Журнал «Медицина неотложных состояний» 3 (66) 2015

Introduction. Prevalence of urolithiasis in Ukraine is 30-45 % amongall urological pathology. 70% patients with urolithiasisare in the active age (30-60 years), and the disease causes disabilityin 11% of cases. The mortality of urolithiasis in Ukraine was estimated as 0,869 % in 2010.

Percutaneous endoscopic intervention (Percutaneous Nephrolithotomy - PCNL) is the method of choice for patients with physiological and technical contraindications to extracorporeal lithotripsy (large stone, multiple stones and high densitystones).

PCNL was performed in terms of general anesthesiain the most clinics. Nowadays are two main methods of general anesthesia often used — total intravenous anesthesia (TIVA) and inhalation anesthesia (IA). The purpose of our study was to determine the effect of different general anesthesia methods on the hemodynamic profile during PCNL.

Materials and methods. After obtaining written consent from the patients 30 patients aged 18-64 years with physiological status ASA I-II were selected, whom was planned PCNL.

The mean arterial pressure (MAP) is a basic indicator of hemodynamic stability. MAP is the indicator of perfusion. To monitor the depth of anesthesia bispectrum index (BIS) was used. BIS values were kept within 40-60.

Patients were randomized into two groups: 1st group -total intravenous anesthesia (TIVA) and 2nd - inhalation anesthesia (IA). In the TIVA group support anesthesia was performed with a solution of propofol 1% for target plasma concentration without feedback by perfusor compact B|Braun Space. In the group IA - low-flow anesthesia with sevoflurane. In both groups with the aim of analgesia was performed continuous infusion of fentanyl solution 0,005% rate of 2 mg/kg/h.

The infusion treatment was same in both groups (a balanced electrolyte solution at the rate of 10 ml/kg on supine position, and 5-6 ml/kg/h on prone position). If three consecutive measurements MAP (intervals of 5 min.) was less than 55 mm Hg, but not less than 50 mm Hg, the colloids infusion (10% solution hydroxyethylcellulose 200/0,5/5) was added. If three consecutive measurements MAP were less than 50 mm Hg, to the infusion of sympathomimetic (phenylephrine)was added.

Roller was mounted in kidney projection on prone position (second stage of the operation) to facilitate surgical access to the kidney specially.

Results. In both groups, we observed a significant decrease systolic blood pressure. There was no statistically significant difference between the groups TIVA and IA (p > 0,05).Average performance of MAP on the second stage of the operation was measured to 72,1 ± 4,64 and 75,1 ± 5,25 mm Hg. It indicates an adequate level of organs and tissues perfusion, despite the significant systolic blood pressure reduction.There was no statistically significant difference in MAP between groups (p > 0,05).

Infusion of the hydroxyethylcellulose solution (MAP < 55 mmHg during three dimensions) was needed in two patients (13,3 %) from group TIVA was necessary to add on the. In the group of inhalation anesthesia infusion of additional colloid solution was performed in one patient (6,7 %). In both groups, three patients (20%) after turning on the prone position had bradycardia (heart rate < 50 abbr./min.), which was needed injection of atropine.

Conclusions. The choice of anesthetic for support general anesthesia on prone position didn't influence on postural changes of hemodynamics during Percutaneous Nephrolithotomy.

This allows the anesthesiologist to provide more individual approach to the choice of anesthesia for the patient. Also take into account, in addition to the indications and contraindications, financial opportunities both patient and clinic.