Bachinin E.A., Utkin S.I., Stolyarov M.V.
THE PREVENTION AND THERAPY OF INTRAOPERATIVE VIOLATIONS OF THE CARDIAC RHYTHM IN THE OPHTHALMOSURGERY ^{[№ 12 ' 2015]}
In ophthalmosurgery during operation under anesthesia possibly emergence of life-threatening arrhythmias, in connection with impact on a myocardium of narcosis preparations and the oculocardiac reflex. In the conditions of purpose-built ophthalmic surgery centre, prophylaxis and well-timed perioperative therapy of cardiac rhythm disturbances are especially actual, because in the round-the-clock working hours of clinic there are no cardiologists and resuscitators. 48 patients with initial cardiac rhythm disturbances were analyzed regarding emergence the life-threatening arrhythmias during ophthalmic surgery under local and general anesthesia. In most cases the combination of local anesthesia with sedation or general anesthesia for patients with initial cardiac arrhythmias, depending on volume and duration of the ophthalmic surgery intervention demanded by it, didn't lead to development of the arrhythmias menacing to life. It is reached thanks to adequate selection of preparations for anesthesia and in due time held medical events. The methods of anesthesiology applied by us to ophthalmic surgery patients with initial cardiac rhythm disturbances taking into account its clinical form, extent of compensation, duration and volume of operation, age of the patient allow in all cases to execute operation and anesthesia quite safely, without life-threatening complications and with sufficient extent of protection of the patient. Obligatory introduction of preoperative screening electrocardiogram; the analysis of the accompanying somatic pathology; reception cancellation of beta-blockers and antagonists of calcium channels (in particular Verapamilum) and a cardiac glycosides (in particular Digoxin) in one day prior to operation allow to significantly reduce risk of development of serious and hemodynamic-significant arrhythmias and cases of sudden death in the perioperative period.