Yakymchuk O. Clinical experimental study of peculiarities of the effects of anesthetics on homeostasis in hyperthyroidism. – Qualifying scientific work on the rights of the manuscript

This dissertation has investigated effects of different anesthetics on various aspects of homeostasis in experimental thyrotoxicosis. Importantly, this work resulted in a novel solution to a relevant scientific problem – optimization of anesthesia during surgical delivery while considering the individual level of sedation. In the experiment, the analysis of integrated criterions of endotoxemia, characteristics of biochemical, metabolic and immunoreactive changes, homocysteine metabolism during experimental intoxication of rats due to effects of different anesthetics in conditions of hyper- and euthyroidism was performed. We have found the severe metabolic disturbances, disbalance in the functioning of oxidative-redox processes and changes in the humoral immune system that altogether contribute to an increased risk of a significant damage to organs and systems in experimental animals because of the effect of various anesthetics in the presence of hyper- and euthyroidism. The peculiarities of the clinical condition of patients were determined prior to surgery that allows to define the risk groups and forecast chances of the higher risk of developing hemodynamic complications of anesthesia. The impact on the mother and child of general anesthesia with an objective assessment of the depth of anesthesia by using BIS-monitoring in comparison with the classical objective assessment of adequacy was studied. The analysis of the peculiarities of the general anesthesia and spinal anesthesia during caesarean section in women with a transient gestational thyrotoxicosis, while considering the functional status of the woman and child, was performed. A novel method was developed and employed for determining the optimal number of anesthetics for pain management by utilizing BIS-monitoring, subjective assessment, and the analysis of arterial oscillograms for the evaluation of the effect of anesthetics on the regulation of the autonomic and cardiovascular systems in patients with transient gestational thyrotoxicosis. The assessment of the impact of general anesthesia on woman’s body, the assessment of pain on the VAS scale and the condition of the newborn after performing different types of anesthesia was completed. Furthermore, the assessment of the changes in structural dynamics of delivering different types of anesthesia to pregnant women who underwent planned operative delivery in the maternity wards of the Tepnopil municipal hospital № 2 over a ten-year time span was conducted. The main early and late complications that occured during anesthesia were identified and improved program of preoperative assessment of patients was implemented. Based on the implemented modern instrumental and statistical methods of examination, the scientific evidence regarding individual prognosis of the duration of an early postoperative period was outlined. The results obtained from a comparative analysis of the outcomes of clinical and functional changes in the dynamics of the main parameters of the cardiovascular and central nervous systems allowed to determine the effectiveness of subjective and improved objective methods of assessing of the depth of anesthesia by monitoring levels of individual sedation during surgery. For the first time, the evaluation of the effectiveness of using the proposed comprehensive algorithm of actions on the course of an early postoperative period while considering the importance of their influence on the subjective assessment of patients, is described.