Istorijski pregled: značaj kombinacije DHBP i fentanila tokom balansirane anestezije na promene tokom laparoskopske holecistektomije - uticaj različitih tehnika anestezije na kardiovaskularni sistem

Introduction: It is unavoidable that anesthesia during surgery leads to a number of hemodynamic changes in patients. This effect is even more pronounced during laparoscopic procedures. The clinical study presented in this paper was conducted nearly two decades ago, and its goal was to determine which of the tested techniques of anesthesia during laparoscopic cholecystectomy provide the best combination of the required depth of anesthesia with the least negative effect on the hemodynamics of the patients. This study is primarily of historical significance, but its results can still be useful today in clinical judgment and decision-making in certain situations in which we can find ourselves in everyday work. Method: By prospective longitudinal study during 1999. and 2000, which included 90 patients, we performed three different anaesthetic techniques, during laparoscopic cholecystectomy in chronic cholecystitis: general balanced anaesthesia, total intravenous anaesthesia and volatile induction and maintenance anaesthesia. We assessed patient's hemodynamic functions during these operations through following parameters: systolic and diastolic blood pressure, heart rate, total peripheral resistance, cardiac output and cardiac index. Seven predefined perioperative moments had been chosen to measure the hemodynamic parameters, and the values are compared between the groups. Result: In this study, all three applied anesthesia techniques showed a statistically significant difference in the values of systolic and diastolic pressure, and the changes were most pronounced in balanced anesthesia. Since the haemodynamic variables in this study were not measured invasively, the conclusions based on the collected data can only indicate the trend of changes in other haemodynamic parameters, which are invasively measured (impact volume, minute volume, heart index, etc.). Conclusion: From the hemodynamic point of view, the results of our study are in favour of the total intravenous anesthesia and volatile introduction and maintenance of anesthesia. Safe and simple control of the depth of anaesthesia and its effective adjustment to the intensity of surgical stimuli at every moment of operation are made possibly by these techniques.