FEATURES OF PERIOPERATIVE MANAGEMENT OF PATIENTS AT LAPAROSCOPIC ANTIREFLUX INTERVENTIONS

Abstract

Aim. The analyzing current available literature on the problem of anesthesiology of antireflux interventions in patients with hernias of the esophageal aperture. Materials and methods. Biblosemantic, comparative and systems analysis. The suggested recommendations are based on the data of contemporary literature analysis, the results of randomized trials and meta-analyzes, devoted to the study of the problem of anesthesiology of antireflux surgery. Results and discussion. The analyzing the problems of anesthesia and analgesia in patients with hernias of the esophageal aperture, it is necessary following next concepts: general inhalation anesthesia in laparoscopic surgery, should be taking into account the technical features of surgery, as well as, the injection and diffusion of CO2 in tissue in time of carboperitoneum, in the same time, besides that to guarantee rapid awakening of the patient without residual sedation. The possibility of developing specific late complications, as well as, ruptures of the esophagus and stomach, pneumothorax makes adjustments in the tactics of the introduction in this category of patients in the perioperative period.The choice of anesthesia method is greatly determined the length of the post-anesthetic rehabilitation period, the stay of the patient with artificial ventilation of the lungs, the need and the length of stay in the intensive care unit. Conclusions. Ourday the question is still remain, which of the methods of inhalation anesthesia Low flow anesthesia or Minimal flow anesthesia is better,  in the case of the requirements of comfort, patient’ safety and pharmacoeconomic feasibility.The principles of accelerated rehabilitation are possible not only if the surgical invasion is reduced, but also with the use of managed general anesthesia with adequate perioperative anesthesia.The operation of the patient in time is the best method of prevention of many early and delayed complications of the postoperative period. This provision has been validated by numerous clinical trials and is rarely take into account at present.The ideology of inhaled anesthesia involves not only sufficient control over the depth of anesthesia, but also predictability at the stage of anesthesia.