Multimodal Combined Anesthesia during Traumatic Operations
Any need for combining the effective antinociceptive defense of a patient during traumatic surgical interventions has give rise to multimodal combined anesthesia (MCA) comprising a combination of epidural analgesia with a small-dose local anesthetic (ropivacaine 2 mg/ml), an opioid (fentanyl 2, µg/ml), and adrenaline (2, µg/ml) with low-flow anesthesia with sevoflurane at low concentrations (≤1 MCA). The paper provides evidence for the reliability of this anesthesia as the results of studying the course of 221 cancer operations on the lung, liver, and pancreas and 24 cases of sudden massive (more than 100% circulating blood volume (CBV)) intraoperative blood loss. The picture is complemented with an example of the course of an operation accompanied by massive blood loss in patients with cyanotic heart disease. The studies showed that during surgery for cancer of the lung, liver, and pancreas, the patients had normodynamic circulation and slightly increased total vascular peripheral resistance, as evidenced by capnometry monitoring of central hemodynamics, by using a NICO monitor). The findings had led to the conclusion that antinoceptive defense is adequate, but absent with excessive (hazardous under acute hypovolemia) sympathetic blockade. Retrospective analysis of cases of sudden massive blood loss (median 150% CBV) has demonstrated that hemodynamic disturbances occurring in these cases can be easily compensated for, without causing serious consequences. MCA is proposed as the method of choice for anesthetic maintenance during traumatic operations