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ANESTHESIOLOGICAL ASPECTS OF ACCELERATED POSTOPERATIVE
RECOVERY IN NEUROSURGERY
Karomov Suhrob Mirmuhsinovich
Asian International University
Tel : +998911329697
ABSTRACT
. Any surgical treatment is obviously stressful for the patient. It inevitably
provokes pain, nausea, hypercoagulation, increased catabolic processes, stress on the
mechanisms of maintaining water-electrolyte balance, increased load on the cardiovascular
system and lungs, often causes sleep disturbance, increased fatigue, leads to cognitive
dysfunction (Gologorsky V.A., 1988; Kehlet H, 2002).
The fight against the listed problems and prevention of their aggravation is the essence of
the work of the anesthesiologist, who in the modern paradigm of medical care has
transformed from a specialist providing safe conditions for the patient and comfortable
conditions for the surgeon to a doctor monitoring the optimal management of the entire
perioperative process (White P.F., 2007). Unfortunately, despite significant progress in
surgery and anesthesiology in recent decades, the frequency of postoperative complications
remains significant, treatment results vary significantly from clinic to clinic, and the patient's
complete recovery after surgery takes quite a long time even after outpatient interventions
(Lassen K., 2005; Cohen M.E., 2009). At the same time, total health care costs are
increasing, despite the lack of significant improvement in the indicators of the system's
efficiency as a whole (Porter M.E., 2010).
These facts stimulate worldwide searches for a balance between limiting the costs of
surgical treatment, determined to a large extent by the patient's stay in the hospital and,
especially, in intensive care units, and patient safety. One of the most successful approaches
to optimizing existing clinical practice has become the concept of accelerated postoperative
recovery (in the English-language literature - Enhanced Recovery After Surgery (ERAS).
The essence of this approach is a thorough analysis of the effectiveness and safety of various
factors and methods based on the principles of evidence-based medicine, aimed at
accelerating the patient's passage through the surgical treatment procedure (Francis N., 2012;
ZatevakhinI.I., 2015; Feldman L., 2015).
The intensive implementation in general surgery of a protocol based on the results of such
an analysis, aimed at selectively combating the above-mentioned components of
perioperative stress, leads, according to the supporters of this ideology, to a decrease in the
time of the patient's stay in the hospital, without increasing the frequency of
rehospitalizations, a decrease in the frequency of postoperative complications, which is
reflected in a reduction in both the costs of the treatment itself and the overall social
expenses, due to earlier return of patients to a full life (Nicholson A., 2014)
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Meanwhile, in our opinion, many components of the accelerated postoperative recovery
concept can improve the quality of treatment of patients not only in abdominal but also in
neurosurgery. New approaches to control of postoperative pain, nausea and vomiting,
management and control of neuromuscular block, reducing the load on the functional
systems of the div, as well as modern anesthesia schemes aimed at rapid awakening, are
probably even more important in neurosurgery, since they allow to improve the quality of
control over severe postoperative complications, primarily the formation of acute
intracranial hematoma, and increase the speed of their correction, which often determines
the results of the entire treatment. Another aspect stimulating the implementation of this
concept in neuroanesthesiology is the management of somatically burdened patients, the
speed of activation and rehabilitation of which often directly affects the outcome.
Of course, neurosurgery is a very specific part of medicine. Patients with this type of
pathology are characterized by a number of features, and special requirements are imposed
on their safe management.
That is why blind adherence in neurosurgery to anesthesiological approaches developed
within the framework of the ERAS concept in general surgery cannot be considered justified
(Hagan K.B., 2015). However, it seems that one should also critically treat the still quite
widespread opinion that after neurosurgical intervention on the brain, it is necessary to have
a slow awakening, many hours of sedation and prolonged mechanical ventilation in the
intensive care unit. Of course, the thesis about the high safety and effectiveness of
monitoring a patient in the intensive care unit should be recognized as fair, but there is also
an undeniable increase in the risk of nosocomial infections, as well as other iatrogenic
complications, not to mention the psychological trauma and increased material costs of
treating a patient for whom staying in the intensive care unit may be unjustified. In other
words, it seems relevant to search for and substantiate the effectiveness of anesthesiological
approaches that ensure safe and rapid postoperative recovery after anesthesia, which create
conditions for early activation and rehabilitation of the patient after neurosurgical
intervention.
CONCLUSIONS
Based on the combination of pharmacological properties (speed of awakening at 16±7
minutes, lower ICP, antiemetic and antiepileptic effects) and economic indicators, the
intravenous anesthetic propofol remains the optimal drug for providing the sedative
component of general anesthesia in neurosurgical practice.
2. The fastest awakening of patients after craniotomy (5±3 minutes) is provided by
inhalation anesthesia with xenon, however, it is significantly inferior to other methods in
terms of the cost of anesthesia (40 times, compared to anesthesia with propofol).
3. The most effective and safe method for providing intraoperative analgesia during
craniotomy is regional anesthesia of the scalp, performed before the incision, reducing the
need for opioids to a level of 1.6±0.7 mcg / kg / h of fentanyl. In addition, regional scalp
anesthesia, regardless of the time of its implementation, provides a high degree of protection
against postoperative pain after craniotomy in the first day after the operation (the
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distribution of pain scores according to VAS one day after the intervention was 0 [0;2],
while 78% of patients did not experience even moderate pain during the day).
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