ПРИМЕНЕНИЕ РЕЖИМОВ САМОСТОЯТЕЛЬНОГО ДЫХАНИЯ НА РАЗЛИЧНЫХ ЭТАПАХ ОБЩЕЙ АНЕСТЕЗИИ. ЛИТЕРАТУРНЫЙ ОБЗОР

V.A. Pyzhov; K.N. Khrapov

doi:10.56871/RBR.2024.75.27.010

V.A. Pyzhov First Saint-Petersburg State Medical University named after I.P. Pavlov. Leo Tolstoy str., 6–8. Saint Petersburg, Russia, 197022 https://orcid.org/0009-0000-7593-4420
K.N. Khrapov First Saint-Petersburg State Medical University named after I.P. Pavlov. Leo Tolstoy str., 6–8. Saint Petersburg, Russia, 197022

DOI: https://doi.org/10.56871/RBR.2024.75.27.010

Keywords: artifi cial lung ventilation, pressure support ventilation, spontaneous breathing, general anesthesia, awakening

Abstract

Among all the respiratory complications observed in surgical patients in the postoperative period, lung tissue atelectasis is one of the most common. In addition to the use of protective intraoperative ventilation, one of the measures to prevent atelectasis of lung tissue may be to maintain independent breathing throughout, or at certain stages of general anesthesia. Currently, most anesthesia machines have a wide range of ventilation modes, including self-breathing mode with pressure support. When performing respiratory support in this mode, the patient is able to influence all phases of the respiratory cycle, the diaphragm remains functional, which reduces the risk of atelectasis and ventilator-induced dysfunction of the diaphragm. Due to the support pressure applied in response to each breath, the patient does little breathing work, which prevents the development of fatigue of the respiratory muscles. However, anesthesia with preserved spontaneous breathing may be limited by the need to administer high doses of opioids and anesthetics, for example, in highly traumatic surgical interventions, since anesthesia drugs can have a significant effect on the respiratory center. There is sufficient information in the literature regarding the effectiveness of its use at the stage of induction of general anesthesia, in order to better preoxygenation. The use of (PSV, pressure support ventilation) mode in combination with positive end expiratory pressure (PEEP) during preoxygenation improves oxygenation, prevents episodes of desaturation, and lengthens the time of safe apnea. In addition to using this regimen during the induction of general anesthesia, its use may be appropriate at the stage of maintaining anesthesia during operations where the introduction of muscle relaxants is not required, as well as at the final (awakening, extubation) stages of general anesthesia in cases where the main surgical stage requires total myoplegia. The use of pressure support at these stages is less common. However, a number of publications have shown that the use of this regimen during general anesthesia while maintaining independent breathing can lead to improved gas exchange and reduced atelectasis of lung tissue, in addition, make awakening and extubation more comfortable and faster, compared with other approaches to respiratory support during anesthesia.

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USE OF SPONTANEOUS BREATHING MODES AT VARIOUS STAGES OF GENERAL ANESTHESIA. LITERATURE REVIEW

Abstract

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