Using long-term epidural anesthesia in the postoperative period in patients with rectal cancer
Science Articles / / August 12, 2017
Antipov YG, Kozlov VV, VE Chuvikov, Maltsev AA, BA Khlebnikov, Frolov LS
Oncology service of the city hospital №5, g. Tolyatti
Our message is based on the analysis of the immediate postoperative period in 181 patients operated on at the oncology service in the period 2001-2003.and received intensive treatment in the department.
All patients were operated on for rectal tumors with histological verification of pathology.Submitted 85 operations abdominal-anal resection with bringing down on Petrov - holding company (BAR), 66 abdominal-perineal extirpation by Kenyu-Maylsu (BPE), 30 anterior resection of the rectum.
Anesthetic management operations - multi intubation anesthesia with catheterization of the superior vena cava, epidural anesthesia.
mean age - 61.6 years.T1-2 - 38 patients (21%), TK-4 - 143 patients (79%).
Hospital has a single department of anesthesiology and intensive care with intensive care for 6 beds for oncology service.The complex of intensive therapy were: respiratory support
need for transfusion of packed red blood cells and red blood correction occurred in 30.9% of patients.Correction gipoproteinemii performed in 38.1%.
Epidural continuous anesthesia was carried out by introducing into the catheter, mounted on the L1-4 level, local anesthetics.40-80 mg of lidocaine administered with an interval of 4-6 hours.The indication for the administration of the next dose of the anesthetic were clinical signs of the appearance of pain.Morphine was administered at a dose of 3.5 mg at intervals of no less than 12 hours.
active peristalsis and bowel recovery comes, as a rule, by the end of 3 days.The indication for the transfer of patients in the profile department was to restore the ability of enteral feeding with stable indicators of homeostasis.
addition to the traditional assessment of the severity of patients were used for evaluation of APACHE-III system.The condition of patients at day 1 were classified as heavy (50.3 points).The average length of stay in intensive care was as follows: at OL - 3.4 days, with APE - 3.3 days, while bringing down the bar with - 3 days.Deaths in the immediate postoperative period was observed.Complications occurred in 6 patients.In 4 - acute delirium, in 3 of them on 4-9 day developed acute peritonitis.Total hospital in this group of patients, 5 patients died, which amounted to 2.8%.
cause of death was acute peritonitis in 3 patients, acute cardiovascular insufficiency in the 1st patient in TEAA 1st patient.Patients with peritonitis on 6-9 th day of re-operated, transferred to the intensive care unit, but on the 12-19 th day of intensive therapy came death.In these patients, APACHE III score was on 91 and 95 points, respectively, at the time of death.
1. Use in Intensive Care prolonged epidural analgesia after surgery for rectal cancer has a beneficial effect, it causes a distinct analgesic effect, promotes early activation of the patient, early recovery passage by the digestive tract.
2. Timely diagnosis of peritonitis due to the masking effect of epidural analgesia requires careful monitoring with regular clinical and laboratory control every 12 hours.
3. Comprehensive assessment by APACHE III allows you to objectively assess the patient's condition and prognosis, with probability 0.8.