Perioperative Metabolism of Patients With Esophageal Hernia of the Diaphragm

Abstract

Summary: Premedication – medical and non-medical preparation of the patient for surgery or examination, which will take place with The study of perioperative changes in metabolism in patients undergoing laparoscopic surgical interventions for esophageal hiatal hernia (EHH) is relevant. The aim of the study. To study the perioperative metabolism in patients with EHH and evaluate the possibilities of its correction. Material and methods. The study was prospective, not randomized. 127 patients, aged 31-76 years, who underwent laparoscopic operations in connection with EHH, were studied (m-59, w-68). Preoperative risk ASA II-III. General anesthesia using the inhaled anesthetic sevoflurane and the narcotic analgesic fentanyl in conditions of low-flow artificial lung ventilation. Perioperative intensive care was carried out in accordance with the International Standards of Safe Anesthesiological Practice of the WFSA (World Federation of Societies of Anesthesiologists, 2010). In group I (n=61), a retrospective energy audit was carried out according to protocols for analgesia of medical charts and calculations of indirect calorimetry with determination of current metabolism (CM) and basal metabolism (BM). In group II (n=66), operational monitoring was supplemented with the use of indirect calorimetry with the determination of CM, BM, target metabolism (TM) and the degree of metabolic disturbance (DMD = 100×(TM-CM) / TM) %, and intensive therapy was supplemented additional infusion therapy and glucocorticoids, accordingly to the dynamics of metabolic changes. The results. The initial indicators of metabolism, in both groups, were without disturbance and significantly exceeded the basal level (in group I – by 30.5%, in group II – by 28.8%) and had the following values: in group I – 749±12 cal× min-1×m-2, in group II – 756±13 cal×min-1×m-2. In both groups, at the stage of reverse Trendelenburg position, imposition of pneumoperitoneum and the beginning of the operation, there were significant metabolic disturbances with a decrease to the basal level. In patients of group I, a slow recovery of PM was observed, the value of which at the moment of awakening remained 7.6% lower than the initial one (p<0.05). In patients of group II, against the background of increased infusion therapy and administration of glucocorticoids, PM recovery was more intense, and, at the moment of awakening, its value exceeded the corresponding value of group I by 10.4% (р<0.05). At the same time, CM and SPM were not high and did not differ from the initial values. Patients of group II, compared to group I, woke up faster and were transferred to the ward, and nausea and vomiting were 2.7 times less frequent: 7.35% in group II and 19.7% in group I (p<0, 05). After 6 and 12 hours after waking up, the feeling of pain on the VAS scale in group II was lower than in group I, respectively, by 24.3% and 34.4% (p < 0.05). Conclusions. Perioperative energy monitoring makes it safer to perform laparoscopic surgery in patients with EHH. Additional definition of the target metabolism and the degree of metabolic disturbance allows more effective construction of perioperative intensive therapy