As the practicing anesthesiologists know well, regional anesthesia has a number of essential advantages before the general. Here more physiologic anesthesia of the place of surgical intervention, maintaining consciousness and reflexes from the upper airways at the patient, good postoperative anesthesia, prevention of tromboemblolichesky complications, early activization of patients and some other enter. Recently regional anesthesia gained considerable distribution with development of techniques of ultrasonic navigation and neurostimulation that allows to improve significantly quality of the carried-out blockade and to make them more comfortable for the patient.
In aspect of a pandemic of a new koronavirusny infection, in the conditions of existence of a large number of patients with the specified infection in healthcare institutions, the question of admissibility of regional anesthesia at this category of patients is interesting and also at those who have no clinical manifestations of a disease and potentially is in an incubation interval or has the asymptomatic form of an infection.
Concerning the patients having clinical manifestations of a koronavirusny infection (or its consequences) and indications to expeditious treatment of this or that pathology, the decision on admissibility of use of techniques of regional anesthesia at them has to decide taking into account a condition of the patient and extent of damage of lungs.
At considerable extent of damage of lungs, existence of the expressed respiratory insufficiency, methods of regional anesthesia, especially neuroaxial blockade, are contraindicated. It is connected with influence of the central blockade on function of external respiration and a possible aggravation of symptoms of the patient against the background of the regional block. The same can be told about the peripheral blockade connected with oppression of function of external respiration such as interladder. Blockade of a phrenic nerve which often meets at this technique of anesthesia can lead to considerable oppression of function of external respiration against the background of damage of lungs and demand the emergency intubation of the patient in the operating room.
Therefore at this category of patients use of the general anesthesia when the anesthesiologist has an opportunity completely to control external respiration of the patient is much more expedient. Regional anesthesia in this case can be used in combination with the general for providing a better intraoperative analgesia or for postoperative anesthesia. At the same time it is necessary to give preference to anesthesia techniques which minimum influence a hemodynamics on the one hand and are sufficiently operated with another. It is possible to give peripheral blockade under control of ultrasonic navigation as an example, for example, blockade of cross space of a stomach in abdominal surgery.
Approach to regional methods of anesthesia at patients who are clinically healthy is also of interest, but can act as carriers, be in an incubation interval or have the asymptomatic course of a disease. The special complexity in this plan is represented by patients at whom it is impossible to receive quickly results of the PTsR-test on various organizational reasons, and surgical intervention needs to be carried out urgently. At such patients who have no defeat of easy and other manifestations of a koronavirusny infection carrying out regional methods of anesthesia can make sense. Regional anesthesia allows to refuse such aerosol - the generating procedures as an intubation and extubation of a trachea, mask ventilation and so on, thereby having lowered potential virus load of personnel of the operating room.
It is necessary to notice that the choice for regional anesthesia is not an occasion of refusal of the precautionary measures dictated by an epidemiological situation. The patient in the operating room has to be in a mask, and personnel to have appropriate means of protection. Regional anesthesia is at all not an occasion to refuse the list of the necessary protective equipment used in the operating room by personnel of surgical and anesthesiology crews. Moreover, it is necessary to understand that unlike the general anesthesia when during bigger time respiratory tracts of the patient are isolated from the surrounding atmosphere by means of the narcotic device, and hit of a virus to the environment is blocked by use of bacterial and virus filters, at regional methods of anesthesia the patient, as a rule, exhales potentially infected air to the environment.
Thus, use of regional methods of anesthesia in the conditions of a pandemic of a koronavirusny infection represents sufficient a difficult question which has to be solved in each case individually, depending on a condition of the patient, extent of allocation of a virus to the environment and the organizations of work in concrete clinic.