Popivnyak K. Optimisation of anesthesiological management of the surgeries on rectal cancer.

The research deals with the issue of efficacy and safety of anesthesiological management of the surgeries on rectal cancer through design and implementation of combined neuraxial and general anesthesia with prolonged epidural analgesia in the early postoperative period. The use of regional analgesia has proved to minimize possible adverse effects, provide pharmacological and cost-benefit effects, improve patients' compliance and reduce the number of medical drugs prescribed to a patient operated on rectal cancer. The use of neuraxial anesthesia, particularly epidural analgesia has showed to improved patients' life quality, ensure adequate painkilling effect and construct opport unity for optimal blood supply of splanchnic area, better anastomoses and surgical wo unds healing, early peristalsis recovery and early enteral nutrition,prophylaxis of lung lesions and others. Generally accepted analgesia of highly traumatic surgeries such as abdominoperineal resection, extirpation or anterior resection of the rectum, fails to provide adequate patient protection from the impact of surgical stress, which triggers per operational stress-related hyperglycemia. A significant reduction I cortisol at the end of surgery suggests an adequate stress-protective effect of the intraoperational analgesia. The use of combined spinal and epidural anesthesia with superficial general anesthesia and mechanical ventilation in patients operated on rectal cancer ensures adequate anesthesiological protection from surgical aggression, reduces the quantity and quality of intraoperative and postoperative complications, shortens patients stay in the intensive care unit and hospital, which contributes not only to the medical but also to the cost-benefit effect. Judging by blood cortisol dynamics, regional anesthesia (one-moment spinal) and general anesthesia are more effective in protecting patient from surgical stress impact, which prevents related intraoperative and postoperative complications: stress-induced gastrointestinal tract lesions, transitory renal dysfunction, hypercatabolism, acute coronary syndrome, etc. Postoperative analgesia by prolonged epidural analgesia with ropivacain in patients operated on rectal cancer ensures adequate painkilling. Assessment of epidural analgesia by the patients according to numeric pain scale proves almost complete absence of pain syndrome during 1-5 days follow-up. The nociception/analgesia balance study according to ANI (analgesia nociception index) 24hours after the surgery, compared to the same period in patients with opiate painkilling, clearly indicates adequate painkilling and state of absolute patient comfort.