Purpose: To improve the quality of anesthetic protection in prosthetics of large joints based on a steady state energy balance. Materials and methods: Prospective, randomized study on the basis of a controlled hemodilution (CM) double mask has been performed. In the first group of patients (32-19 women) hemodilution (HS) has not been done. The second group of patients (31-17) consisted of patients with HS. Three phases of the survey have been selected — before surgery, traumatic phase of the operation, after the operation. Analyzed the parameters of central hemodynamics (Cl (I/ min/m2) and total peripheral vascular resistance TPVR (dyn * sec1 * cm5), gas exchange (DO (ml / min) and V02 (ml / min), energy metabolism (kcal / min; kcal / day). For data processing statistical package STATISTICA6,0 was used. Results: Central hemodynamic parameters in both groups did not significantly change, and did not differ between the groups. A significant reduction in D02. DO differences between groups of patients at all stages of the studies found has been determined in both groups of patients. Oxygen consumption in the first group of patients decreased significantly to traumatic phase of the operation, and the next stage rose to baseline. Oxygen consumption in the group with CM increased by traumatic phase of the operation, but then returned to baseline. In patients with CM oxygen consumption was significantly higher than in patients without CM at all time points. It is found that there is a significant drop in energy metabolism in the first group of patients in traumatic phase of the operation, followed by reduction of the energy poten- tial. It is noted that insignificant increase of energy on stage traumatic operation in the second group of patients, with a subsequent decrease to the original level. Energy exchange at all stages of the study was significantly higher in the second group of patients. Logistic regression analysis found that controlled hemodilution is associated with increased energy metabolism at the stage prior to surgery for traumatic stage and after the intervention. Conclusion: It has been established a connection with the growth of energy controlled hemodilution with radical intervention on the hip joint. Substantial energy deficit in patients without HS on traumatic phase of the operation reveals that the high probability of occurrence of cardiovascular complications.
Prigorodov М.V., Pominova I.V., Noskova I.L, Tashkaev I.V., Virsta A.M. Anaesthesiological maintenance in total endo-prosthesis of large joints // Saratov Journal of Medical Scientific Research, Vol. 9, Issue 2, 2013, pp. 241-246