Influence of the Dynamics of Рerfusion Index as a Criterion the Efficiency of the Blood Circulation on the Response of the Body of Obesous Patients to Surgical Stress During Laparoscopic Cholecystectomy Using Different Methods of Anesthesia

Abstract

Summary. Objective. To evaluate the energy efficiency of blood circulation in different variants of anaesthetic support during laparoscopic cholecystectomy based on the study of correlations between the perfusion index in dynamics and the level of adaptation of the body to surgical stress. 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 was assessed by determining the correlation between the perfusion index and the level of adaptation of the body to surgical stress. Results and discussion. The study showed that in patients of group II, where the method of anaesthetic support in patients with a high body mass index (obesity of the second degree) during laparoscopic cholecystectomy was a combination of sevoflurane and fentanyl, statistically significant correlations were determined between the perfusion index in the dynamics and the level of adaptation to surgical stress.In patients of group II, at the time of intubation, a strong positive correlation (r=0.87) was determined between the level of perfusion index and the state of adaptation, which depends, according to the calculation formula, on hemodynamic parameters, namely heart rate, systolic and diastolic blood pressure. A similar relationship was determined in patients of group II at the control point — CO2 insufflation, r=0.84, CO2 desufflation, r=0.82, at the time of extubation, r=0.62 and 3 hours after surgery, r=0.78. Conclusions. In patients with a high body mass index, metabolic features impose certain conditions for the choice of anaesthetic support.During laparoscopic surgery, it is important to maintain normal tissue perfusion, especially in obese patients, which is the key to preventing postoperative complications.The perfusion index as an indicator of the ratio between pulsating and non-pulsating vessels of the capillary network has statistically significant correlations with the level of adaptation to surgical stress when using sevoflurane as the main component of general anaesthesia in obese patients undergoing laparoscopic surgery.