Explosive injury. Anesthesia

Background. The combat operations taking place in Ukraine present many questions to anesthesiologists regarding the medical assistance to the injured with blast injury. Explosive trauma is combined in pathogenesis and localization. It occurs as a result of the combined damaging effect on the human body of shock wave, gas jets, fire, toxic explosion and combustion pro-ducts, ammunition casing fragments, secondary projectiles. This type of trauma is often combined with damage to 2–4 anatomical areas and sometimes more. Moreover, the hospital care is mostly provided in civilian hospitals located next to the combat operation zone. Aim: reduction of mortality by choosing the anesthetic technology and intraoperative intensive care in victims of explosive trauma, depending on its severity and their condition. Materials and methods. During January-December 2023, 1059 (1040 men, 19 women) victims of explosive injuries who were examined according to the GKO scale (a standardized system for assessing the severity of injuries and the patient condition) were admitted to the operating rooms of the Zaporizhzhia Regional Clinical Hospital. 1071 surgeries were performed: in 1 anatomical area — 593 operations; in 2 — 292; in 3 — 118; in 4 — 49; in 5 — 19. When assessing the patient condition on the GKO scale, 106 patients had up to 10 points; 201 had 11–19 points; 402 had 20–29 points; 350 had more than 30 points. Results. Before the operation, there was normotension and moderate tachycardia. However, 202 victims had a systolic blood pressure of less than 90 mm Hg, which required the use of sympathomimetics and infusion therapy with crystalloids and colloids. Sympathomimetics and their combinations continued to be used during the surgery in 202 patients. Norepinephrine was used in 148 patients in a dose of 0.1–0.4 μg/kg/min, dopamine — in 39, adrenaline — in 4, mezaton — in 11 victims in bolus doses of 20–100 μg. The indicators of systolic, diastolic, pulse, mean arterial pressure and heart rate at the completion operative stage did not differ significantly from the baseline. Before the surgery, the victims had subcompensated metabolic and respiratory acidosis, increased lactate concentration (3.6 ± 0.1 mmol/l). During the operation, the metabolic acidosis phenomena increased, respiratory acidosis and an increase in pCO2 in the blood persisted. The blood lactate concentration increased significantly, on average up to 4.0 ± 0.1 mmol/l (р < 0.001). Conclusions. Assessment of the victim severity according to the GKO scale allows choosing the anesthesia technology taking into account the hemodynamic effect of anesthetics. During treatment of blast injury victims, it was possible to maintain normotension thanks to infusion-transfusion therapy and vasopressor support. At the end of the operation, mixed decompensated acidosis and increased lactate required further treatment in the intensive care unit.