Method for anesthetic management of radical operations in cancer patients

摘要

FIELD: medicine.SUBSTANCE: after patient admission to the operating room dexmedetomidine administration starts at a dose of 0.6-0.8 mcg/kg/h. Then epidural space catheterization is perform lying on the side. Analgesic mixture administration starts at a rate of 5 ml/hour and continued throughout the operation. During denitrogenation, intravenous dexmedetomidine sedation is performed at an dose of 0.6-0.8 mcg/kg/hr, after repeated denitrogenation and transition to closed circuit, oxygen supply is stopped. The breathing bag is completely emptied, then Xe is fed rapidly, once filling the breathing bag, ventilation by pure Xe flow of 150-300 ml per minute is begun under the control of FiOto reduce the oxygen concentration in the breathing circuit to 40% and Xe concentration to 60%, and then oxygen is supplied at a dose of 4 ml/kg, maintaining the balance in the ratio of Xe:O60:40. Xe flow is reduced to 0-100 ml/min intravenous administering of dexmedetomidine is continued throughout the operation at a dose of 0.3-0.6 mcg/kg/hr. Prior to surgical wound suturing Xe supply is stopped. After surgery, anesthesia machine is converted to a semi-open circuit, oxygen flow is increased to 5 l/min, sodium sugammadex is introduced at the rate of used bromide rocuronium. The patient extubated, in the early postoperative period analgesic mixture administration is continued at a rate of 5 ml/hr and intravenous dexmedetomidine administration is continued at a dose of 0.3-0.6 mcg/kg/h under the control of sedation level and hemodynamics.EFFECT: method allows to obtain an efficient multimodal anesthetic protection, reduce xenon and narcotic analgesics consumption during extended and highly-traumatic cancer surgery.2 ex