| 摘要 |
FIELD: medicine. ^ SUBSTANCE: method involves carrying out patient premedication with Phenozepam tablets at a dose of 0.0005-0.001 g, Sibazon intramuscularly introduced at a dose of 10 mg 30 min before operation on the eve and in the morning at operation day and Dimedrol at a dose of 10 mg. Then the patient is placed on operational table on mattress heated to temperature of 37-39C and connected to monitor. The central vein is punctured and catheterized and preoperative patient infusion preparation is started by intravenously dropping 500 ml of crystalloid solutions heated to temperature of 37-42C like Ringer solution or Acesol, or Trisol, or Lactasol, and the same quantity of colloid solutions HES 6% or HES 10%. Then epidural space is punctured at Th7-L1 level with subsequent catheterization following so that with catheter top being arranged at Th5-Th11 level. 4 ml of 0.5% Bupivacaine hydrochloride solution test-dose is epidurally introduced in bolus mode into the epidural space with its action being estimated. Then anesthetic is fractionally introduced in 4-5 ml large portions under arterial blood pressure and pulse control with the total amount reaching 15-20 ml with earlier entered test-dose quantity being taken in account. Oxygen inhalation is carried out through narcosis apparatus mask at a rate of 5-8 l/min on the background of independent patient breathing. Then intravenous bolus 0.1% atropine injection is introduced at a dose of 0.005 mg/kg. Anesthesia induction of 2% sodium thiopental solution is carried out at a dose of 4-5 mg/kg, and also 0.005% Phentanyl solution at a dose of 0.0025-0.0035 mg/kg as intravenous bolus injection into the central vein. Trachea intubation is carried out on the precurarization background by introducing Arduan at a dose of 1-2 mg or Esmeran at a dose of 10-20 mg. The patient is transferred to artificial lung ventilation on the background of a muscular relaxation by introducing 2% Ditiline solution at a dose of 1.5-2 mg/kg, and body temperature control gauge is arranged in the middle one-third of patient esophagus. Anesthesia is supported at all stages of operation under artificial lung ventilation conditions by carrying out inhalation with nitrous oxide and oxygen mixture with their proportion being from 2:1 up to 3:1 using flow-reversing respiratory contour having respiratory ventilation volume of 7-8 ml/kg and minute ventilation of 100-120 ml/kg. 0.5% Bupivacaine hydrochloride solution is also introduced into the epidural space every 120-150 min at a dose of 3-5 ml, Arduan is intravenously introduced every 40-60 min at a dose of 2-4 mg or Esmeron every 25-35 min at a dose of 10-20 mg. Intravenous dropping infusion of crystalloid solutions heated to temperature of 37-42C is carried out at a rate of 10-20 ml/kg/h at neoplasm removal stage. 500 ml of colloid solutions heated to temperature of 37-42C or 400 ml of 20% albumin solution heated to temperature of 36-37C is intravenously introduced 25-35 min prior to the beginning of chemotherapy. Transfusion of 400-450 ml of fresh frozen blood heated to temperature of 36-37C is carried out. The warming up mattress is switched off at chemotherapy preparation stage. Patient head occipital part and main cervical blood vessel passage area is compulsorily cooled with ice packages at the beginning of chemotherapy stage, with intravenous heated crystalloid and colloid solutions, albumin and blood plasma introduction being simultaneously terminated and crystalloid solutions introduction at room temperature being continued with patient body temperature controlled not to be above 38.5C according to esophageal gauge indications. Sodium bicarbonate and electrolytes are intravenously introduced in planned amount after having finished the chemotherapy treatment. Anesthesia is stopped at operation finish stage by stopping introducing the preparations into the epidural space and intravenously introducing relaxants, continuing artificial lung ventilation using oxygen and air mixture with FiO2 equal 0.4-0.6. ^ EFFECT: maximum nociceptive pulsation blockade from surgical intervention zone; patient body temperature supported at the level of 36-37C; prevented brain hyperthermia. ^ 4 cl |
