Formation of surgical stress response and the efficiency of anestesia during surgical correction of spine deformations depending on the type of anesthesia

In anesthesiology practice, an actual problem is the perioperative modulation of the surgical stress response through a multimodal effect on the nociceptive system. The severity of the patient’s stress response to any surgical intervention to the greatest extent depends on the invasiveness of the operation and the adequacy of the performed perioperative anesthesia. Surgical stress response, a complex of neuroendocrine, metabolic and inflammatory changes that develops as a result of surgical trauma, is considered as the main cause of postoperative complications.

AIM OFTHE STUDY: To assess the formation and severity of the surgical stress response, the effectiveness of anesthesia and hemodynamic parameters during surgical correction of spinal deformities, depending on the type of anesthesia.

MATERIALS AND METHODS. After approval by the local ethics committee and taking written informed consent, a prospective randomized single-center study included 70 patients aged 18 to 39 years who underwent elective surgical interventions for the correction of spinal deformities of congenital or idiopathic (kyphoscoliotic deformities) genesis.

RESULTS. The response to surgical stress reflects the combination of endocrine, immunological, and hematological changes that occur after injury and injury. By modulating mediators of neurohumoral stress, anesthesia can indirectly influence the inflammatory response of surgical patients by suppressing or releasing various cytokines and neurotransmitters. In addition, anesthetics can directly affect the functions of immunocompetent cells, such as phagocytosis, proliferation, and cell number through apoptosis. Inhalation anesthetics cause apoptosis of lymphocytes by increasing mitochondrial permeability. Opioid receptors are located at varying densities throughout the body, central, peripheral, and autonomic nervous systems, as well as in endocrine tissues and cells of the immune system. In our study, we have shown that, as a rule, the maximum immunosuppression and stress response in almost all parameters of the immune system are observed on the 2nd and 3rd day after surgery. Thus, we found a statistically significant difference in the level of lymphocytes in patients. A proper inflammatory response is essential for tissue healing and infection control after surgery. However, an imbalance between pro- and anti-inflammatory mediators increases the risk of postoperative infection. In addition to a weaker preoperative physical condition, a strong inflammatory response is one of the reasons for slower functional recovery.

CONCLUSION. Combined anesthesia provided the best pain relief. Adequate analgesia and hemodynamic stability in the CA+PEA group led to a reduction in fentanyl doses. The results of the present study confirm that blockade of afferent nerves with spinal and epidural analgesia can reduce the postoperative neuroendocrine stress response and optimize hemodynamics in patients undergoing spinal deformity surgery through effective pain control and consumption of fentanyl, promedol, and morphine.

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