[Correction of cognitive dysfunction after laparoscopic cholecystectomy under inhalation anesthesia with sevoflurane]. / Korrektsiya kognitivnoi disfunktsii posle videolaparoskopicheskoi kholetsistektomii v usloviyakh ingalyatsionnoi anestezii sevofluranom.

OBJECTIVE: To study the dynamics of markers of brain damage, determine their role in postoperative cognitive dysfunction (POCD) and evaluate the effectiveness of therapeutic correction of POCD in patients undergoing laparoscopic cholecystectomy under inhalation anesthesia with sevoflurane. MATERIAL AND METHODS: We analyzed data of two representative groups of patients (aged 55 years and older) who underwent laparoscopic cholecystectomy under inhalation anesthesia with sevoflurane. Perioperative neuropsychological testing was performed for monitoring of higher mental functions (MoCA and FAB). In the 1st group (n=30), POCD was not corrected. In the 2nd group (n=30), Cellex 0.1 mg was subcutaneously injected once before surgery and then throughout 5 postoperative days to correct cognitive disorders. RESULTS: Neuropsychological testing revealed moderate POCD in the 1st group. In the 2nd group, Cellex provided a significantly lower level of brain-specific proteins compared to the 1st group. This limited brain damage and ensured no severe cognitive deficit in early postoperative period. CONCLUSION: Laparoscopic cholecystectomy under inhalation anesthesia with sevoflurane in patients aged 55 years and older is accompanied by moderate POCD in early postoperative period. Injections of Cellex 0.1 mg before surgery and then for 5 postoperative days prevent POCD and improve quality of life.

[Violations of higher mental functions and their correction in patients undergoing video laparoscopic cholecystectomy under conditions of inhalation anesthesia with sevoflurane]. / Narusheniya vysshikh psikhicheskikh funktsii i ikh korrektsiya u bol'nykh, perenesshikh videolaparoskopicheskuyu kholetsistektomiyu v usloviyakh ingalyatsionnoi anestezii sevofluranom.

OBJECTIVE: To substantiate the advisability of using cytoflavin to correct postoperative cognitive dysfunction (POCD) in patients undergoing video laparoscopic cholecystectomy (VLCE) under conditions of inhalation anesthesia with sevoflurane. MATERIAL AND METHODS: The data of two representative groups of patients (n=60) who underwent video-laparoscopic cholecystectomy under the conditions of inhalation anesthesia with sevoflurane were analyzed. At the stages of the perioperative period, in order to monitor the state of higher mental functions, neuropsychological testing was performed: anxiety and depression scales (HADS), the Montreal scale of cognitive dysfunction (MoCA), and frontal dysfunction batteries (FAB). Patients of the first group (n=19) were not corrected for POKD. For the correction of cognitive impairment, patients of the second group (n=41) were treated with Cytoflavin according to the 20 ml regimen per 250 ml of 0.9% sodium chloride solution intravenously once before the operation, then within 4 days of the postoperative period. RESULTS: Neuropsychological testing in group I patients revealed the development of moderate POCD. The inclusion of Cytoflavin in the treatment regimen in the II group of patients contributed to an improvement in the state of HMF, accompanied by a decrease in the level of anxiety and depression. CONCLUSION: The inclusion of Cytoflavin in treatment regimens helps prevent the development of POKD and is accompanied by an improvement in the state of higher mental functions, which is manifested by a decrease in the level of anxiety and depression, favorably affecting the emotional background of patients.

CORRECTION PARAMETERS OF RESPIRATORY SUPPORT IN ENDOSCOPIC RESECTION OF THE STOMACH IN PATIENTS WITH THE MORBID OBESITY.

BACKGROUND: In recent years, steadily increasing the number of operations for morbid obesity. One of the most frequently performed worldwide operations at this pathology is the sleeve gastrectomy are approximately 28% of all bariatric surgeries per year It must be stressed that obesity is accompanied by hard changes andfunctional disorders of all body systems, including the respiratory and cardiovascular The aim: to study the effect of respiratory support options combined with high thoracic epidural analgesia, as a component of anesthetic management on central hemodynamics during anesthesia providing endoscopic gastroplasty in patients with morbid obesity. MATERIALS AND METHODS: a randomized study of 37 patients with morbid obesity who underwent endoscopic sleeve gastroplasty under anesthesia combined with high thoracic epidural analgesia. Depending on the choice of tactics respiratory support patients were divided into two groups; In group 1 (n-17), the traditional mode of ventilation in group 2 (n-20) modified the ventilation mode. Intraoperative central hemodynamic parameters, external respiration were monitored; acid-base balance is achieved partly by recycling carbon dioxide in a closed breathing circuit using NICO 7300 system (Novametrix Medical Systems Inc. USA), based on the Fick principle. RESULTS: the use of ventilation mode with inversion of the respiratory cycle, high-level application of PEEP titration in stages so you can optimize the parameters of external respiration, gas exchange without adverse effects on the central hemodynamics. The continued elevated levels PaCO2, PvCO2, when applying carboxiperitoneum, did not cause gross changes in acid-base balance.

[Prevention of cognitive disorders in postoperative period after carotid endarterectomy].

238 patients with atherosclerosis of carotid arteries after reconstructive operations under different types of anesthesia were enrolled in the study. Neuropsychological survey with Montreal cognitive assessment scale, frontal assessment battery and clock drawing test was performed in dynamics. Minimal cognitive dysfunction was mentioned in patients with symptomatic and asymptomatic stenosis after combined anesthesia with regional anesthesia. Postoperative cognitive dysfunction was developed after sevoflurane and propofol anesthesia in patients with asymptomatic stenosis. After inhalation anesthesia it was more severe. Prevention of postoperative cognitive dysfunction with ceraxon was clinically effective. This therapy can facilitate mental functions recovery and improve quality of life.

[The dynamics of the state of higher mental functions after surgical reconstruction of carotid stenosis using different types of anesthesia].

It was studied 238 patients after the reconstructive surgeries of atherosclerotic stenosing lesions of carotid arteries using different types of anesthesia. Neuropsychological testing included MMSE, the Frontal Assessment battery and the Clock drawing test. Regional anesthesia in the combination with reduced general anesthesia caused the less pronounced cognitive deficits in patients with symptomatic or asymptomatic stenoses. Inhalation anesthesia with sevofluorane led to the more pronounced cognitive impairment compared to total intravenous anesthesia with propofol. Ceraxon was used for the correction of cognitive impairments. This treatment increased the recovery of brain functions and quality of life of patients.

[Characteristics of central hemodynamics and cerebrovascular circulation during various anesthesia modes in reconstructive surgeries for the extracranial vessels].

The purpose of the study was to choose an optimal anesthetic method to ensure adequate cerebral blood flow and to reduce the number of perioperative complications during carotid endarterectomy. Total intravenous anesthesia with diprivan, combined cervical plexus block anesthesia, and inhaled sevoflurane anesthesia were assessed in 190 patients undergoing carotid endarterectomy. The study of cerebral blood flow and central hemodynamic parameters indicated that deprivan anesthesia suppressed the major hemodynamic parameters, causing associated cerebral circulation depression. The use of cervical plexus block as a major component of anesthesia after Pashchuk stabilized the mean blood pressure and cardiac index, causing the optimization of cerebral blood flow parameters with a considerable postload increase. During sevoflurane anesthesia, the most physiological conditions for the performance of the circulatory system were found at all stages of surgical treatment, which predetermined the stable parameters of central hemodynamics and cerebral blood flow. The studies revealed that deprivan anesthesia was followed by a considerable number of both cardiac and neurological complications. The patients with cervical plexus block had fewer neurological disorders, but the increased postload accompanying these changes caused an increase in the number of cardiac complications. The most optimal parameters of cerebral blood flow and central hemodynamics during sevoflurane anesthesia induced a statistically significant reduction in the number of cardiac and neurological complications.

[Comparative assessment of various general anesthesia methods during reconstructive operations on the carotid arteries].

Total intravenous anesthesia with diprivan and inhaled sevoflurane was assessed in 130 patients undergoing carotid endartectomy. The parameters of hemodynamics and cerebral circulation and the markers of brain lesion were studied. Sevoflurane anesthesia was shown to induce less depression of hemodynamic parameters and to maintain the more optimal level of cerebral circulation, limiting brain ischemic and reperfusion lesions and causing a fewer number of postoperative complications.

[Comparative assessment of inhalation anesthesia with sevofluran and intravenous anesthesia with propofol for carotid endarterectomy].

Total intravenous anesthesia with propofol and inhalation sevofluran was assessed in 130 patients with carotid endarterectomy. The parameters of brain blood circulation, brain damage markers were studied. It was shown that sevofluran anesthesia caused less depression of the hemodynamic parameters, supported more optimum level of brain blood flow that limited ischemic and reperfusion damage of the brain and was accompanied by a fewer number of postoperative complications.

[Changes in central hemodynamics and their correction during reconstructive surgery in Leriche's syndrome]. / Izmeneniia tsentral'noi gemodinamiki i ikh korrektsiia v protsesse rekonstruktivnoi operatsii po povodu sindroma Lerisha.

Study of the parameters of central hemodynamics in the course of aortofemoral shunting for Leriche's syndrome revealed the role of lipid peroxidation dysfunction in the genesis of cardiovascular disorders developing in the immediate postoperative period. The postoperative period is characterized by expressed hypotension developing in the presence of activation of lipid peroxidation and suppression of plasma antioxidative activity. The authors recommend alpha-tocopherol, cytochrome C, and dalargin to prevent these hemodynamic disorders.