Yevsieieva V. Optimization of methods of perioperative analgesia of patients with morbid obesity undergoing laparoscopic bariatric interventions based on the principles of enhanced recovery

Accelerated postoperative rehabilitation protocols have been implemented in almost all surgical fields over the past 20 years. Bariatric surgery is no exception. Reduction of invasiveness and early activation of the patient are today the leading areas of bariatric surgery, which has become possible thanks to laparoscopic techniques. But, despite the many benefits, according to English W.J. et al. (2018), laparoscopic surgery for obesity, given the various comorbidities, remains potentially high risk and requires both advanced laparoscopic surgical techniques and excellent perioperative anesthesia. Despite the large amount of data on various schemes of anesthesia for patients during bariatric interventions, today the search for optimal schemes of anesthesia for patients with morbid obesity, especially in the implementation of the protocol of accelerated rehabilitation. According to a group of experts on multimodal analgesia led by Beverly A. et al. (2017), there is no such term as "ideal method of analgesia" or "ideal combination of drugs" for an obese patient. The work of King A.B. et al. (2018) showed that bariatric patients still receive large amounts of opioids in the perioperative period, suffer from postoperative nausea and vomiting (PONV), intestinal paresis, which adversely affects the recovery period and prolongs hospital stay. Thus, the ambiguity of the available literature on the benefits of different methods of perioperative analgesia during laparoscopic bariatric surgery has determined the relevance of this study. Purpose of the study: to improve the results of anesthesiological support of surgical treatment of patients with morbid obesity by optimizing the methods of perioperative anesthesia on the principles of accelerated rehabilitation. Objectives of the study. 1. To analyze anesthesiological risks, the prevalence of concomitant cardiac and noncardiac pathology, features of anesthesia and anesthesia in patients with morbid obesity who underwent laparoscopic bariatric interventions in a specialized short-term surgical center. 2. To study the indicators of central hemodynamics in patients with morbid obesity during laparoscopic bariatric interventions and on the basis of the established features of the pathogenesis of hemodynamic disorders to develop an algorithm for their adequate correction against carboxyperitoneum in the position of the patient on the operating table in reverse. 3. To improve the methods of general anesthesia for adequate anesthesia of laparoscopic bariatric interventions. To improve the technique of preventive multimodal analgesia in laparoscopic bariatric interventions, by reducing the number of narcotic analgesics used in patients with morbid obesity by prescribing extended premedication with non-narcotic analgesics. 4. To determine the intensity of pain syndrome and to optimize the methods of multimodal postoperative analgesia in patients with morbid obesity after laparoscopic bariatric interventions. 5. To develop an algorithm of anesthesiological perioperative management according to the principles of accelerated rehabilitation of a bariatric patient.