Pathophysiological dynamics of pain sensitivity in burned patients, taking into account the value of the oxygen fraction in the inhaled gas mixture
ORIGINAL PAPERS
Abstract
Introduction. Pain (nociception) is an unpleasant subjective sensation, depending on its localization and strength, having a different emotional coloring, signaling damage or a threat to the existence of the body and mobilizing its defense systems, aimed at conscious avoidance of the action of a harmful factor and the formation of non-specific reactions, ensuring this avoidance. The nociceptive system perceives and conducts a pain impulse, forming a reaction to pain. The antinociceptive system is a hierarchical set of neural structures at different levels of the central nervous system, with its own mechanisms, capable of inhibiting the activity of the pain (nociceptive) system. Purpose of the study. To conduct a comparative pathophysiological study of the dynamics of pain sensitivity in burned patients, taking into account the value of the oxygen fraction in the inhaled gas mixture (FiO2). Materials and methods. The study was conducted in the Department of Thermal Injuries of the St. Petersburg Scientific Research Institute of Emergency Medicine named after I.I. Dzhanelidze. The results of the examination of 106 burned patients of both sexes with deep burns were studied, who were supplied with an oxygen-air mixture in the following proportions during anesthesiological care and in the postoperative period during surgical necrectomy under artificial ventilation: FiO2 30–35% — in 30% of those burned (45); FiO2 50–55% — in 45% of those burned (37); FiO2 75–80% — in 25% of those burned (24). The burned were divided into 3 groups, taking into account the fraction of oxygen in the inhaled gas mixture (FiO2).
Results. It was found that those burned in group 1 developed mild tissue hypoxia. At the same time, in order to provide full-fledged antinociceptive protection to those burned, an increase in doses of the opioid narcotic analgesic (fentanyl) by 18–20% was required. Normoxemia was noted in the burned patients of group 2 (control) and no increase in doses of the opioid narcotic analgesic (fentanyl) above the recommended doses was required, taking into account the nature and scope of surgical intervention. In the burned patients of group 3, the amount of opioid narcotic analgesic (fentanyl) necessary for adequate analgesia during anesthesia and the postoperative period practically did not differ from the control group. Our proposed method of increasing the oxygen fraction in the inhaled gas mixture (FiO2). more than 50% under the control of the gas composition of arterial blood has reduced pain sensitivity by half and the frequency of administration of opioid narcotic. Conclusion. The use of a high fraction of oxygen in an inhaled gas mixture (FiO2) of more than 50% over a period of time (from 180 to 720 minutes), reduces pain sensitivity by half and the frequency of intravenous, intramuscular and transdermal administration of an opioid analgesic (fentanyl) by 18–20%.
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