoracic surgery includes perioperative control of oxygenation and hemodynamic parameters, changes in which can negatively affect the postoperative period and increase the frequency of perioperative complications. Objective: To study the specifics of the impact of various methods of perioperative anesthesia during surgeries on the respiratory organs, using the evaluation of the hemodynamics and oxygenation indicators. Materials and methods. There were included 180 patients with lung cancer who underwent thoracotomy at the Kyiv City Clinical Hospital No. 17 from 2018 to 2021 within an open noncommercial randomized controlled clinical trial. Patients were randomized into four groups. Multimodal analgesia (MA) group: according to the concept of pre-emptive analgesia, 1 hour before incision - patients received 1000 mg of paracetamol intravenous, as well as dexketoprofen 50 mg intravenous, in the postoperative period dexketoprofen and paracetamol were administered every 8 hours, + epidural anesthesia: administration of 40 mg of 2% lidocaine solution during catheter placement, in the postoperative period - ropivacaine 2 mg/ml (3-14 ml/h). Thoracic epidural anagesia (TEA) group: epidural anesthesia: administration of 40 mg of 2% lidocaine solution during catheter placement, in the postoperative - ropivacaine 2 mg/ml (3-14 ml/h). Preemptive analgesia (PA) group: according to the concept of preemptive analgesia, 1 hour before incision - patients received 1000 mg of paracetamol intravenous, as well as dexketoprofen 50 mg intravenous, in the postoperative period dexketoprofen and paracetamol were administered every 8 hours. Control (C) group: patients received dexketoprofen 50 mg intravenous and opioid analgesic intramuscularly as needed. Results. There were not observed any statistically significant differences in the groups by age, height, weight, degree of anesthetic risk (ASA), blood loss, duration and volume of surgery (p>0.05). A 10-15% decrease in hemodynamics was noted after epidural support with subsequent need for infusion therapy prior to induction of general anesthesia. An increase of the frequency of manifestations of hypotension, itching at the injection site, and urinary retention were observed in the MA and TEA groups in the postoperative period. Conclusion. Epidural analgesia in thoracic surgery has a number of negative complications in the perioperative period, taking into account the lack of statistical difference (p>0.05) in groups according to oxygenation indicators, the use of a multimodal approach without the use of epidural support reduces the frequency of complications at all stages of complex treatment of patients.