Potentiation of general multimodal anesthesia by contact laser effects on the body in the red range in patients with lower limb high amputations

Objective. The aim of the study is to develop a technique of potentiating traditional multimodal anesthesia with contact laser exposure to the body in the red range (650 nm) in patients with critical lower limb ischemia (CLI).

Materials and methods. Multimodal anesthesia in the main group was performed with the potentiation of modern laser technology in 70 to 94 years old 35 patients [7 (20.0 %) women and 28 (80.0 %) men] with CLI and associated diseases. As a comparison group, a retrospective group of 23 patients was selected who underwent a high amputation of the lower extremities without potentiation of multimodal anesthesia with laser blood radiation. Multimodal anesthesia was additionally potentiated with quantum hemotherapy sessions. Sessions were carried out using a fifth-generation semiconductor contact laser irradiation of blood LASPOT (PRC) in the form of a wristwatch with an additional effect on the acupuncture points Nei-Guan, Tun-li – the heart meridian, connection with the inner world, Ling-dao – the meridian hearts, the road of the spirit. The first session was performed to patients before surgery — a duration of 15 minutes; the second — during surgery — a duration of 30 minutes.

Results. The obtained data on the shifts of peripheral hemodynamic parameters at the stages of surgical interventions in patients of both groups practically did not demonstrate significant differences from the baseline values, reflecting the adequacy of the degree of anesthesiological protection. In patients of the main group, central hemodynamic indices: the cardiac index (CI) significantly increased from 2.81 ± 0.49 to 3.15 ± 0.58 (p < 0.05) l/min∙m2, and total peripheral vascular resistance (TPVR) decreased from 1587.5 ± 494.3 to 1492.7 ± 427.8 dyn∙s∙cm-5. In patients of the comparison group, CI increased during surgery from 2.83 ± 0.53 to 3.02 ± 0.35 l/min∙m2, and at the end of the operation it returned to baseline. Potentiation of multimodal anesthesia with modern laser technologies in patients of the main group made it possible to reduce during surgical interventions the average dose of fentanyl, which was 0.98 ± 0.12 mcg/kg/h, while in patients of the comparison group, the consumption of fentanyl was 3.28 ± 0.18 mcg/kg/h (with traditional combined general anesthesia, the flow rate of fentanyl during surgery is on average 5–12 mcg/kg/h or more).

Conclusion. The method of potentiation of the traditional scheme of general combined anesthesia with optical radiation of the red range (650 nm) allows to achieve more pronounced effects of hemodynamic control, makes it possible to reduce the dose of fentanyl, reduce the pharmacological load on the operated patient.

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