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Evaluation of vegetative cardiac changes after intravenous administration of anesthetics during induction of general anesthesi


Author: Feghiu Iuliana
Degree:doctor of medicine
Speciality: 14.00.37 - Anaesthesiology and Reanimathology
Year:2022
Scientific adviser: Serghei Şandru
doctor habilitat, professor, Nicolae Testemitanu State University of Medicine and Pharmacy of the Republic of Moldova
Scientific consultant: Mihail Todiraş
doctor habilitat, associate professor (docent), Nicolae Testemitanu State University of Medicine and Pharmacy of the Republic of Moldova
Institution: Nicolae Testemitanu State University of Medicine and Pharmacy of the Republic of Moldova

Status

The thesis was presented on the 6 April, 2022
Approved by NCAA on the 1 July, 2022

Abstract

Adobe PDF document – 1.12 Mb / in romanian

Thesis

CZU 616-089.5-031.81-06:616.12-008(043.2)

Adobe PDF document 5.39 Mb / in romanian
174 pages

Keywords

heart rate variability, spectral analysis, sympathetic heart tonus, parasympathetic cardiac tonus, sympathycotonia

Summary

The thesis is exposed on 137 pages and comprises: introduction, 4 chapters, conclusions, bibliography which consists from 244 sources, 4 annexes, 47 figures and 15 tables. The results of the research were published in 8 scientific works, from these 3 without co-authors.

Aim of the study: analysis of evolution of vegetative heart tonus and associated hemodynamic changes during induction of general anesthesia and endotracheal intubation, with intravenous agents.

Objectives of the study: 1. Evaluation of changes in heart vegetative tonus during intravenous induction of general anesthesia with thiopental, midazolam or propofol; 2. Assessment of the relation between heart vegetative balance and the changes of arterial blood pressure and frequency of heart rhythm during induction of general anesthesia; 3. Assessment of the risk for development of arterial hypertension, arterial hypotension, sinus bradycardia, sinus tachycardia during intravenous induction of general anesthesia in relation with pre-anesthetic cardiac vegetative tonus; 4. Assessment of the risk for onset of ectopic heart arrhythmias during intravenous induction of general anesthesia and evaluation of the risk for their development in relation with pre-anesthetic vegetative tonus of the heart.

The scientific novelty and originality: There was conducted scientific work oriented to underline the changes in vegetative heart balance during induction of general anesthesia and was studied the relationship between hemodynamic changes and the presence of enhanced sympathetic or parasympathetic heart tonus in pre-anesthetic stage.

The result obtained that contributes to solve the important scientific problem in the thesis: Pre-anesthetic vegetative tonus of the heart represents a factor with predictive power for dynamic changes of arterial blood pressure, heart rate and heart rhythm after administration of agents for induction of general anesthesia and laryngoscopy with endotracheal intubation.

The theoretical significance: The theoretic bases of knowledge referring to the effects of agents for induction of general anesthesia on vegetative heart balance was completed. The effects of 3 agents (midazolam, propofol and thiopental) on the heart vegetative balance was studied, as well as was found the relation between changes in sympathetic and parasympathetic balance of the heart and changes of arterial blood pressure and heart rhythm. Also, there were studied changes of vegetative cardiac balance during laryngoscopy and endotracheal intubation.

The applicative value of thesis: Assessment of ECG and hemodynamic parameters of the patients during pre-anesthetic consultation (presence of sinus tachycardia, sinus bradycardia, arterial hypertension) or knowing the chronic medication of patients, especially if these are drugs which can interfere with vegetative cardiac tonus (beta-blockers, converting enzyme inhibitors, thyroxin, etc…) and knowing the effects of agents for induction of general anesthesia on sympathetic and parasympathetic tonus of the heart, these allow to choose the optimal agent for induction of general anesthesia, such diminishing the risk for development of unfavorable hemodynamic changes after induction, laryngoscopy and endotracheal intubation.

Implementation of scientific results: The results of this study were implemented in the clinical, didactic and scientific work in the Institute of Emergency Medicine from Chișinău and State University of Medicine and Pharmacy „Nicolae Testemiţanu”.