Mashyn O. Improving the effectiveness of anesthetic management of surgical interventions when performing laparoscopic cholecystectomy

The thesis provides a theoretical generalization and substantiates a new solution to the scientific and practical problem of improving the effectiveness and safety of anesthetic support for surgical interventions during laparoscopic cholecystectomy by personalized anesthetic support. The work was carried out based on the analysis of the course of various anesthesia options in the perioperative period in 120 patients with cholelithiasis who underwent laparoscopic cholecystectomy under total intravenous anesthesia with the use of propofol in manual mode, with the use of inhalation anesthesia with sevoflurane and total intravenous anesthesia with the use of propofol by the method of infusion of the drug at the target concentration. The use of the bispectral index monitoring method and the analgesia and nociception index monitoring method for assessing the adequacy of anesthesia in various types of anesthetic support has been expanded. It is possible to monitor the assessment of hemodynamic parameters and vegetative regulation in real time and to predict changes in indicators intraoperatively. The informative value of changes in the parameters of Central hemodynamics as a variant of assessing the patient's volemic status in the preoperative period using non-invasive essso technology is proved. The results obtained allow us to state that there are wide opportunities to minimize the impact on the cardiovascular system in the conditions of a transient increase in intra-abdominal pressure. It is proved that total intravenous anesthesia with infusion at the target concentration of the anesthetic has a high controllability, comparable to low-flow inhalation anesthesia with sevoflurane.