Attestation committee
Accreditation committee
Expert committee
Dispositions, instructions
Normative acts
Scientific councils
Scientific advisers
Doctoral students
Postdoctoral students
CNAA logo

 română | русский | english

Multimodal approach for perioperative pain sindrome

Author: Adrian Belîi
Degree:doctor of medicine
Speciality: 14.00.37 - Anaesthesiology and Reanimathology
Scientific advisers: Valeriu Ghereg
doctor habilitat, professor
Laurent Beydon
doctor habilitat, profesor universitar, Universitatea Angers, Franţa
Scientific council:


The thesis was presented on the 18 September, 2006
Approved by NCAA on the 26 October, 2006


Adobe PDF document0.43 Mb / in romanian


CZU 616-089.5:615.21(043.2) B42

Adobe PDF document 1.06 Mb / in romanian
128 pages


pain syndrome, analgesic, pharmacokinetic modeling, fast-track, automatized weaning from mechanical ventilation, decision three, electronic expert system


The present paper show the results of a research from 103 patients, who were submitted to the cardiac surgery, under TIVA-TCI anesthesia, with extracorporeal circulation, in early postoperative rehabilitation period in the ”fast-track" regime.

The potential and therapeutic limits of the analgesic protocols based on the continuous opioid intravenous infusion were evaluated through the special procedure.

It was also created and tested an algorithm for weaning from mechanical ventilation, which was used on the post-operative patients without respiratory pathology; it was estimated clinical usefulness of the new dynamic predictive indexes for successful weaning from mechanical ventilation – absolute and relative variability of Vt, RR, in comparison with the rapid breathing shallow index (f/Vt).

It was compared disunity among hemodynamic assessment and cardiovascular treatment, and the values were provided from the central venous vs Swan-Ganz samples. Also, it was determined the “cut-off” values for CI, D(a-v)O2, CVP, PAWP, ΔPP, SvO2 and evaluated the error of hemodynamic assessment and cardiovascular treatment, depending on the range of the values, straggled around the “cut-off” point. It was performed the integration of cardiovascular treatment, weaning from mechanical ventilation and perioperative pain syndrome management based on the common effects concerning oxygen delivery and consumption, ventricular interference, heart-lung relation, and pharmacokinetic modeling in the a new “fast-track” concept. It was proposed the notion like “dynamic” and “static” therapeutic element that allowed introducing new principles in the “fast-track” display.

For perioperative pain syndrome control, concerning “fast-track” concept, the best opioid is morphine, following by sufentanil (if it wasn’t used in same time in peroperative), and alfentanil, in minimal recommended infusion regime. Introduction of an algorithm for weaning from mechanical ventilation allow decreasing the artificial ventilation time with 40-50%, minimize hemodynamic responsiveness to extubation. The Swan-Ganz sampling is considered indispensable for postoperative management of cardiosurgical patients. CI, CVP, PAWP, MAP parameters, with SvO2 and ΔPP are considered to be enough for a correct hemodynamic assessment and cardiovascular treatment.