Pharmacological prevention of surgical stress in patients with spinal cord injury

Abstract

Objective. To evaluate the effectiveness of dalargin and polyoxidonium as neurovegetative protection components, when performing decompression and stabilization operations in patients in the late period of spine and spinal cord injury. Material and Methods. Perioperative parameters of central hemodynamics and stress hormone levels were analyzed in 68 patients operated on using technology of multi-stage treatment in one surgical session under three variants of general anesthesia with mechanical ventilation: sevoflurane, fentanyl, and rocuronium bromide in Group I (n = 23); sevoflurane, fentanyl, dalargin, and rocuronium bromide-in Group II (n = 21); and sevoflurane, fentanyl, polyoxidonium, and rocuronium bromide-in Group III (n = 24). Results. The duration of operation was: 385.7 ± 54.8 min in Group I, 391.5 ± 43.5 min in Group II, 399.2 ± 51.2 min in Group III, and blood loss was 1008.7 ± 89.2 ml, 968.3 ± 71.8 ml, 1001.4 ± 80.3 ml, respectively. Statistically significant differences in cardiac output parameter from initial values were recorded during anterior spinal fusion procedure and at the stage of spinal deformity correction. There were no significant differences in hemodynamics between the groups. The greatest deviations in stress hormone levels were recorded in Group I at stages of anterior spinal fusion, deformity correction, and on the first day after surgery. The level of endogenous intoxication in Group I corresponded to high severity, in Groups II and III-to moderate severity. The need for opioid analgesics was significantly lower in Groups II and III (p < 0.05). Conclusion. Inclusion of dalargin and polyoxidonium into the anesthesia program allows achieving a required level of anesthetic protection of patients during operation, while maintaining adequate reactivity of the patient's body defenses.