PECULIARITIES OF INTRA-ABDOMINAL AND ABDOMINAL PERFUSION PRESSURES IN EPIDURALLY ANESTHETIZED PATIENTS WITH CHOLECYSTOPANCREATITIS

1Barseghyan H. A.,
2Voskanyan A. A.,
1Harutyunyan H. V.

Armenia, YSMU,
1Department of General Surgery;
2Department of Endoscopic and Endocrine Surgery

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Abstract.

Background: Epidural anesthesia (EA) is still being investigated as a non-surgical method of abdominal decompression, with the help of which selective abdominal myorelaxation is conducted. The aim of this work is to investigate the role of EA on the dynamic peculiarities of intraabdominal pressure (IAP) and abdominal perfusion pressure (APP) values in patients with cholecystopancreatitis.
Methods: SIRS in patients has been estimated by R. Bone et.al (1992), which was confirmed by the resolution of the International Sepsis Definitions Conference in 2001. In order to estimate the intra abdominal  hypertension (IAH) degree the classification, worked out by M.Cheatham in 2006 and adopted by the World Society of the Abdominal Compartment Syndrome (WSACS) in 2007 was implemented. 63 patients with cholecystopancreatitis who underwent treatment in “Astghik” MC (previously Nataly Pharm Malatia MC) from 2014 to 2016 have been included in the investigation.
These patients were divided into 2 groups according to the type of anesthetics they had received during the treatment course. The patients of the first group received EA (n=33) as a means of anesthesia, for the second group patients was implemented nonsteroidal anti-inflammatory drugs (NSAID) (n=30).
Results: In the first group of patients after receiving EA IAP values have decreased faster in dynamics and after 7 days of hospitalization was registered 13.2±1.4mmHg value of IAP, whereas in the second group patients the IAP values decreases more slowly in dynamic and compared with the first group even after 21 days of hospitalization was registered a higher value of IAP (12.1±2.3mmHg.). Besides, in the first group patients SIRS symptoms were maintained during 4-6 days after hospitalization and in the second group patients-during 6-15 days. APP in the first group patients has gradually improved during the 1-10 days after hospitalization ranging from 86.1-89.4mmHg., and in the second group patients-82.6-85.1mmHg. On the 21st day after hospitalization APP was 93.7±3.4mmHg. in the first group patients and in the second group patients-86.2±5.2mmHg.
Conclusions: In patients with cholecystopancreatitis epidural anesthesia promotes faster improvement of IAP and APP values, which, in its turn, results in the elimination of the secondary spasm of the anterior abdomen wall, SIRS symptoms regression. It also can increase elasticity of the anterior abdomen wall. Hence, it can be used as a non-surgical method of abdominal decompression in patients with cholecystopancreatitis.

Keywords: cholecystopancreatitis, epidural anesthesia, intra-abdominal pressure

References

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