METHOD OF ANAESTHETIC MANAGEMENT OF INTRAOPERATIVE MONITORING OF SPINAL FUNCTION

摘要

FIELD: medicine.;SUBSTANCE: invention refers to medicine, namely to anaesthesiology, and may be used as an anaesthesia care of surgical correction of severe spinal scoliosis with a high risk of developing neurological complications. For this purpose, 30 minutes prior to the operation, intramuscular pre-medication with Dormicum 0.1 mg/kg and Dimedrol 0.4 mg/kg is required. The anaesthesia is induced by Phentanyl 0.002 mg/kg, Propofol 2.5 mg/kg. The introduction of Nimbex 0.1 mg/kg is followed by the trachea intubation. After the trachea intubation and transition to artificial pulmonary ventilation, loading doses of Clopheline 0.004 mcg/kg and Ketamine 0.25 mg/kg are introduced. Sevorane in the concentration of 4 vol. % immediately follows the trachea intubation and transition to artificial pulmonary ventilation assisted by the air and oxygen flow rate of 4-5 l/min to reach the breath-out sevorane concentration min. 2.6 vol. % (1.04 minimum alveolar concentration). Then the air and oxygen flow rate is decreased to 1 l/min. Artificial pulmonary ventilation is enabled by an anaesthesia apparatus for sevorane delivery in forced pulmonary ventilation mode with the low fresh gas flow rate 1 l/min with minute tidal volume to ensure the breath-out concentration of carbon dioxide within 32-37 mm Hg, the concentration of oxygen in the mixture 40%. The mandatory safety monitoring involves blood pressure, heart rate, electrocardiogram, arterial blood oxygen saturation, mixture oxygen concentration, breath-out carbon dioxide concentration, air and oxygen sevorane concentration, breath-out sevorane concentration, breath-in air and oxygen carbon dioxide and bispectral electroencephalogram and electromyography index recordings. The anaesthesia is maintained by sevorane inhalations 3-1.5 vol. %. (1.2-0.6 minimum alveolar concentration), bolus introductions of Fentanyl 0.004±0.001 mg/kg/h, continuous infusion of Clopheline 0.004 mcg/kg/h, Ketamine 0.25 mg/kg/h and supporting Nimbex 0.05-0.03 mg/kg/h. 30 Minutes before the patient wakes up, sevorane dose is maintained at 1.0-0.8 vol. %, 20 minures before, the Nimbex introduction is completed, 15 minutes before, sevorane delivery is completed, 30 minutes before the waking up, the Fentanyl introduction is completed, while Clopheline and Ketamine are kept to be introduced. The spinal function monitoring is controlled by electroencephalogram activity and nervomuscular conduction as shown by electromyography. Patient contact is considered to be allowed if observing the bispectral electroencephalogram index min. 75-78% and the degree of residual neuromuscular blocks max. 20%. After obtaining the spinal function monitoring data, the bolus introduction of Fentanyl 0.002 mg/kg, Nimbex 0.1 mg/kg, while sevorane is started to be introduced in the concentration of 4 vol. %. Then concentration of Sevorane is reduced to 3-1.5 vol. % (1.2-0.6 minimum alveolar concentration), Clopheline and Ketamine are kept to be infused in the previous dosages.;EFFECT: method enables high control of the anaesthesia and an effective level of antinociceptive protection while the patient wakes up that is ensured by multidirectional action of the presented components of the anaesthesia.