CHANGES IN FUNCTIONAL PARAMETERS OF THE CARDIOVASCULAR SYSTEM AND MICROCIRCULATION IN OBESE FEMALE PATIENTS UNDERGOING LIPOSUCTION UNDER THE INFLUENCE OF SYSTEMIC EPINEPHRINE ABSORPTION DURING GENERAL ANESTHESIA

The aim of the research: Was to determine the nature of changes in functional parameters of the cardiovascular system and microcirculation in obese female patients undergoing liposuction under the influence of systemic epinephrine absorption during general anesthesia.

Materials and methods. A prospective randomized study was conducted in 60 obese female patients with grade II–III obesity who underwent liposuction of more than 4000 mL. Three methods of maintaining general anesthesia were used: sevoflurane, desflurane, and propofol-based anesthesia. During the intraoperative period, systemic cardiovascular responses, including heart rate (HR) and mean arterial pressure, were assessed. Continuous microcirculation monitoring was performed using laser Doppler flowmetry. The study was carried out in three phases: before anesthesia (T₁), after solution infiltration (T₂), and during lipoaspiration (T₃). Intraoperative blood loss was determined based on the hemoglobin concentration in the liquid fraction of the lipoaspirate. Statistical analysis was performed using nonparametric methods. The results are presented as tables, box-and-whisker diagrams, and correlation plots generated with IBM SPSS Statistics 23.0.

Results. Systemic epinephrine absorption during liposuction is accompanied by a phased microcirculatory response with an increase in the pulsatile component of blood flow. At the stage of subcutaneous adipose tissue infiltration with tumescent solution, a significant increase in the microcirculation index (M) and heart rate (HR) was recorded, which was most pronounced during inhalational anesthesia. The increase in M was associated with an enhanced influence of the cardiac regulatory mechanism and a decrease in the endothelial component contributing to the index. A direct correlation was found between HR and the volume of intraoperative blood loss. When HR was ≥ 90 bpm, blood loss exceeded 500 mL; when HR was ≥ 100 bpm, blood loss exceeded 800 mL. M values exceeding 25 arbitrary units were associated with marked hyperperfusion and a 30% increase in blood loss. Inhalational anesthetics potentiated the observed changes, whereas propofol reduced the severity of these manifestations.

Conclusion. Systemic epinephrine absorption during tumescent infiltration is accompanied by pronounced phasic changes in microcirculation and functional parameters of the cardiovascular system, manifesting as tachycardia, increased tissue perfusion, and predominance of the cardiac mechanism in the regulation of microvascular blood flow. The degree of these reactions correlates with the volume of intraoperative blood loss and depends on the anesthesia method. The identified patterns should be taken into account when selecting anesthetic management, and heart rate monitoring should be used as a modifiable factor for the prevention of blood loss during liposuction.

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