COMPREHENSIVE ASSESSMENT OF VEGETATIVE AND NOCICEPTIVE STATUS IN PATIENTS WITH CARDIAC ARRHYTHMIAS

The perfect strategy for anesthesia in patients during the correction of rhythm disorders should provide comfort for patients, adequate ventilation, minimal physical activity of the patient and stability of the catheter position. The meta-analysis of electrophysiological interventions in patients with atrial fibrillation demonstrates that the most commonly taken medications are hypnotics (propofol and midazolam) and analgesics (remifentanil and fentanyl). A distinctive feature of these treatments is their minimal impact on electrophysiological indicators and cardiac conduction, as well as ability to induce arrhythmia and reduce negative impact on mapping and ablation. According to systematic reviews, the number of surgical interventions performed under general anesthesia and deep sedation during treatment of complex arrhythmias is increasing. It suggests a risk of developing anesthesia-related complications. The specific of surgical interventions in patients with complex cardiac arrhythmias, heterogeneity and variability of traumatic and reflexogenic effect, as well as individual pain threshold require objective evaluation of anesthesia depth and level of analgosedation in the perioperative period. This tendency necessitates the development of multimodal monitoring approaches, providing observation of analgesia and nocicetsia balance. Methods based on the analysis evolving in response to nociceptive stimulation of automatic nervous system activity, including heart rate variability (HRV), and methods based on evaluating electroencephalogram (EEG) and electromyogram (EMG) patterns are used for objective assessment of periprocedural analgesia.