Kolganova K. Optimization of anaesthesia and perioperative intensive care in case of major liver resection in oncosurgery

The thesis deals with the working out of the anesthetic management scheme of liver resection, which includes premedication with dexketoprofen and ketamine, combined inhalation anesthesia with sevoflurane, accompanied by prolonged thoracic epidural analgesia with bupivakaine, normovolemic hemodilution in combination with preoperative autoblood reservation and use, perioperative anticoagulant thromboprophylaxis. The maximal stress-limiting potential of the developed anesthesiology scheme has been proved with the help of the assessment of central hemodynamics parameters, cardiac rhythm variability, serum glucose concentration and cortisol. The influence of various analgesia techniques on the course of rehabilitation period, prolonged artificial pulmonary ventilation duration, time before tracheal extubation, post-surgery pain and sedation intensity, early enteral feeding introduction, respiratory and infectious complications frequency after liver resection, length of patient's stay in intensive care unit and hospital stay duration has been shown. Efficiency and safety of the technique of autoblood reservation and thromboprophylaxis with low molecular heparins have been proved based on the markers of hemogramma, coagulation profile, activated anti X-factor of blood coagulation, frequency of thrombotic and hemorrhagic complications.