Denysenko A. Personalized anesthetic management and intensive perioperative therapy in surgical interventions

The thesis presents a theoretical substantiation and practical solution of an actual scientific problem in the field of medicine, which consists in the development and implementation of personalized anesthetic management and perioperative intensive care during surgical interventions, based on the developed technology of indirect calorimetry and the created mathematical model of personalized perioperative energy monitoring with the definition of the Metabolic Rate (MR), Target Metabolic Rate (TMR) and the degree of Metabolic Disorders (MD), in the form of a computer program on a special device for Android 5. It was established that the use of the technology with minimal gas flow (FGF < 0.5 l/min), without dynamic control of perioperative metabolism, carries real risks of disruption of vital functions of organs and systems, as a result of the possible occurrence of absolute oxygen deficiency, due to low gas flow, which may not meet the real needs of the body. It is important to control factors that can increase the need for oxygen (body temperature, tachycardia, degree of surgical aggression, thyrotoxicosis, etc.). It has been proven that in cases of reduction of the FiO2–FeO2 difference below 4.4%, an immediate transition to FGF ≥ 1/min is necessary. The created methodology of personalized perioperative energy monitoring was used in 1116 studied persons: retrospectively examined 122 patients (61 with hernias of the esophageal opening of the diaphragm, 61 with acute calculous cholecystitis), prospectively – 994 patients with diseases of the neck, anterior abdominal wall and abdominal cavity. «International standards of safe anesthesiological practice» WFSA, increases the perioperative safety of patients and reduces the bed-day, due to the detection of metabolic disorders and the timely implementation of the appropriate pathogenetic correction.