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ANESTHESIOLOGICAL CARE AND INTENSIVE CARE OF
GERONTOLOGICAL PATIENTS IN UROLOGY
Bakhromov Bekzod Shavkatovich
Asian International University
Tel : +998934500601
bekzodbahromov 56@ gmail . com
ABSTRACT:
Is accompanied by an expansion of indications for surgical interventions
previously considered impossible, in particular, in elderly and senile patients (Gorilovsky
L.M., 1993; Kosachenko V.M., 2005, etc.) - According to epidemiological data from the
Russian Federation, in recent years the proportion of gerontological patients undergoing
hospital treatment has been significantly increasing, and according to UN forecasts, the
number of elderly and senile people in the world by 2010 will amount to 15% of the total
population (Burov N.E., 2000; Gorilovsky L.M., 1999; Seltsovsky A.P., 1999, etc.). In this
regard, the problem of treatment and, in particular, anesthetic care for this category of
patients is extremely urgent. It is well known that during the aging process, numerous
involutional changes occur in the div, characterized by a decrease in the functional
capabilities of organs and systems, a decrease, and in some cases, a perversion of metabolic
processes, a decrease in the reactivity of the div and resistance (or resistance) to stress
effects (Fedorovsky N.M., 2002; Folkes-Crabbe.D., 1993, etc.).
In this regard, anesthesia in gerontological patients is associated with an increased surgical
and anesthetic risk, complications in the early postoperative period, and, as a consequence,
increased mortality (Buyanov
V.M., 1983; Sviridov SV., 2000, etc.). Therefore, there are often cases when patients are
denied surgical treatment, although it is technically possible to carry it out, or are offered
palliative interventions that cannot radically cure the elderly from the disease (Igelnik A.M.,
1992).
The protocol for anesthesia in gerontological patients differs from that in other age groups
due to altered metabolism of drugs, decreased sensitivity of organs and tissues to them,
different distribution coefficient of drugs in altered water sectors, etc. (Ovechkin A.M., 2000;
Fedorovsky N.M. et al., 2002, 2003; Papin A.A.,
1988; Hosking M.P. et al, 1989, etc.). Unfortunately, the initial status of the gerontological
patient's div is not always taken into account by anesthesiologists and resuscitators when
performing anesthesia and intensive care (IT) in the postoperative period (Craig B.D., 1987).
Objective of the study:
To develop optimal methods of anesthesia, analgesia and corrective intensive care for
elderly and senile urological patients, allowing to expand the indications for surgical
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treatment, improve its results, reduce the number of complications in the intra- and
postoperative period.
Research objectives:
1. To develop algorithms for preoperative examination and preparation of elderly and senile
patients depending on concomitant pathology, to assess the adequacy of preoperative
preparation of gerontological patients based on the dynamics of the risk degree according to
ASA.
2. Based on the identified homeostasis disorders of the gerontological contingent, to develop
optimal methods for anesthetic care depending on the nature of the surgical intervention.
3. Based on the individual characteristics of the aging organism, to develop tactics of
qualitative and quantitative infusion-transfusion therapy
during anesthesia and in the early postoperative period.
4. Optimize the technique of postoperative analgesia for gerontological patients depending
on the nature of the urological surgery.
5. Based on the obtained results, develop algorithms for IT at all stages of the study (before,
during and after surgery) for elderly and senile patients in urology for practical healthcare.
6. Conduct an analysis of the effectiveness of IT, postoperative complications and mortality
of gerontological patients in urology
Scientific novelty of the work:
Based on our own research, algorithms for optimal preoperative examination and
preparation of patients have been developed, allowing to reduce the degree of surgical and
anesthetic risk in gerontological patients and expand the indications for surgical treatment.
Indications for the type of anesthesia depending on the nature of the urological operation
have been determined.
Algorithms for anesthesia, infusion therapy in the intra- and postoperative periods, a
protocol for weaning the patient from a respirator in the postoperative period have been
developed, taking into account the gerontological stress norm.
A method of postoperative analgesia without the use of narcotic analgesics has been
developed, indications have been determined and the feasibility and effectiveness of using
intrapleural analgesia has been proven.
An algorithm for the treatment of postoperative gastrointestinal paresis in gerontological
patients in urology has been proposed. Practical significance of the work:
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Elderly patients are the most "severe" group of patients due to the presence of both age-
related involutional changes in the div and severe intercurrent background. The use of
algorithms for preoperative examination and preparation of patients allows to reliably reduce
the degree of surgical anesthetic risk in gerontological patients and expand the indications
for radical surgical treatment. A complete preoperative examination with the necessary
correction of concomitant diseases, coupled with the applied anesthesia techniques, as well
as the features of intensive care in the postoperative
period, made it possible to reduce and minimize the number of postoperative complications.
The developed and implemented technique of postoperative pain relief without the use of
narcotic analgesics in combination with rational infusion-transfusion therapy allows to
improve the quality of treatment of this
group of patients. The use of preoperative examination algorithms, optimal anesthesia
techniques, postoperative analgesia and IT allows us to optimize and standardize treatment,
reduce the percentage of complications and mortality in this category of patients.
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