THE EFFECT OF DEPTH OF ANESTHESIA ON THE INCIDENCE OF EARLY POSTOPERATIVE COMPLICATIONS DURING SURGERY IN THE BEACH CHAIR POSITION
DOI:
https://doi.org/10.15674/0030-59872025487-91Keywords:
Semi-sitting position, BIS monitoring, cognitive dysfunction, postoperative nausea and vomitingAbstract
Objective: To investigate the effect of BIS-controlled anesthesia depth on hemodynamic changes and early postoperative complications during shoulder surgery in the BCP. Methods. The prospective study involved 50 patients who underwent shoulder surgery in the BCP. Group Ι (n = 25) — patients whose BIS values were maintained intraoperatively within the range of 40– 48, Group ΙΙ (n = 25) — patients whose BIS monitoring values were maintained at the level of 49–57. Intraoperative BIS fluctuations beyond the range of 40–60 were not allowed in patients of both groups. The average age of patients in the Ι group was 43.2 ± 12.5 years, in the ΙΙ group — 41.8 ± 10.2 years. After induction of propofol/fentanyl in a standard dosage, tracheal intubation, the patient was transferred to the BCP. For postoperative pain relief, patients received paracetamol and non-steroidal anti-inflammatory drugs without the use of narcotic analgesics. BIS monitoring with COVIDEN was used to control the depth of sedation. The Minimental state examination (MMSE) scale and the number linking test were used to assess cognitive impairment 24 hours before surgery and 2 days after surgery. Pain was assessed using a visual analogue scale (VAS). Results. Haemodynamic parameters were assessed before induction, after induction, and 20 minutes after positioning. Patients in group Ι had a significantly higher pulse rate (79.04 ± 7.51 vs. 72.76 ± 9.46 mm Hg, p < 0.05). No significant changes in MMSE and number binding test were found when comparing pre- and postoperative indicators. Significant differences in the intensity of pain syndrome were found between the groups: 3.72 ± 1.06 vs. 5.11 ± 0.90 points on the first day after surgery (p < 0.001). In group 1, 12.0 % of patients experienced postoperative nausea and vomiting on day 1, compared to 20.0 % in group 2. The time of extubation showed a significant difference between groups 1 and 2: 19.08 ± 2.87 versus 15.30 ± 2.55 points (p < 0.001). Conclusions. Maintaining the level of sedation under BIS monitoring at 49–57 in patients during surgery in NSP conditions is accompanied by less postoperative pain and a lower incidence of PONV.
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