Anaerobic threshold – predictor of the prognosis of critical incidents with planned surgical interventions on the abdominal organs

Abstract

Despite the progress and the ever-increasing prevalence of intraoperative monitoring, improvement of the methods of anesthesia, the success of clinical pharmacology, the importance of surgical, medicamentous aggression in the manifestation of mechanisms of surgical stress remains. In these conditions, the role of anesthesiologists in ensuring patient safety during surgical intervention and anesthesia becomes even more important, as well as in the early postoperative period. All of the above circumstances determine the urgency of searching for opportunities to improve the safety of anesthesia by means of objective forecasting of the development of critical incidents and complications. To this end, a prospective study was conducted with the participation of 96 patients who underwent planned surgery on the abdominal organs. In the preoperative period, the functional condition was assessed using a cardiorespiratory and a six-minute walk test. It is shown that the anaerobic threshold, determined with the help of a cardiorespiratory loading test, can be used as a predictor for predicting the development of critical incidents. A decrease in the anaerobic threshold value of less than 11.95 ml/kg/min indicates a high probability of developing critical incidents with a sensitivity of 92% and a specificity of 77%. At the same time, the available method of objective evaluation of the functional state - a six-minute step test, was not informative, which was proved by the input of statistical analysis.

Keywords

anaerobic threshold / preoperative examination / critical incidents / hypotension / cardiorespiratory exercise test / prevention of complications / functional status / metabolic equivalent / cardiac complications / complication forecasting

References

[1] Заболотских, И.Б. Федерации анестезиологов и реаниматологов. Клинические рекомендации. Периоперационное ведение больных с сопутствующей ишемической болезнью сердца / И.Б Заболотских, К.М. Лебединский, К.В. Григорьев // Анестезиол. и реаниматол. – 2013. – № 6. – C. 67–78.

[2] Казакова, Е.А. Внутренний медицинский аудит на основе регистрации критических инцидентов в отделении анестезиологии многопрофильной клиники: дис. … канд. мед. наук / Е.А. Казакова. – М., 2007. – 102 с.

[3] Лебединский, К.М. Ишемия и острый инфаркт миокарда в послеоперационном периоде / К.М. Лебединский, И.С. Курапеев // Вестн. анестезиол. и реаниматол. – 2010. – №6. – С. 36–40.

[4] Субботин, В.В. Регистрация и анализ критических инцидентов как способ оценки вариантов общей анестезии в амбулаторной хирургической практике / В.В. Субботин, Н.Н. Ситников, С.Ю. Терехова // Вестн. анестезиол. и реаниматол. – 2009. – № 3. – С. 51–57.

[5] Цыганков, К.А. Способ модификации протокола физической нагрузки для кардиореспираторного нагрузочного тестирования в предоперационном периоде / К.А. Цыганков, Р.Е. Лахин, А.В. Щёголев // Извест. Росс. воен.-мед. акад. – 2016. – № 1. – С. 37–41.

[6] Цыганков, К.А. Первый опыт использования кардиореспираторного нагрузочного тестирования для оценки функционального состояния пациента в предоперационном периоде / К.А. Цыганков [и др.] // Воен-мед. журн. – 2017. – Т. 338, № 4. – С. 27–32.

[7] Щёголев, А.В. Анализ частоты критических инцидентов при плановых оперативных вмешательствах на органах брюшной полости / А.В. Щёголев [и др.] // Вестн. Росс. воен.-мед. акад. – 2016. – № 1 (53). – С. 29–32.

[8] ACC/AHA 2005 guideline update for the diagnosis and management of chronic heart failure in the adult: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Update the 2001 Guidelines for the Evaluation and Management of Heart Failure). J. Am. Coll. Cardiol. – 2005. – Vol. 46, № 6. – P. 1–82.

[9] Butland, R.J. Two, six, and 12 – minute walking tests in res” respiratory disease / R.J. Butland, J. Pang, E.R. Gross // Br. Med. J. – 1982. – Vol. 284, № 6329. – P. 1607–1608.

[10] Cooper, J.B. Critical incidents associated with intraoperative exchanges of anesthesia personnel / J.B. Cooper, C.D. Long // Anesthesiology. – 1982. – Vol. 56, № 6. – P. 456–461.

[11] Hennis, P. Cardiopulmonary exercise testing predicts postoperative outcome in patients undergoing gastric bypass surgery / P. Hennis // Br. J. Anaesth. – 2012. – Vol. 109, № 4. – P. 566–571.

[12] Jose, L. ESC/ESA Guidelines on non-cardiac surgery: cardiovascular assessment and management. The Joint Task Force on non-cardiac surgery: cardiovascular assessment and management of the European Society of Cardiology (ESC) and the European Society of Anaesthesiology (ESA) / L. Jose, S. Maurizio // Eur. Heart J. – 2014. – Vol. 35. – P. 2383–2431.

[13] Menkhaus, P.G. Cardiovascular effects of esmolol in anesthetized humans / P.G. Menkhaus [et al.] // Anesth. Analg. – 1985. – Vol. 64, № 3. – P. 327–334.

[14] Myers, J. A cardiopulmonary exercise testing score for predicting outcomes in patients with heart failure / J. Myers, R. Arena, F. Dewey // Am. Heart J. – 2008. – Vol. 156, № 6. – P. 1177–1183.

[15] Older, P. Preoperative evaluation of cardiac failure and ischemia in elderly patients by cardiopulmonary exercise testing / P. Older, R. Smith, P. Courtney, R. Hone // Chest. – 1993. – Vol. 104, № 3. – P. 701–704.

[16] Roseano, M. Evaluation of the surgical risk and preparation to major surgical intervention in geriatric surgery / M. Roseano, R. Eramo, C. Tonello // Ann. Ital. Chir. – 1997. – Vol. 68, № 1. – P. 67–72.