[Balanced regional anesthesia based on epidural blockade in extensive abdominal interventions in aged patients]

A high risk of hemodynamic disorders is the main problem associated with regional blocking in elderly patients subjected to abdominal surgery. There are theoretical reasons for ganglionic blocking without hypotonus as a means preventing hemodynamic complications of regional anesthesia in traumatic interventions. Extensive operations on the abdominal organs were performed in 40 patients aged 60 to 82 years. Before surgery the epidural space at the levels from T12 to T7, depending on the level of the intervention, was catheterized. Epidural blocking was combined with drugs for intravenous anesthesia (dipidolor, diazepam, nitrogen oxide). Pentamine in a dose of 1.36 +/- 0.06 mg/kg/h and dopamine in a dose of 3 to 4 micrograms/kg/h were special component of anesthesia. Intubation of the trachea and forced ventilation of the lungs were used; myorelaxants were administered only before intubation. The intra- and postoperative periods were characterized by hemodynamic and metabolic stability and early postoperative rehabilitation. The authors consider that preventive ganglionic blocking without hypotonus attained by a combination of a dosed injection of a ganglion blocker and injection of a highly selective adrenomimetic dopamine in the microcirculation dose ensure the hemodynamic and metabolic stability of balanced anesthesia based on epidural blocking in elderly and senile patients subjected to extensive abdominal interventions. The proposed method of balanced anesthesia is an effective means of neurovegetative inhibition during epidural blocking as the basic component of anesthesia, which permits minimizing the doses of general anesthetics and ensures positive changes in the respiratory system of elderly patients, manifesting by improved pulmonary and bronchial conduction and improvement of blood gas composition.