Varied Anesthesia Depending on Autonomic Tone During Laparoscopic Surgery

P.A. Volkov1,2, V.A. Guryanov1

1 Chair of Anesthesiology and Critical Care, State Federal-Funded Educational Institution of Higher Professional Training, I.M. Sechenov First Moscow State Medical University of the Ministry of Health of the Russian Federation, Moscow

2 Closed Joint Stock Company Medical Rehabilitation Unit «Clinic K+31», Moscow

For correspondence: Pavel Aleksandrovich Volkov — anesthesiologist-resuscitator of Department of anesthesiology and reanimatology, JSC Inter Regional Center «Klinka K+31», Moscow; e-mail: volkovpavel@ymail.com

For citation: Volkov PA, Guryanov VA. Varied Anesthesia Depending on Autonomic Tone During Laparoscopic Surgery. Intensive Care Herald. 2017;2:26–30.


Adequacy of nonspecific perioperative adaptive reactions of the adaptation syndrome, in the first place, depends on the initial state and interaction of the autonomic nervous system. The satisfactory state of the regulation of physiological system, based on the principles of functional synergy and the relative antagonism of its sympathetic and parasympathetic components, can easily be disrupted by unbalanced pharmacological effects during anesthesia. As a result of autonomic dysfunction, regardless of the cause of its development, the initial or iatrogenic, adaptation failure may occur with the development of hemodynamic changes and postoperative complications. Recently, the number of publications by domestic and foreign authors that demonstrate the advantages of intraoperative use of a new selective alpha2-adrenoagonist drug, dexmedetomidine, has significantly increased. Nevertheless, the appointment of a drag with such pronounced effect on the autonomic nervous system, without regard to the initial vegetative status, can lead to catastrophic consequences. We conducted a comparative analysis of the relationship between changes in hemodynamic parameters and vegetative status during balanced anesthesia, where dexmedetomidine was used as part of the analgesia component. It has been shown that cholinolytic premedication and a decrease in the rate of dexmedetomidine administration in patients with parasympatotonia not only allow to avoid a decrease in the cardiac index during the operation, but also are accompanied by a physiologically more beneficial redistribution of blood circulation determinants. In addition, the results of the work indicate an unchanged quality of analgesia in the case of a decrease in the dose of dexmedetomidine in patients with parasympatotonia.

Keywords: autonomic nervous system, dexmedetomidine, multimodal analgesia

Received: 15.01.2017


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