Using epidural anesthesia with preserved spontaneous breathing in oncological patients during long-term gynecological laparoscopic interventions

M.V. Krasnoselskiy, Ye.M. Krutko, M.V. Shulga, V.G. Seredenko, Ye.V. Shulga


Background. To maintain spontaneous breathing with comfortable anesthesia using epidural ane­sthesia for many hours of surgery, it is necessary to study more thoroughly the possibility of conducting it with advanced therapy of possible complications and a comfortable state for patients. Objective: studying and justification of the expediency of using epidural anesthesia with sedation on spontaneous breathing in cancer patients during prolonged gynecological laparoscopic interventions to provide anesthesia with advanced the­rapy of possible complications and obtain a more comfortable condition of patients. Materials and methods. A study was carried out among 64 patients aged 62.6 ± 2.1 years with ovarian, uterine and cervical cancer with gynecological laparoscopic interventions, ASA I and II, whо were stratified depending on anesthesia: group А (control; n = 25) — combined general anesthesia with epidural analgesia according to standard protocols, and group B (n = 39) — epidural anesthesia on spontaneous breathing with sedation. Plasma concentrations of interleukin-6 and -8 cytokines were measured before and 4 and 24 hours after the operation. Health-related quality of life was evaluated with the help of the standard Short Health Status Assessment Questionnaire (SF-36), using the Evidence methodology. Results. The results show that in the group with anesthesia according to our method, there is an improvement both in the quality of life and the indices of cellular immunity. The absence of significant complications during this type of anesthesia is important. Conclusions. Thus, epidural anesthesia with the addition of propofol or thiopental infusion on spontaneous breathing provides minimal invasiveness in long-term interventions. It is more comfortable for patients and both psychoemotional and economically justified, which indicates its priority use.


gynecological laparoscopy; bupivacaine; combined general epidural anesthesia

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