BACKGROUND: The presence of various comorbid conditions in patients with obesity increases operational risk, and high sensitivity to sedatives and opioid drugs can contribute to their aggravation. OBJECTIVE: To compare and evaluate two methods of perioperative analgesia, namely, multimodal without opioid and non-opioid when performing longitudinal gastric resection for patients with morbid obesity using the enhanced recovery after surgery protocol. MATERIALS AND METHODS: A prospective randomized study of patients with morbid obesity was conducted. Depending on the type of analgesic component of anesthesia, the patients are divided into two groups. In both groups, low-flow desflurane inhalation was used; in group 1 (n=30), the technique of non-opioid analgesia was used, which included intraoperative infusion of ketamine, dexmedetomidine, lidocaine, and magnesium sulfate. In group 2 (n=30), traditional combined anesthesia using fentanyl was administered. In the postoperative period, the infusion of the above drugs continued for 10 h in group 1. Central and peripheral hemodynamic parameters, and the depth of anesthesia were studied, and TOF-monitoring was carried out. Postoperative rehabilitation was assessed based on the time of extubation, achievement of 13 points on the PARS scale, first getting up on ones feet, appearance of overstrain, and gas discharge. Postoperative analgesia was assessed on a 10-point visual analog scale, and anesthesia-related complications were recorded. RESULTS: Surgical intervention under low-flow inhalation anesthesia based on desflurane in combination with multimodal opioid-free analgesia reduced the need for opioid analgesics intraoperatively (in group 1, the fentanyl dose was 0.2 [01; 0.2] mg; in group 2 0.4 [0.3; 0.5] mg; p=0.002), provided less fluctuation of intraoperative hemodynamic parameters (AvBP: stage 1: group 1 102 [100; 103]; group 2 102 [98; 105], p=0.96; stage 2: group 1 93 [90; 95]; group 2 96 [93; 99], p=0.003; stage 3: group 1 95 [95; 97]; group 2 100 [96; 102], p 0.001; stage 4: group 1 95 [92; 97]; group 2 98 [98; 101], p 0.001; CI stage 1: group 1 492.2; group 2 49.52.2, p=0.39; stage 2: group 1 44.42; group 2 44.62.1, p=0.26; stage 3: group 1 45.52.11; group 2 50.62.8, p=0.001; stage 4: group 1 44.52.1; group 2 48.82.5 p 0.001), and contributed to a lower level of pain and faster rehabilitation. In addition, anesthesia-related complications such as postoperative nausea and vomiting, hypoxemia, and dysphoria were less frequently recorded. CONCLUSION: The use of multimodal non-opioid analgesia contributes to a lesser fluctuation in hemodynamic parameters, a low level of postoperative pain, early activation of patients and restoration of peristalsis, and a decrease in the number of postoperative complications in patients who underwent longitudinal gastric resection for morbid obesity.

Introduction . In 2016, M. Forero published data on the successful application of a new method of analgesia for chest pain – blockade of the fascial space of the erector spinae muscle, which was given the name Erector Spinae Planeblock (ESP). With the accumulation of clinical experience in the use of this blockade, it became obvious that the range of indications for its use can be significantly expanded. We propose a technique for using ESP blockade as a component of anesthesia in retroperitoneoscopic adrenalectomy for aldosteroma. Research . The authors conducted a systematic literature review in accordance with the principles of the PRISMA Statement. A bibliographic search was carried out in September–November 2021 in the MEDLINE, EMBASE, Cochrane Library databases. The search terms were: ‘ESP – blocks’, ‘postoperative analgesia’, ‘retroperitoneoscopic adrenalectomy’, ‘preoperative preparation before adrenalectomy’.

Сахарный диабет является доказанным предиктором развития послеоперационных осложнений, особенно гнойно-септических и кардиальных, а также значительно увеличивает вероятность летального исхода. В статье представлен пересмотр национальных рекомендаций Федерации анестезиологов и реаниматологов (ФАР) по периоперационному ведению взрослых пациентов с сахарным диабетом, в котором обобщены и оценены все имеющиеся на момент пересмотра данные литературы о ведении пациентов в периоперационный период. Поиск литературы был сосредоточен на метаанализах и рандомизированных контролируемых исследованиях, но также включал регистры, нерандомизированные сравнительные и описательные исследования, серии случаев, когортные исследования, систематические обзоры и мнения экспертов. Перед публикацией рекомендации были утверждены Президиумом Правления ФАР. В пересмотренную версию 2022 г. по сравнению с предыдущей внесены изменения: обоснована предоперационная диагностика кардиальной автономной нейропатии с помощью теста глубокого дыхания и ортостатического теста, представлены принципы отмены плановой операции в зависимости от уровня гликированного гемоглобина и тактика назначения пероральных сахароснижающих препаратов. Также обоснован выбор между общей и регионарной анестезией на основании выявления кардиальной автономной нейропатии и полинейропатии, аргументирован выбор препаратов для анестезии и принципы их дозирования, определена антиэметическая терапия. Для каждой рекомендации представлен уровень достоверности доказательств и уровень убедительности доказательств. Рекомендации разработаны экспертами в области периоперационного ведения пациентов для врачей анестезиологов-реаниматологов в качестве помощи в принятии клинических решений, окончательное решение по конкретному пациенту принимается лечащим врачом после консультации врача-эндокринолога и/или на основе решения консилиума.

It is becoming increasingly important to prevent complications of surgical treatment, including perioperative acute kidney injury due to prolongation of life expectancy and age-related multicomorbidity. The objective was to review the recommendations of the expert groups and the studу results on risk factors, criteria and biomarkers of perioperative acute kidney injury. Materials and methods . Reports on search results for the last 15 years as of May 15, 2023 in the eLibrary, PubMed databases for the keywords «acute kidney injury», «biomarker», «perioperative period». The inclusion of reports in the review and their evaluation are based on the authors consensus. Results . In the perioperative period, acute kidney injury without a decrease in diuresis and/or an increase in serum creatinine levels up to a certain time may occur. This condition, which varies in causes and mechanisms of development, is potentially reversible with timely detection and treatment. The study of both biomarkers that surpass creatinine and diuresis in the timing and accuracy of detecting kidney damage/dysfunction, as well as tools for a comprehensive assessment and risk stratification of perioperative acute kidney injury, have not yet been completed with evidence-based conclusions. Conclusion . The strategy of using laboratory biomarkers in combination with the clinical context and risk factors for the prevention, diagnosis and treatment of subclinical acute kidney injury of various origins, supported by the Acute Disease Quality Initiative (2020), could be implemented based on additional evidence from future clinical studies.

Objective. To improve the results of treatment of comorbid patients with acute arterial ischemia by substantiating the optimal type of spinal anesthesia for surgical intervention on the affected limb.Materials and methods. The study involved 70 patients who were treated in the Department of Vascular Surgery of Clinical Hospital of ‘Russian Railways-Medicine Co.’ in Barnaul. The patients were divided into two groups: group 1 – patients operated under conditions of bilateral (bilateral) spinal anesthesia, group 2 – patients operated under conditions of monolateral (unilateral) spinal anesthesia. All patients underwent an assessment of the level of spinal block on the Bromage scale, monitoring of central hemodynamics using a MARG-10–01 rheograph, postoperative assessment of myocardial ischemia on the ECG, acute kidney damage to control diuresis.Results. In the 2nd group, there was a sufficient sensory and motor block to perform surgery. In the intraoperative period in the group of patients who underwent unilateral blockade, the mean arterial pressure decreased by 3 mm Hg. In this regard, there was no clinically significant increase in heart rate and a decrease in the stroke index and the index of total peripheral vascular resistance. In the 1st group, the decrease in mean arterial pressure reached 20% of the original, which led to an increase in heart rate by 12% and a decrease in stroke index by 11%.Conclusions. During the perioperative period, the indicators of central hemodynamics in the group 2 were more stable compared to the group 1, they did not need the use of vasopressor drugs and crystalloids. And in the early postoperative period, patients who underwent unilateral anesthesia did not show signs of acute kidney injury. Monolateral spinal anesthesia, compared with conventional spinal anesthesia, provides more stable hemodynamics in elderly patients with acute arterial ischemia.

The most common agent used for infusion therapy in patients with diabetic ketoacidosis (DKA) is isotonic 0.9% sodium chloride solution. However, infusion of required volumes can result in development of iatrogenic complications — i. e., worsening of metabolic hyperchloremic acidosis in DKA patients with already altered acid-base balance. Balanced crystalloid solutions can be used as alternative to saline. Objective. To evaluate the feasibility of using meglumine sodium succinate (MSS) balanced crystalloid solution in DKA. Material and methods. We examined 2 groups of patients, 30 subjects each, with moderate and severe diabetic ketoacidosis admitted to anesthesiology and intensive care unit. Patients from both groups were administered with insulin and an infusion therapy was employed according to current clinical guidelines for the management of patients with complications of diabetes mellitus. In the comparison group, infusion therapy included 0.9% sodium chloride, 4% potassium chloride, and 5% dextrose. In the study group MSS intravenous drip infusions 10 ml/kg/daily were added to the infusion protocol. Volumes and infusion rates were comparable in both groups. The following indicators were evaluated: time to resolution and DKA resolution rates during thorough monitoring (first 48 hours of therapy), the time (in hours) before discontinuation of insulin infusion; the time to complete consciousness recovery (15 items on the Glasgow Coma scale); the duration (in hours) of stay in the intensive care unit (ICU), dynamics of blood electrolytes; parameters of acid-base balance; levels of glycemia and lactatemia. Results. All patients improved and were transferred from ICU, the mortality rate was 0%. Infusion of MSS shortened the time to DKA resolution (30.0 h [24.0 h; 36.0 h] in the study group, vs 44.5 h [36.5 h; 51.5 h] in the comparison group ( P =0.001)); DKA resolution rates during 48 hours from initiation of therapy achieved 90.0% (27) in the study group, vs 66.7% (20) in the comparison group ( P =0.060)); duration of intravenous insulin infusion was 32.0 h [24.5 h; 40.0 h] in the study group vs 48.0 h [40.0 h; 55.5 h] in the comparison group ( P =0.001)); duration of ICU stay was 41.0 h [30.0 h; 48.0 h] in the study group, vs 56.0 h [50.0 h; 66.3 h] in the comparison group ( P =0.001). Conclusion. Infusion of a balanced succinate-containing crystalloid solution improves the results of DKA treatment, as compared to traditional infusion of 0.9% sodium chloride.

Impairment of higher mental functions can complicate the course of the postoperative period even after short and minimally invasive, including laparoscopic, surgical procedures. Postoperative cognitive dysfunction significantly challenges patients’ quality of life, negating real success of surgical intervention and anesthetic support. In some cases, early postoperative cognitive dysfunction may be one of the main predictors of persistent cognitive impairment. The purpose of the review. To contemplate etiology, pathogenesis and the current perspective of postoperative cognitive dysfunction. We analyzed 96 publications in various databases (PubMed, Medline, RSCI and others), including 67 papers published over the past 5 years. The review provides an overview of current definitions and classification of postoperative cognitive dysfunction, data on the prevalence, polyethyology and risk factors, potential impact of the type of anesthesia and surgical intervention on the development of postoperative cognitive dysfunction. Various pathogenetic mechanisms of higher mental functions impairment alongside with available effective pharmacotherapies to correct them were considered. Conclusion. Numerous adverse factors of the perioperative period, such as neurotoxic effects of general anesthetics, neuroinflammation in response to operational stress and surgical trauma, impaired autoregulation of the cerebral blood flow, imperfect oxygen homeostasis, interactions of neurotransmitter, etc., can potentially cause postoperative cognitive dysfunction. Further deeper insights into etiology and pathogenesis of early postoperative cognitive dysfunction are relevant and necessary to improve prevention strategies and identify most effective pharmacotherapies to correct such disorders.

Diabetes mellitus is a proven predictor of postoperative complications, especially infectious and cardiac, and also significantly increases the risk of mortality. The article presents a revision of the national guidelines of the Federation of Anesthesiologists and Reanimatologists (FAR) on the perioperative management of adult patients with diabetes mellitus, which summarizes and evaluates all available data at the time of revision on this topic. The literature search was focused on meta-analyses and randomized controlled trials, but also included registries, non-randomized comparative and descriptive studies, case series, cohort studies, systematic reviews, and expert opinions. Before publication, the guidelines were approved by the Presidium of the FAR Board. In the revised version of 2022, changes were made in comparison with the previous one: the preoperative diagnosis of cardiac autonomic neuropathy using a deep breathing test and an orthostatic test was justified, the principles of elective surgery canceling depending on the level of glycated hemoglobin and the tactics of preoperative oral hypoglycemic drugs prescribing were presented. The choice between general and regional anesthesia based on the detection of cardiac autonomic neuropathy and polyneuropathy was also justified, the choice of drugs for anesthesia and the principles of their dosing were reasoned, antiemetic therapy was determined. For each recommendation, the level of evidence is presented. The guidelines were developed by experts in the field of perioperative management of patients for anesthesiologists and intensive care specialists to help in decision-making, the final decisions concerning an individual patient must be made by the by the attending physician after consultation with an endocrinologist and/or based on the decision of the council of specialists.

OBJECTIVETo study the dynamics of markers of brain damage, determine their role in postoperative cognitive dysfunction (POCD) and evaluate the effectiveness of therapeutic correction of POCD in patients undergoing laparoscopic cholecystectomy under inhalation anesthesia with sevoflurane.MATERIAL AND METHODSWe analyzed data of two representative groups of patients (aged 55 years and older) who underwent laparoscopic cholecystectomy under inhalation anesthesia with sevoflurane. Perioperative neuropsychological testing was performed for monitoring of higher mental functions (MoCA and FAB). In the 1st group (n=30), POCD was not corrected. In the 2nd group (n=30), Cellex 0.1 mg was subcutaneously injected once before surgery and then throughout 5 postoperative days to correct cognitive disorders.RESULTSNeuropsychological testing revealed moderate POCD in the 1st group. In the 2nd group, Cellex provided a significantly lower level of brain-specific proteins compared to the 1st group. This limited brain damage and ensured no severe cognitive deficit in early postoperative period.CONCLUSIONLaparoscopic cholecystectomy under inhalation anesthesia with sevoflurane in patients aged 55 years and older is accompanied by moderate POCD in early postoperative period. Injections of Cellex 0.1 mg before surgery and then for 5 postoperative days prevent POCD and improve quality of life.

BACKGROUND: Anesthetic management during interventions on the adrenal glands is quite complex. Difficulties in conducting anesthesia are often determined by concomitant obesity, which is associated with an increased sensitivity of the respiratory center to the action of opioids. This condition contributes to an increase in the frequency of respiratory and other disorders with the use of opioids. AIM: This work aimed to study the influence of different variants of perioperative anesthesia and analgesia administered during retroperitoneoscopic adrenalectomy in obese patients during the perioperative period. MATERIALS AND METHODS: A randomized study of 94 patients who underwent retroperitoneoscopic adrenalectomy for adrenal neoplasms was performed. Depending on the type of perioperative analgesia, the patients were divided into two groups. In group 1 (n=33), the operation was performed under combined anesthesia based on the low-flow desflurane inhalation; for perioperative analgesia, only systemic opioid administration was provided. In group 2 (n=30), the operation was performed under anesthesia based on low-flow desflurane inhalation in combination with the blockade of the fascial space of the erector muscle. In group 3 (n=31), the operation was performed under anesthesia based on desflurane in combination with drugs for non-opioid analgesia. critical incidents. RESULTS: Surgical intervention of the wound under inhalation anesthesia with ESP blockade (ropivacaine) and a combination of drugs for non-opioid analgesia promotes faster post-anesthetic rehabilitation, effective postoperative analgesia, and fewer complications in the early postoperative period compared with anesthesia using systemic opioid analgesics. This effect contributed to significantly shorter hospitalization of 97 hours for group 2 (95% CI 85-102) (p=0,042) and 94 hours for group 3 (95% CI 82-101) (p=0,039) compared with the 126 hours for group 1 (95% CI 114-135). CONCLUSIONS: Anesthesia based on desflurane in combination with ESP blockade and a multiple drugs for non-opioid anesthesia is an effective method that promotes fast post-anesthesia rehabilitation and shortens the hospitalization period for retroperitoneoscopic adrenalectomy for aldostectomy in the perioperative period.

ЦЕЛЬ ИССЛЕДОВАНИЯ Изучить динамику уровня маркеров мозгового повреждения, состояния высших психических функций (ВПФ) и эффективность применения Цитофлавина с целью терапии послеоперационной когнитивной дисфункции (ПОКД) у пациентов, перенесших видеолапароскопическую холецистэктомию (ВЛХЭ) в условиях ингаляционной анестезии севофлураном. МАТЕРИАЛ И МЕТОДЫ Проанализированы данные репрезентативных групп пациентов (n=60), которым в условиях ингаляционной анестезии севофлураном проведена ВЛХЭ. На этапах периоперационного периода в динамике определяли уровни маркеров мозгового повреждения (протеин S-100 и нейронспецифическая енолаза, НСЕ), с целью мониторинга состояния ВПФ проведено нейропсихологическое тестирование: использованы Монреальская шкала когнитивной дисфункции (Montreal Cognitive Assessment, MoCA), тест «Батарея лобной дисфункции» (Frontal Assessment Batter, FAB). Пациентам 1-й группы (n=30) коррекцию ПОКД не проводили. Пациентам 2-й группы (n=30) с целью коррекции когнитивных расстройств назначали Цитофлавин по схеме 20 мл на 250 мл 0,9% раствора натрия хлорида внутривенно капельно однократно перед операцией, далее в течение 4 дней послеоперационного периода. РЕЗУЛЬТАТЫ У пациентов 1-й группы выявлено повышение уровней протеина S-100 и НСЕ и развитие умеренной ПОКД. В результате проведения корреляционного анализа выявлена статистически значимая зависимость между уровнем НСЕ и оценкой по шкале FAB. Включение Цитофлавина в схему терапии пациентов 2-й группы сопровождалось меньшим уровнем маркеров мозгового повреждения, способствовало улучшению состояния ВПФ. ВЫВОДЫ Проведение видеолапароскопической холецистэктомии в условиях ингаляционной анестезии севофлураном сопровождается повышением уровня маркеров мозгового повреждения и развитием послеоперационной когнитивной дисфункции. Корреляционный анализ выявил наличие зависимости между уровнем нейронспецифической енолазы и состоянием высших психических функций, в значительной степени обусловленной проведением ингаляционной анестезии. Применение в периоперационном периоде Цитофлавина способствует профилактике развития послеоперационной когнитивной дисфункции и улучшению качества жизни.

Purpose of the study. Extract original operational data containing information on the effect of non-steroidal anti-inflammatory drugs (NSAIDs) and the inclusion in the outcomes of the new coronavirus infection SARS-CoV‑19, descriptive analyzes and meta-analyzes, as in emergency and planned in gynecology, NSAIDs are used for the purpose of pain relief.Materials and methods. A systematic literature search was carried out to identify suitable studies in the electronic databases MEDLLINE, the Cochrane Central Register of Controlled Trials, the Chinese Biomedical Literature Database (CBM), domestic publications of the Russian information and analytical portal eLibrary.ru. The time horizon of publications on the problems of pain relief in women during endovideoscopic operations was 20 years. The search for publications in all languages on the use of NSAIDs in the conditions of SARS-CoV‑19 in all patient populations, regardless of gender, age, severity of the condition, was carried out for 2019–2021. The last search query is of 12/20/2021.Results and conclusions. The solution to a number of problems of anesthesia can be the refusal to use narcotic analgesics for endovideoscopic operations for female infertility. There is no clear clinical indication of the effect of NSAIDs on the risk of infection or an increase in the severity of SARS-CoV‑19 disease.

The ischemia-reperfusion syndrome complicates the course of a number of emergency conditions in various fields of clinical medicine, determines the course, prognosis and outcome of the disease. This review examines various aspects of the etiology, pathogenesis, and clinical manifestations of this syndrome. Particular attention is paid to its prevention and treatment. It is indicated that most of the studies devoted to this problem are of an experimental nature. The use of preparations based on succinic acid in the clinic is seen as the most promising direction in solving this issue.

Modern anesthesia, based on the use of halogenated hydrocarbons, nitrogen monoxide, or xenon, cannot fully ensure the interruption of nociceptive impulses at the level of the stem and spinal and subcortical formations, which caused vegetative and metabolic signs related to pain. To prevent the negative effects of pain, additional methods are used, including intraoperative analgesia and regional blockades. This study was conducted to assess the effects of various types of anesthesia, including epidural blockade, on the parameters of the immune system in patients with cancer. A total of 438 patients with malignant neoplasms of the abdominal organs were examined. In these patients, levels of cytokines (such as tumor necrosis-alpha and interleukin-6) and T-lymphocytes of various clusters of differentiation in the blood were measured. Impaired cytokine balance in patients with oncological diseases of the abdominal cavity was accompanied by the formation of suppression of cellular immunity in the postoperative period. Measurements revealed immunosuppression that was largely dependent on the type of anesthesia used. Cellular parameters with the greatest relationship with immunity were preserved during combined anesthesia, including epidural blockade.

Purpose. To improve the immediate results of surgical treatment of endogenous hypercorticism throughoptimizing the perioperative management of patients using accelerated rehabilitation protocols.Materials and methods. A randomized prospective study of 53 patients with a body mass index 35 kg/m2 was carried out. In the control group (n=27), TIVA based on propofol was used with postoperative analgesia by systemic administration of opioids. In the accelerated rehabilitation protocol group (n=26), we used anesthesia based on low-flow inhalation of desflurane with sympatholytic mixture infusion in intra- and postoperative periods, multimodal postoperative analgesia, and use of accelerated rehabilitation protocol in the perioperative period. The time of patients' achievement of BIS90 index, time of extubation, time of achievement of 10 points by the Aldrete scale and 0 points by the Bidway test, duration of stay in the in-patient hospital, number of postoperative complications were assessed. Effectiveness of analgesia was evaluated by the time of the first analgesia requirement, consumption of narcotic analgesic, VAS and Verbal Descriptor scale.Results. The study revealed that the time of awakening and reaching 10 points by the Aldrete scale in patients of group 2 was significantly shorter than in group 1: 3 (2; 6) and 6.5 (3.5; 9) min respectively (P=0.046). They had fewer postoperative complications, shorter hospitalization time — 58 (39; 71) hours compared to the control group with 74.5 (58.5; 87) hours (P=0.032).Conclusion. Perioperative management of obese patients after retroperitoneal video endoscopic adrenalectomy with the use of accelerated rehabilitation protocols contributed to earlier mobilization, reduction of the number of complications in the early postoperative period, reduction of the duration of stay in the in-patient hospital, which together facilitates improving the immediate results of surgical treatment of endogenous hypercorticism.

Patients with obesity who have undergone intra-abdominal endoscopic intervention belong to the category of patients with an increased risk of developing the syndrome of intra-abdominal hypertension (SIAH), which dictates the need to develop interventions aimed at its prevention.The OBJECTIVE was to evaluate the effectiveness of complex integrated methods of SIAH prevention in patients with morbid obesity with endoscopic bariatric surgery.MATERIAL AND METHODS. A randomized trial of 69 patients with a body mass index >35 kg/m INTENSIVE 2 was conducted; patients were divided into two groups depending on the type of anesthesia. In the 1st group (n=34), the operation was performed under combined anesthesia based on low-flow inhalation with desflurane in combination with prolonged epidural analgesia (PEA) with ropivacaine. Maintaining a deep level of myorelaxation under the control of acceleromyography in the post-tetanic counts (PTC) mode was achieved by continuous infusion of rocuronium. In the perioperative period, the infusion patients were in the «beach chair» position, and their research was carried out according to the principles of fast track surgery. In the 2nd group (n=35), the operation was performed under combined anesthesia based on lowflow inhalation with desflurane, neuromuscular blockade was performed by bolus injection of rocuronium under the control of acceleromyography in train of four (TOF) mode. Analgesia was provided by systemic administration of opioids. In both groups, markers of kidney injury were investigated, intra-abdominal pressure was monitored, the effectiveness of recovery after surgery and the quality of postoperative analgesia were assessed.RESULTS. A significantly lower level диурез of intra-abdominal pressure (IAP), связь higher compliance evaluation of the anterior crit abdominal внутрибрюшной wall, and a significantly стаканов lower level управляемой of markers of renal study injury in the отмечено postoperative period bariatric were revealed raga in the first дозе group compared to the second group during темпу the perioperative study period. keulenaerСONCLUSION. The effectiveness of using the position of deep muscle relaxation in the continuous infusion mode, adequate analgesia in the perioperative period using neuraxial techniques, using the «beach chair» position on the operating table and in the postoperative period, managing patients using fast track surgery for preventing the development of SIAG was identified.The authors declare no conflict of interest.The authors confirm that they respect the rights of the people participated in the study, including obtaining informed consent when it is necessary, and the rules of treatment of animals when they are used in the study. Author Guidelines contains the detailed information.

Justification. Among patients with large postoperative ventral hernias, the most common are patients with varying degrees of obesity. This group of patients presents a certain complexity for anesthesia in connection with a number of anatomical and physiological changes and a high risk of complications in the early postoperative period in connection with which this study was conducted. Purpose of trial. Study of the influence of various anaesthetic management and perioperative analgesia with simultaneous hernioplasty and abdominoplasty of major postoperative incisional hernia (PIH) in patients with obesity during the perioperative period. Materials and methods. A randomized trial of 59 patients with a body mass index > 30 kg /m2 was performed. Depending on the type of anesthesia, patients are divided into two groups. In the 1st group (n = 30), the operation was performed on low-flow inhalation of desflurane based anaesthesia in combination with prolonged epidural analgesia (PEA) with ropivacaine, in the 2nd group (n = 29), the operation was performed on low flow inhalation of desflurane anesthesia based in combination with blockade of transverse abdominal plane (TAP) with 0.5% solution of ropivacaine, in the 3rd group (n = 31) the operation was performed under combined anesthesia based of low flow desflurane and opioids as main perioperative analgesic. The indicators adequacy of anesthesia parameters investigated, central and peripheral hemodynamics were monitored neuromuscular conduction, evaluated the efficacy of recovery after surgery and postoperative analgesia quality, postoperative critical incident were studied. Results. It was found that surgical intervention in low-flow inhalation desflurane anaesthesia based combined with PEA ropivacaine promotes faster recovery after surgery and effective postoperative analgesia and fewer complications in the early postoperative period, which contributed to significantly shorter hospital lengths of stay for patients in group 1 — 82,5 hours (95% CI 76–93,5) compared with group 2 — 94 hours (95% CI 85,5–113) (p = 0,015). Conclusions. Combined desflurane-based anesthesia in combination with regional methods is an effective method of anesthesia and analgesia in the perioperative period and contributes to faster recovery after surgery and shorter surgical treatment with simultaneous hernio- and abdominoplasty of large (PIH) in obese patients.

Обоснование. Среди пациентов с большими послеоперационными вентральными грыжами нередко встречаются больные с высокой степенью ожирения. Эта группа пациентов представляет определенную сложность при проведении анестезиологического обеспечения в связи с целым рядом анатомо-физиологических изменений и высоким риском развития осложнений в раннем послеоперационном периоде, это явилось основанием для выполнения настоящего исследования. Цель исследования. Изучение влияния различных вариантов анестезиологического пособия и периоперационной анальгезии при симультанной гернио- и абдоминопластики больших послеоперационных вентральных грыж (ПВГ) у пациентов с сопутствующим ожирением на течение периоперационного периода. Материалы и методы. Проведено рандомизированное исследование 59 пациентов с индексом массы тела > 30 кг/м2. В зависимости от вида анестезиологического пособия пациенты поделены на две группы. В 1-й группе (n = 30) операция выполнена в условиях сочетанной анестезии на основе низкопоточной (low flow) ингаляции десфлурана в комбинации с продленной эпидуральной анальгезией (ПЭА) ропивакаином, во 2-й группе(n = 29) операция выполнена в условиях сочетанной анестезии на основе low flow ингаляции десфлурана в комбинации с блокадой поперечного пространства живота (transversus abdominal plane — TAP) 0,5% раствором ропивакаина, в 3-й группе (n = 31) операция выполнена в условиях комбинированной анестезии на основе low flow ингаляции десфлурана с парентеральным введением опиоидов как основного анальгетика в периоперационном периоде. Исследовались показатели адекватности анестезии, центральной и периферической гемодинамики, проводился мониторинг нейромышечной проводимости, оценивалась эффективность послеоперационной реабилитации и качество послеоперационной анальгезии, количество послеоперационных критических инцидентов. Результаты. Было выявлено, что оперативное вмешательство в условиях низкопоточной ингаляционной анестезии на основе десфлурана в сочетании в ПЭА ропивакаином способствует более быстрой постнаркозной реабилитации, эффективной послеоперационной анальгезии и меньшему количеству осложнений в раннем послеоперационном периоде по сравнению с использованием блокады ТАР. Это способствовало достоверно меньшим срокам госпитализации пациентов в 1-й группе — 82,5 ч (95% ДИ 76–93,5) в сравнении со 2-й группой — 94 ч (95% ДИ 85,5–113) (р = 0,015). Выводы. Сочетанная анестезия на основе десфлурана в комбинации с ПЭА является эффективным методом анестезии и анальгезии в периоперационном периоде, способствует более быстрой постнаркозной реабилитации и сокращению сроков госпитализации при симультанной гернио- и абдоминопластики больших ПВГ у пациентов с ожирением по сравнению с блокадой ТАР.