Melnyk S. Anaesthetic management oftransduodenal endoscopic surgeries on the biliary tract.

The dissertation is devoted to the improvement of anaesthetic management and conditions of anaesthesia provision, the enhancement of the safety and results of transduodenal endoscopic surgery on the biliary tract. A retrospective study of the results of performing transduodenal endoscopic surgery without general anaesthesia has revealed a large number of complications, namely 4.6% of patients developedlaryngospasm and 2.2% of patients developed bronchospasm; intraoperative hypertensive crisis occurred in 4.1% of patients; cardiac arrhythmias were observed in 2.3% of patients; hemodynamic instability was seen in 1.8% of patients; in 32% of cases surgery was terminated due to technical problems; in 12.9% of casessurgery was cancelled due to the patient's refusal. Three kinds of anesthetic management of endoscopic retrograde cholagiopancreatography have been amalysed at the prospective stage.General anaesthesia with preserved spontaneous breathingdoes not cause significant hemodynamic changes; however, it results in decreased oxygenation index, moderate hypercapnia, high intraoperative cortisol level, decrease in the ANI-index and increase in the time for running psychometric testing.General anaesthesia with endotracheal intubation and artificial lung ventilationdoes not cause significant changes in hemodynamics, oxygenation and alveolar ventilation; it reduces cortisol levels in the blood towards normal ones, creates the conditions for the reduction in the time needed for applying psychometric testing; however, it is accompanied by a decrease in the BIS-index and increase inthe expression of the rSpO2gene.General anaesthesia (propofol+phentanyl) with the use of thesynchronized intermittent mandatory ventilation (SIMV) mode and the gastro-laryngeal tube provides hemodynamic stability, optimal oxygenation/ventilation, normalization of cortisol levels as well as the reduction in the time to exit the maze and the increase in cerebral oxygenation.