Dziuba D. Optimization of anesthesiological support during coronary artery stenting

The dissertation research is devoted to the study of reducing the percentage of complications and increasing the efficiency of analgosedation during X-ray endovascular stenting of coronary arteries due to the development of optimal methods of anesthesia. At the first stage of the work, a retrospective study of maps of 73 patients (58 men and 15 women) aged 35-83 years with coronary heart disease, who were treated at the State Institution "Heart Institute of the Ministry of Health of Ukraine". All patients underwent coronary angiography and coronary artery stenting as scheduled or urgent, under routine sedation (RAMSEY sedation level II-III) with diazepam and / or fentanyl, and / or morphine. At the prospective stage of the work, the results of examination and treatment of 270 patients treated at the Kyiv Regional Hospital and the Heart Institute of the Ministry of Health of Ukraine were analyzed. These were patients with coronary heart disease, stable angina, FC II-III, aged 35- 75 years, in whom the heart attack developed 1 week before surgery, with a degree of anesthesia risk ASA II-III. During the clinical assessment of patients, we used physical and general clinical techniques, we also monitored the systemic indicators of gas exchange and blood circulation, laboratory-biochemical and immunological blood tests. Also at this stage, an experimental part was carried out, during which an electro- physiological study of smooth muscle cells of the mouse intestine was applied. At the first stage of the prospective study, we determined the required depth of anesthesia. During the first phase of a prospective study, it was found that the optimal depth of analgesia during coronary artery stenting was "moderate sedation" or level three on the RAMSEY scale. In the second stage of the prospective study, a number of groups were formed to study the various components of anesthesia.