ANAESTHESIOLOGIC ASPECTS OF ENHANCED RECOVERY PROTOCOL IN ABDOMINAL AORTIC SURGERY

The article presents the results of enhanced recovery after surgery (ERAS) or fast track surgery during abdominal aortic surgery from the position of an anesthesiologist and emergency physician.

The objective of the study: to improve outcomes of surgical treatment in patients with infrarenal aortic abnormality through development, introduction and optimization of enhanced recovery after surgery.

Subjects and methods. 67 patients who had infrarenal aortic surgeries were enrolled in the study. Depending on the use of ERAS, patients were divided into two groups. The protocol developed by ourselves was applied in Group 1 (Protocol, n = 27), which included auxiliary pulmonary ventilation, intra- (after the main stage of surgery) and post-operative epidural analgesia (for at least 48 hours), limited infusions with volume control through assessment of pulse wave variations, extubation of patients early or immediately under the surgery. In Group 2, (VIS, n = 40), the anesthesia was done as per the methods traditionally accepted in Vishnevsky Institute of Surgery, which included forced pulmonary ventilation at all stages of surgery, intra-operative epidural anesthesia and liberal infusion therapy.

Results. In Group 1, the volume of infusion therapy (inclusive compensation of visible losses) made 7.7 ml · kg^-1 · h^-1 [6.3; 9.2], while in Group 2, it made ‒ 9.8 ml · kg^-1 · h^-1 [7.6; 11.5] (p < 0.05). 100% of patients from Group 1 was extubated in the operating room versus 62% in Group 2. No difference in oxygenation indices was registered between the groups during surgery, extubation and stay in the intensive care wards. However, in the morning when patients were transferred out from intensive care wards after surgery, oxygenation index made 357 [297; 445] in Group 1, while in Group 2 it made 295 [280; 380] (p < 0.07). It means that in the patients with auxiliary pulmonary ventilation, oxygenation index reduced by 17% versus the initial value, while in the patients with forced pulmonary ventilation it went down by 44% (p = 0.003). Analysis of peri-operative complications discovered a bigger number of pronounced complications as per Clavien ‒ Dindo classification in Group 2 (p < 0.05). The applied protocol allowed reducing the time of hospital stay by 3.5 days ‒ 8.0 [6.0; 8.0] versus 11.5 [9.5; 18.5] in Groups 1 and 2 respectively (p < 0.05).

Conclusion. The application of enhanced recovery protocol in infrarenal aortic surgery results in a lower number of post-operative complications and reduction of hospital stay.

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