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№4' 2014
ANESTHESIOLOGYInternational Medical Journal, Vol. 20., Iss. 4, 2014, P. 75−79.
CARDIAC SAFETY OF DIFFERENT VARIANTS OF TOTAL INTRAVENOUS ANESTHESIA IN PATIENTS WITH CORONARY ARTERY DISEASE
Kharkiv Medical Academy of Postgraduate Education, Ukraine
Anesthetic management of patients with coronary artery disease undergoing surgery remains a pressing issue in modern medicine. The reason for this is the prevalence of the disease, and chronic multiple organ dysfunction syndrome in such patients. Therefore, the risk of perioperative complications is much higher. The basic schemes of total intravenous anesthesia used in patients with ischemic heart disease were described. The main drugs for general anesthesia, which are used in Ukrainian anesthesiology, are intravenous anesthetics, cardioprotective ability of total intravenous anesthesia is still not sufficiently clear and is under investigation. This paper analyzes the impact of different variants of total intravenous anesthesia in patients with coronary artery disease and heart failure in abdominal surgery on myocardial blood flow to select the best option from the TIVA cardiac safety profile by studying the dynamics of hemodynamic, level of biomarkers of myocardial ischemia and complications. The best option TIVA in these patients is the use of total intravenous anesthesia with propofol anesthetic baseline in continuous infusion in combination with subnarcotic doses of ketamine. Revealed that most ischemic myocardial damage and heart failure develop in the early postoperative period, due to the mismatch of the oxygen regime sharply growing metabolic demand emerging from anesthesia. These patients required perioperative monitoring of hemodynamics, ECG, blood glucose, pulse oximetry, capnography, blood gases, electrolytes, hemoglobin, cardiac troponin for early detection of cardiac complications and timely correction.
Key words: total intravenous anesthesia, coronary artery disease, troponin I, NT−proBNP.