Safety of anesthesia in acute blood loss moderate hypovolemia

Abstract

Acute blood loss is the most common cause of death in armed conflicts. During the great Patriotic war, 37.2% of the wounded died on the battlefield from acute blood loss and its consequences. According to statistics of military surgeons in local wars, the percentage of deaths from bleeding on the battlefield has remained quite high in recent decades: in Afghanistan, 43% due to untimely first aid for gunshot and mine-explosive wounds, of which 27% died from acute blood loss. During counter-terrorism operations in the North Caucasus, acute blood loss was the cause of death in 26.6% of cases. Analysis of recent armed conflicts shows that the main causes of death on the battlefield are the consequences of penetrating wounds, in particular blood loss with combined traumatic brain injuries of various origins. The issue of analgesia for a lack of circulating blood volume, as well as for continuing bleeding, is complex due to the need to prevent the development of shock conditions against the background of possible side effects of anesthesia. The paper presents pharmacometric and toxicometric characteristics of a model agonist of opioid receptors in acute blood loss of moderate hypovolemia in an experiment. It was shown that the sensitivity of white rats and rabbits to intravenous anesthesia according to the criteria of deep anesthesia increased by 7.3 and 7.5 times, respectively; there were no changes in the mortality criterion for acute blood loss of moderate hypovolemia. A decrease in the speed of action and an increase in the duration of the effect of deep anesthesia in hypovolemia after intravenous administration of a model opioid receptor agonist at doses of 1 ED₅₀ was revealed. An assessment of the breadth of therapeutic action of the model agonist of opioid receptors was made, according to the results of which an increase in this indicator was revealed. It is shown that it is necessary to clarify the anaesthetic manual for more severe variations of polytrauma with blood loss.

Keywords

acute blood loss / polytrauma / agonists of opioid receptors / anesthesia / Pharmacopeia / toxicometry

References

[1] Bisenkov LN, Tynyankin NA. Osobennosti okazaniya khirurgicheskoi pomoschi postradavshim s minno-vzryvnymi raneniyami v armii Respubliki Afganistan. Voenno-meditsinskii zhurnal. 1992;1:19–22 (In Russ.)

[2] Бисенков Л.Н., Тынянкин Н.А. Особенности оказания хирургической помощи пострадавшим с минно-взрывными ранениями в армии Республики Афганистан // Военно-медицинский журнал. 1992. № 1. С. 19–22.

[3] GOST 12.1.005-88 Sistema standartov bezopasnosti truda (SSBT). Obschie sanitarno-gigienicheskie trebovaniya k vozdukhu rabochei zony. Vveden 1989-01-01 (pereizdanie 2008-01-01). Moscow: Standartinform; 2008. 95 p. (In Russ.) Available from: http://docs.cntd.ru/document/1200003608. Accessed: 2021 Feb 25.

[4] ГОСТ 12.1.005-88. Система стандартов безопасности труда (ССБТ). Общие санитарно-гигиенические требования к воздуху рабочей зоны. Введ. 1989-01-01 (переиздание 2008-01-01). М.: Стандартинформ, 2008. 95 с. Режим доступа: http://docs.cntd.ru/document/1200003608 Дата обращения: 25.02.21.

[5] Antipenko VS, Badalov VI, Bojko JeV, et al. Voenno-polevaya khirurgiya. Gumanenko EK, ed. Moscow: GEOTAR-Media; 2008. 768 p. (In Russ.)

[6] Антипенко В.С., Бадалов В.И., Бойко Э.В., и др. Военно-полевая хирургия / под ред. Гуманенко Е.К. 2-е изд., изм. и доп. М.: ГЭОТАР-Медиа, 2008. 768 с.

[7] Lebedinskii KM. Krovoobraschenie I anesteziya. Saint Petersburg: Chelovek; 2012. 1068 p. (In Russ.)

[8] Лебединский К.М. Кровообращение и анестезия СПб.: Человек, 2012. 1068 с.

[9] Voenno-polevaya khirurgiya. Lysenko MV, ed. Moscow: GEOTAR-Media; 2010. 576 p. (In Russ.)

[10] Военно-полевая хирургия / под ред. Лысенко М.В. М.: ГЭОТАР-Медиа, 2010. 576 с.

[11] Nechaev EA, Kosachev ID. Klassifikatsiya I obschaya kharakteristika vzryvnykh porazhenii. Trudy Voennoi-Meditsinskoi Akademii. 1994;236:8–30 (In Russ.)

[12] Нечаев Э.А., Косачев И.Д. Классификация и общая характеристика взрывных поражений // Труды Военно-медицинской академии. 1994. Т. 236. С. 8–30.

[13] Samokhvalov IM, Golovko KP, Denisov AV et al. The first domestic devices for intraosseous infusion – is the great advance of military medicine in pre-hospital stage enhancement. Bulletin of the Russian Military Medical Academy. 2018;(4):106–113. (In Russ.)

[14] Самохвалов И.М., Головко К.П., Денисов А.В., и др. Первые отечественные устройства для внутрикостной инфузии — значимый вклад в улучшение догоспитальной помощи // Вестник Российской военно-медицинской академии. 2018. № 4. С. 106–113.

[15] Samokhvalov IM, SChegolev AV, Gavrilin CV, et al. Anesteziologicheskaya I reanimatologicheskaya pomosch’ postradavshim s politravmoi. Saint Petersburg: InformMed; 2013. 142 p. (In Russ.)

[16] Самохвалов И.М., Щеголев А.В., Гаврилин С.В., и др. Анестезиологическая и реаниматологическая помощь пострадавшим с политравмой. СПб.: ИнформМед, 2013. 142 с.

[17] Stepanov YA, Erdniev LP, Mikshta AY, et al. Effektivnost’ anestezii pri cherepno-mozgovoi travme. Bulletin of the Russian Military Medical Academy. 2018;(3S):107–108. (In Russ.)

[18] Степанов Я.А., Эрдниев Л.П., Микшанов А.Ю., и др. Эффективность анестезии при черепно-мозговой травме // Вестник Российской военно-медицинской академии. 2018. № S3. С. 107–109.

[19] Khabriev RU. Rukovodstvo po eksperimental’nomu (doklinicheskomu) izucheniyu novykh farmakologicheskikh veschestv. Moscow: Medicina; 2012. 832 p. (In Russ.)

[20] Хабриев Р.У. Руководство по экспериментальному (доклиническому) изучению новых фармакологических веществ. М.: Медицина, 2012. 832 с.

[21] Shanin VY. Patofiziologiya kriticheskikh sostoyanii. Saint Petersnurg: Elbi-SPb; 2003. 435 p. (In Russ.)

[22] Шанин В.Ю. Патофизиология критических состояний. СПб.: Элби-СПб, 2003. 435 с.

[23] Morton DB, Abbot D, Barelay R, et al. Removal of blood from laboratory mammals and birds: First Report of the BVA/FRAME/RSPCA/UFAW Joint Working Group on Refinement. Laboratory animals. 1993;27(1):1–22.

[24] Morton D.B., Abbot D., Barelay R., et al. Removal of blood from laboratory mammals and birds: First Report of the BVA/FRAME/RSPCA/UFAW Joint Working Group on Refinement. Laboratory animals. 1993. Vol. 27, No 1. P. 1–22.

RIGHTS & PERMISSIONS

Klimov A.G., Stepanov Y.A., Erdniyev L.P., Mokshanov I.V., Mikshta A.Y., Ivashev I.P., Stepanova N.V., Andreev V.A.