[Enhanced recovery program in thoracoabdominal surgery]. / Programma uskorennogo vosstanovleniya v torakoabdominal'noi khirurgii.

Significant improvement of treatment outcomes and reduction of postoperative hospital stay can be achieved, provided a multifaceted approach used in the management of patients. The introduction of the enhanced recovery program addressing all possible factors of the perioperative period will contribute to the treatment protocol development for patients after extensive surgery on the esophagus. OBJECTIVE: To improve medical rehabilitation outcomes in patients after extensive surgery for benign and malignant diseases of the esophagus by implementing an enhanced recovery program. MATERIALS AND METHODS: Patients with benign and malignant esophageal diseases underwent radical surgical repair under general balanced anesthesia with mechanical ventilation. With the collaboration of surgery, anesthesiology, and intensive care staff, a proprietary day-by-day enhanced recovery program was developed based on existing guidelines for patient management and systematic reviews on the enhanced recovery protocol after surgical esophageal repair. RESULTS: The developed patient management program was effective due to the reduction of intensive care unit stay and the total postoperative stay in all main group patients. The use of minimally invasive video-endoscopic techniques contributed to the reduction of intensive care unit stay. A less severe surgical stress response was observed in patients in the group of thoracoscopic subtotal esophageal resections. CONCLUSION: The introduction of the enhanced recovery program promotes the reduction of hospital stay and ICU stay in surgical esophageal repair patients. Also, it allows optimizing the postoperative management of patients with complicated and uncomplicated postoperative periods.

[Intensive therapy in thoracoabdominal surgery]. / Intensivnaia terapiia v torakoabdominal'noi khirurgii.

Since the creation of the intensive care unit, active scientific work has been carried out. Pre- and postoperative management of patients undergoing thoracoabdominal surgery was one of the main directions of this work. Diagnostic approaches, preventive measures and standards of treating patients after thoracoabdominal surgery have been developed. The results of this work allowed to reduce significantly contraindications for surgical interventions in these patients, to perform radical operations in patients with severe concomitant diseases, to reduce the incidence of postoperative complications and mortality.

[Thoracoscopic repair of postoperative intrapleural complications]. / Torakoskopicheskaia korrektsiia posleoperatsionnykh oslozhnenii.

AIM: To justify and develop the indications for thoracoscopic procedures in patients with complications after advanced cardiothoracic surgery including combined and simultaneous operations. MATERIAL AND METHODS: From 2013 to 2017 was performed treatment of complication in 27 patients undergoing various cardiothoracic intervention with the use of thoracoscopic technology. RESULTS: We have analyzed immediate results of thoracoscopic operations in 27 patients with various intrapleural complications after advanced cardiothoracic surgery. Satisfactory results of these interventions confirm safety of thoracoscopic technologies and serve as an argument in favor of this direction in thoracic surgery.

[Coxibs for postoperative analgesia].

Coxibs can be regarded as an effective way of postoperative pain treatment with proven analgesic and opioid-saving effects. When comparing the opioid-saving effect after the large surgical interventions, COX-2 inhibitors are not inferior to NSAIDs and surpass paracetamol. The combination of coxibs and opiate receptors antagonists, as well as epidural analgesia is effective in the frames of multimodal analgesia. The reasonability of coxibs and paracetamol combination is questionable. In patients at risk of gastrointestinal complications development, but with none cardiovascular risk, COX-2 inhibitors are more safe, than the combination of NSAIDs and proton pump inhibitors. Due to no cross-reactivity with aspirin and NSAIDs, coxibs can be recommended to patients with aspirin asthma and related diseases. Specific COX-2 inhibitors prescription is able to inhibit comissure formation after laparotomy, suppressing blood vessels proliferation. It is assumed that the COX-2 inhibitors may inhibit vascular endothelial growth factor of the tumor and so inhibit angiogenesis of solitary tumors and metastases, without affecting the normal endothelium. Thus, today coxibs are not inferior in eficiency to certain opioid analgesics and have improved safety profile compared with traditional NSAIDs. These qualities allow to consider them as a group of non-opioid analgesics for postoperative analgesia.

[Surgery for lung cancer in elderly].

The growth of malignant tumors of lungs among elderly patients together with overall increase of people older then 70, aroused new problems in surgery and anesthesiology. Nowadays, modern medicine succeeded minimal postoperative mortality and lethality among such patients, 19,7 and 6,4%, respectively. 3 and 5-year survival among operated patients was 68 and 42%. Actually, overall lethality rate was determined mainly by relative and conquering diseases. Lobectomy should be considered a method of choice, although sublobar resection is appropriate by lung tumors of stages 1 and 2.

[Comparison of analgesics using two devices for the patient-controlled analgesia].

INTRODUCTION: A pilot unicenter blind placebo-controlled study comparing different analgesics was conducted in parallel groups, by concurrently using two patient-controlled analgesia (PCA) apparatuses in one patient, was conducted Subjects and methods. The study included patients after laparotomy. Group I patients (n=22) were proposed 2 PCA apparati, one of which contained trimeperidine solution and the other did placebo. Group 2 patients (n=17) were proposed 2 PCA apparatuses, one of which contained trimeperidine solution and the other did lornoxycam. PCA was adjusted in the same manner in both apparati. The patients were asked to determine which analgesic is best in providing 24-hour analgesia. RESULTS: There were no differences in the intensity of pain between the groups. The latter did not differ in the number of adverse reactions. Comparison showed no significant differences in the use of trimeperidine between Groups 1 and 2 patients. Among Group 1 patients, 61% considered trimeperidine as the best analgesic and 22% did placebo; 17% called none. Group 2 patients chose trimeperidine in 41% of cases and lornoxycam in 41%, none was called in 18%. CONCLUSION: Comparative assessment of analgesics, by employing 2 PCA apparatuses in one patient, allows evaluation of the efficacy of analgesics added to the conventional methods.

[Parenteral nutrition in the treatment of short bowel syndrome].

Relevance of nutritive support problems at patients with SRL is shown in experiences of RSSC members named by B.V. Petrovski RAMS. This article demonstrates feasibility of artificial therapeutic nutrition and role of parenteral nutrition, clinical and social rehabilitation at patients with SRL.

[Multimodal approach to postoperative analgesia in patients with neuropathic pain].

Chronic neuropathic pain syndrome observed prior to surgery not only influences the intensity of pain, but also reduces the efficiency of selective use of analgesics. The purpose of the investigation was to study the efficiency of various analgesics and their combinations after lumbar microdiskectomy. Seventy-six patients who had undergone lumbar microdiskectomy and who suffered from chronic back pain were examined. According to the mode of postoperative analgesia, the patients were divided into 4 groups: 1) 20 patients received i. m. promedol 20 mg (a control group); 2) 20 had i. v. tramal (patient-controlled anesthesia); 3) 18 were given i. v. xefocam 24 mg/day; 4) 18 i. v. ketamine 0.1 mg/kg/hour + i. v. xefocam 24 mg/day. Their analgesic effect was evaluated using a visual analogue scale 1, 2, 4, 6, and 24 hours after surgery. The use of xefocam in combination with microdose ketamine was ascertained to cause no increase in the frequency of adverse reactions, to upgrade the quality of analgesia, and to minimize the intensity of pain 24 hours following surgery.

[Clinical aspects of analgesia with intravenous paracetamol in the early postoperative period].

This open one-center study included 40 patients operated on the abdomen and chest, who had moderate resting pain in the immediate postoperative hours. Paracetamol was used as a dropwise intravenous 1-g infusion for 10-15 min; the dose of the agent was 4 g. The interval of paracetamol re-infusion was not early than 4 hours. If additional analgesia was required, opioid analgesics (promedol, tramadol) were administered. As a whole, assessment of analgesia within 24 hours showed excellent and good results reported by patients in 85% of cases; and in 71% of the patients the intensity of postoperative pain was less than they had expected before surgery. The use of opioid analgesics was required in 65% of the patients and 25% did not need these agents. The remaining 10% of the patients received a combination of nonsteroidal anti-inflammatory drugs, paracetomol, and opioids. Postoperative analgesia based on the intravenous infusion of paracetamol in a single dose of 1 g (4 g/day) caused a reduction in the intensity and duration of pain. The intravenous formulation of paracetamol should be regarded as one of the essential nonopioid components of multimodality therapy for pain in patients in the early postoperative period.

[Clinical aspects of using patient-controlled analgesia with nonsteroidal anti-inflammatory agents in postoperative period]. / Klinicheskie aspekty primeneniia kontroliruemoi patsientom analgezii nesteroidnymi protivovospalitel'nymi sredstvami v posleoperatsionnom periode.

We used lornoxicam (n = 16) and ketorolac (n = 20) to study the possibilities of applying the non-steroid anti-inflammatory drugs within the postoperative patient-controllable analgesia (PCA). With respect to a used analgetic, the frequency rate of good PCA anesthetic results was found, on day 1, to be 60-77%. The good anesthetic results were registered in 25% of patients when the routine scheme was in use. Non-steroid anti-inflammatory agents (lornoxicam, ketorolac) can be prescribed within the early postoperative PCA as basic analgetics, which essentially reduces the need in promedol without worsening the analgesia efficiency.

[Clinical aspects of the use of nubain, tramal and moradol in patients in the early postoperative period]. / Klinicheskie aspekty primeneniia nubaina, tramala, moradola u bol'nykh v rannem posleoperatsionnom periode.

Opioid analgesics were used in 282 patients on the first-third day after heart, lung and abdominal surgery. The main indication for their use was pain syndrome. Adequate analgesia with tramal, nubain and moradol was noted in 73, 76 and 81% of cases. In marked pain syndrome after thoracotomy the most effective agents were moradol and morphine. Computer monitoring of the respiratory function in tramal analgesia has shown a decrease in lung ventilation, esophageal pressure, inhalation volume, O2 production. Tramal, nubain and moradol in analgesic doses did not inhibit respiration. In adequate analgesia there was a decrease in lung ventilation which was not accompanied by shifts in acid-base balance of the arterial blood. The above analgesics had no considerable effect on systemic hemodynamics, though the use of tramal decreased systemic blood pressure and the use of moradol decreased systemic blood pressure and total peripheral vascular resistance. Tramal was most effective for synchronization of spontaneous respiration with a lung ventilation device in prolonged ventilation, as well as for the arrest of muscular tremor in the postoperative period. Tramal was effective in 95% of patients in the early post-anesthesia and postoperative period.