Perspective perioperative management in the surgical treatment of patients with colorectal cancer
Background. Interest in the study of sevoflurane properties increased in recent years due to its influence on hemodynamics and morphological condition of the respiratory department of lungs determines advisability of analyzing the structure of organs directly involved in the reactions of radical surgery for colorectal cancer. The purpose of the study is to select the optimal method of anesthesia protection of patients from operating aggression during surgical treatment of colorectal cancer and to perform comparative analysis of tissue and cell ultrastructure in intraoperative biopsies of the colon in the conditions of application of the standard ataralgesia and combined anesthesia with epidural analgesia. Materials and methods. It was performed a comparative analysis of clinical and morphological data and results of treatment of the colorectal cancer using total intravenous anesthesia followed analgesia with opiates analgesics, and combined techniques using low-flow sevoflurane anesthesia and epidural analgesia, followed by prolonged epidural anesthesia. Results. It was shown a significant advantage of combined techniques in comparison with total intravenous anesthesia due to: normodynamic type of hemodynamics during operation, possibility to extubate patient in operating room, effective analgesia in early postoperative period. Implemented methodology reduced the incidence of postoperative mortality, complications, average length of hospital stay and frequency of patient returns to intensive care unit. The central link in the development of pathological changes in the colon wall at anesthesiology maintenance of surgical interventions in the treatment of colorectal cancer is the system of microcirculation. Combined low-flow sevoflurane inhalation anesthesia and epidural analgesia with bupivacaine during radical operations is followed by containment of endothelial dysfunction by limiting the destructive and degenerative changes in the endothelial cell organelles, stabilization of membranes, preventing spasm of arterioles, stasis and erythrocyte sludge. Conclusions. Methods of epidural analgesia versus opioid analgesia lead to a significant reduction of the phenomena of infiltration, perivascular and interstitial edema in the composition of the intestinal wall in the area of surgical procedure. Combined use of low-flow sevoflurane anesthesia and epidural analgesia followed by prolonged epidural anesthesia is an optimal method of anesthesia protection of patients from operating aggression during surgical treatment of colorectal cancer.
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