Perioperative management of scoliosis correction and application of pharmacokinetic and pharmacodynamic approaches in dosing of anaesthetic drugs
Keywords:scoliosis, perioperative medicine, multimodal anesthesia, pharmacokinetics, pharmacodynamics
AbstractBackground. Anesthesiology has already become multidisciplinary science and acquires more features of perioperative medicine. Confirmation of this is the development and implementation of Enhanced Recovery after Surgery (ERAS) protocols in various fields of medicine. In addition, current advances in understanding the principles of pharmacodynamics and pharmacokinetics make it possible to accurately select the dose of the drug in order to achieve the desired concentration at the site of action, avoiding too deep anesthesia and creating the conditions for adequate neurophysiological monitoring during surgery. The aim of our work is to adapt the perioperative management of scoliosis correction to the recommendations of ERAS, and to introduce pharmacokinetic and pharmacodynamic approaches to the dosage of drugs for analgesia and sedation. Materials and methods. Forty patients, who underwent surgery for scoliosis and other spinal deformities, were randomly divided into two groups depending on the method of dosing and administration of fentanyl intraoperatively: group 1 — those who received fentanyl every 15–20 minutes at a dose of 100–200 μg, and group 2 — patients who received fentanyl infusions to reach the concentration of 3–6 ng/ml at the site of action. The amount of fentanyl administered per hour of surgery was evaluated, and the time of weaning the patient from the ventilator was recorded. Results. When dosing fentanyl at the target concentration and during infusions, its amount was 250 ± 50 μg per hour that was significantly different from the amount of drug administered by bolus injection, which was 350 ± 50 μg per hour. The duration of postoperative ventilation with fentanyl infusion at the target concentration was within 14.2 ± 2.1 min in contrast to bolus management, where the duration of ventilation reached 25.3 ± 6.8 min. Conclusions. The study proposes and substantiates the need for the implementation of ERAS protocols for scoliosis correction and the introduction of pharmacokinetic and pharmacodynamic approaches to the dosing of anesthestic drugs.
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