The dissertation identifies an effective and safe method of anesthesia for laparoscopic interventions for cholelithiasis in elderly and senile patients based on changes in hemodynamics, stress markers, depth of anesthesia according to PSI index, level of cerebral oxigenation, cognitive function, postoperative anesthesia.
In accordance with the goal, the tasks were defined and a special research program was developed, which performed the following methods: anamnestic, instrumental, laboratory, scale and test, mathematical and statistical, which allowed to obtain fairly complete information to evaluate the object of study.
The clinical base of the study was the Department of Anesthesiology of the Municipal Non-profit Enterprise «City Clinical Emergency and Critical Care Hospital named after Prof. O.I. Meshchaninov» Kharkiv City Council. To achieve this goal, 101 patients with a mean age of 67,9 ± 0,6 years were examined and laparoscopic cholecystectomy (LHE) was indicated.
Glucose level – glucose oxidase method using test systems «Glucose SpL 100» manufactured by «SpineLab» (Ukraine).
The level of pain in both groups was assessed on the visual analog scale (VAS).
The study of the state of cognitive functions was carried out using the Luria test and the MMSE scale.
The paper collects data on the feasibility and effectiveness of intraoperative neuromonitoring (determination of the depth of anesthesia by PSI index and level of cerebral oxygenation rSO2), when using different types of general anesthesia in laparoscopic surgery in elderly and senile patients. Based on these data, it is proved that anesthesia with sevoflurane provides a deeper level of the hypnotic component of general anesthesia according to the PSI index and leads to a decrease in stress hormones in the perioperative period, reduces the brain's need for oxygen.
It has also been shown that anesthesia with inhaled anesthetics (sevoflurane) retains cerebral oxygenation during anesthesia better than propofol-based TIVA (total intravenous anesthesia) and is more effective in preventing postoperative cognitive dysfunction.
The effect of carboxyperitoneum on the level of cerebral oxygenation in the perioperative period was studied for the first time. There was a decrease in rSO2 at the time of imposition of CP in both groups, but it should be noted that the decrease in rSO2 was short-lived and recognized in time, so it did not significantly affect the cognitive functions of elderly patients in the postoperative period. Patients operated on in IA in the early postoperative period had higher results of cognitive tests than patients operated on in TIVA based on propofol, but on the fifth day after surgery, the results of cognitive tests between groups did not differ significantly and were close to baseline.
The dissertation substantiates the choice of anesthesia method for laparoscopic cholecystectomy in elderly and senile patients based on the study of changes in hemodynamic, instrumental, laboratory, cognitive characteristics, as well as stress response of patients, and the results of postoperative anesthesia, which contributed to improving quality and anesthesia.
The following patent for the invention has been developed, issued and implemented in healthcare practice: A method of preventing hypoxic conditions in elderly and senile patients during laparoscopic cholecystectomy under general anesthesia. Patent of Ukraine UA from September 2020.
Recommendations for the inclusion of neuromonitoring in routine intraoperative monitoring along with monitoring of cardiovascular and respiratory parameters in elderly and senile patients are given.
A mathematical method of tree-like solution of the problem of choosing the method of anesthesia for laparoscopic interventions in elderly and senile patients using the method of classification trees (DC, Decision tree) and CHAID-analysis (Chi Square Automatic Interaction Detection Analysis) has been developed.
The results of the research were introduced into the work of the Department of Anesthesiology of the Municipal Non-profit Enterprise «City Clinical Emergency and Critical Care Hospital named after Prof. O.I. Meshchaninov» Kharkiv City Council, Department of Anesthesiology with Intensive Care Units of the State Institution «Institute of General and Emergency Surgery named after V.T. Zaitsev of the National Academy of Medical Sciences of Ukraine», Department of Anesthesiology with beds for intensive care of the Municipal Non-profit Enterprise «City Clinical Hospital № 2 named after prof. O.O. Shalimov» Kharkiv City Council, Department of Anesthesiology and Intensive Care of the City Medical Center «City Multidisciplinary Hospital № 18», Department of Anesthesiology and Intensive Care of the Municipal Non-profit Enterprise «Regional Clinical Trauma Hospital» Kharkiv Regional Council.
