PubMed1993
The new aspects of the use of the central adrenopositive agent clopheline as a component of combined endotracheal anesthesia were studied. In distinction to the recommendation of some authors, clopheline was used in the preanesthesia period in an average dose of 2.5-3.0 mcg/kg (in debilitated patients in a dose of 1.8-2.2 mcg/kg). The authors examined 86 patients 60 to 85 years of age during planned and emergency operations on the biliary tract. All of them suffered from arterial hypertension: 70% had three and more concomitant diseases; 20% of patients were related to IB category of anesthesiological risk, 65% to IIB category, and 15% to IIIB category. The condition of peripheral and central hemodynamics, the stress index, and the excretion of the free forms of catecholamines (CA), their precursors, and metabolites were studied. During anesthesia with the use of clopheline by the suggested method, moderate activation of the sympathoadrenal system within the stress-norm occurs. During anesthesia as well as in the postanesthesia period the mechanisms of autoregulation, which contribute to rapid return of the activity of the sympathoadrenal system to the initial level and the control of the relationship of the synthesis and inactivation of CA, their precursors, and metabolites, are maintained. The method made it possible to reduce the doses of barbiturates to 2-3 mg/kg, and the doses of fentanyl by 3-4 times as compared with those in neuroleptanesthesia, which, in turn, facilitated rapid regaining of consciousness, adequate spontaneous breathing, a good cough reflex, and sufficient physical activity immediately after the operation. There were no complaints of pain hyperdynamic circulatory shift, trembling of muscles, suppressed respiration, and acrocyanosis.