Khalimonchyk V. Optimization of anesthetic management and postoperative period during laparoscopic surgery in gynecology

The dissertation is devoted to the substantiation, research and implementation into the clinical practice the optimal total intravenous anesthesia (TIVA) with mechanical ventilation of lungs in laparoscopic surgery in gynecology based on the research of hemodynamic status, stress and inflammatory markers, and severity of pain. 84 patients were examined. Depending on the type of the intraoperative analgesia, the patients were divided into three groups: patients of Group I (n=34) were given standard TIVA (propofol and fentanyl); Group II (n=25) - additionally to the standard TIVA the ketamine was administered in sub-anesthetic doses; Group III (n=25) - additionally to the standard TIVA the ketamine was administered in sub-anesthetic doses and dexketoprofen at the end of the surgery. It was defined that under standard TIVA, the creation of pneumoperitoneum and Trendelenburg position forms isolated hypertension, which persists until the end of the operation, rapidly developing intense pain, which activates the reactions of stress and inflammation. The use of sub-anesthetic doses of ketamine does not affect the type of blood circulation during surgery, reduces the intensity of pain and inhibits the endocrine-metabolic stress response after surgery, but does not affect the severity of inflammation. Combination of intraoperative administration of ketamine (up to 0.5 mg/kg) with dexketoprofen promotes the formation of eukinetic type of blood circulation, provides a powerful stress-limiting effect, reduces the severity of inflammation and pain in the first 12 hours after surgery, decrease length of inpatient treatment and improves quality of life after surgery.