EVALUATION OF THE INFLUENCE OF COMBINATIONS OF DRUGS FOR GENERAL ANESTHESIA ON CHANGE OF ACTIVITY OF STRESS-LIMITING AND STRESS-REALIZING LINKS ON THE CLINICAL MODEL OF ACUTE STRESS DAMAGE

Introduction: When a person is in a state of anesthesia - sedation, the realization of the stress reaction is carried out through the mesocortical - limbic system, while performing intensive therapy outside sedation - through the amygdala and the hippocampus. In this regard, the response of the stress system under anesthesia and outside it will be different and, consequently, the evaluation of reactions during anesthesia is extremely interesting and necessary for targeted (individual) choice of combinations of drugs for anesthesia, depending on their effect on the links of the stress system. The more interesting is the response of the stress system in the conditions of the existing pathology, which in itself is accompanied by a stressful response. Objectives: Evaluation of the reaction of the stress system (with the identification of age-specific features), determining the response characteristics of the stress-realizing and stress-limiting links, determining the total response of the stress system, depending on the combination of drugs used for general anesthesia on the clinical model of general surgical acute stress (adults and children). Methods: Multicentre open clinical trial (2003-2015). This article presents the data of the group without the syndrome of intracranial hypertension (WSICH) - a general surgical group: 78 adults and 87 children. The group without SICH was interesting, as a group of "typical response" to stress in the form of trauma, emotional stress, pain factor. Two types of total intravenous anesthesia were used: standard (SA) - fentanyl, propofol and modified (MA) - fentanyl, propofol, ketamine, sodium oxybate. The markers of activity of the stress system (cortisol, corticotropic releasing factor (CTRF), β-endorphin, serotonin, histamine) were studied, the concentrations of interleukins in the blood serum (IL-4, IL-6, TNFa, IL-lß, IL-2). The study was conducted in the preoperative period and on the 5th-7th day after the operation. Statistical processing of the results was carried out. Results and discussion: The normal initial reaction of the stress-realizing-link (SR) of the stress system was determined (the normal stress-typical stress response in adults and children) on preoperative (psycho-emotional) and pain (traumatic) stress, which is expressed in: normal level of cortisol (adrenal level); normal level of CTRF (hypothalamic level); increased level of histamine; The normal level of IL1; normal level of IL6; increased IL2; decrea