Influence of the type of anaesthetic support on the development of postoperative cognitive dysfunction in gynecologic oncology patients

Aim. Determination of the influence of age and type of anesthesia on the patient’s cognitive abilities. Methods. 30 females who underwent surgical intervention were examined. The first group consisted of 14 patients who received general inhalational anesthesia, group 2 included 16 patients who received general inhalational anesthesia in combination with epidural anesthesia. All patients underwent neuropsychological testing at several stages: one day before the surgery, the first day after surgery, on day 28 after the surgery. Cognitive status was assessed using Mini-Mental State Examination (MMSE) and the clock-drawing test (CLOCK). Results. Given the combination of indices of both types of neuropsychological testing, postoperative cognitive dysfunction was diagnosed when a decrease by 10% or more of both MMSE and clock-drawing test and the MMSE score in patients with diagnosed postoperative cognitive dysfunction was less than 24 on both days 1 and 28. It should be noted that the results of testing before surgery in all groups of patients showed mild cognitive dysfunction. After the surgery, the measures of intellectual ability significantly decreased. The results of the analysis in the early recovery period in the group of patients who underwent combined anesthesia were significantly higher. And in the group of patients with combined anesthesia compared to the group that received only general anesthesia on day 28, cognitive indices were significantly higher: MMSE — pMW=0.041 and CLOCK — pMW Conclusion. General anesthesia combined with epidural anesthesia affects cognitive function of female patients less negatively than the use of general anesthesia alone

Biological markers as predictors of postoperative neurocognitive disorders

Aim of the study: to highlight the main discussed tactical points of anesthesiologist's management of patients, to outline more promising aspects of biochemical laboratory diagnosis of postoperative neurocognitive disorders.Цель исследования — выделить основные обсуждаемые тактические моменты ведения анестезиологом пациентов, обозначить более перспективные аспекты биохимической лабораторной диагностики послеоперационных нейрокогнитивных расстройст

Рак мочевого пузыря и использование метода fast track в ранней реабилитации онкоурологических пациентов (обзор литературы)

In the last 20 years, a concept of using multimodal programs of early rehabilitation of patients after surgical interventions – Enhanced Recovery After Surgery (ERAS) – has been developed in medicine. In oncological urology, the ERAS protocol is used only in treatment of bladder cancer. At the same time, not all available elements of this program are used despite the fact that in Russia 24.4 % of malignant tumors are urogenital tumors, and bladder cancer comprises one sixth (4.6 %) of them. Frequently, reconstructive plastic surgery is an integral part of bladder cancer treatment, and it’s accompanied by various complications many of which are associated with incorrect tactics of perioperative patient care. This situation can be dramatically improved by a more widespread use of the ERAS protocol. The immediate problem  of oncological urology is development of an effective, safe, and available for wide use algorithm of postoperative rehabilitation of patients with malignant tumors of the bladder after cystectomy with cystoplasty.В медицине 20 лет назад появилась концепция использования мультимодальных программ ранней реабилитации пациентов после хирургических вмешательств – Enhanced Recovery After Surgery (ERAS). В онкоурологии протокол ERAS применяется только при лечении рака мочевого пузыря (РМП). При этом используются не все возможные элементы данной программы, и это несмотря на то, что в России в структуре злокачественных новообразований 24,4 % занимают опухоли органов мочеполовой системы, среди них шестую часть (4,6 %) составляет РМП. Часто неотъемлемым компонентом лечения РМП являются реконструктивно-пластические операции, сопровождающиеся различными осложнениями, многие из которых связаны с неверной тактикой периоперационного ведения пациентов. Кардинально изменить эту ситуацию возможно благодаря более широкому использованию протокола ERAS. Ближайшая актуальная задача онкоурологии – разработка эффективного, безопасного и доступного для широкого применения алгоритма ранней послеоперационной реабилитации больных со злокачественными новообразованиями мочевого пузыря, перенесших цистэктомию с цистопластикой

Experience in the successful application of extracorporeal methods in treatment of tumor lysis syndrome

Introduction. This article, using a clinical case as an example, reflects the problem of the development of tumor lysis syndrome (TLS). The most common cause of SLO development is antitumor treatment: radiation therapy, radiofrequency ablation, vascular embolization, the use of monoclonal antibodies, high-dose chemotherapy with transplantation of stasis from peripheral blood. This disorder leads to the development of metabolic, hemodynamic, respiratory and renal disorders. The TLS distinguished by high mortality rates, from 17% to 70%.Введение. В данной статье на примере клинического случая отражена проблема развития синдрома лизиса опухоли (СЛО). Чаще всего причиной развития СЛО является противоопухолевое лечение: лучевая терапия, радиочастотная абляция, эмболизация сосудов, применение моноклональных антител, высокодозная химиотерапия с трансплантацией СТК из периферической крови. Данное нарушение приводит к развитию метаболических, гемодинамических, респираторных и ренальных нарушений СЛО, отличает высокие показатели летальности — от 17% до 70

The role of clinical histological justification of the diagnosis in the protocol of early rehabilitation after surgical treatment of bladder cancer

In the structure of malignant neoplasms (EIT) bladder cancer (RMP) in 2015 amounted to 2.7%. For ten years, the incidence of the RMP remains at the same level of 9.3 to 11.9 cases per 100 thousand population. More than 90.0% of the patients aged 59 to 92 years (mean age of 75.5±12,6). Much of the effectiveness of rehabilitation is the tactics of postoperative management of patients from surgeons, oncologists and anesthesiologists-resuscitators. Conducting cystoscopy with biopsy of the tumor at the ambulatory stage, an early macro - and microscopic evaluation of the tumor allows to assess the prognostic risk factors and to plan radical treatment. The possibility of early rehabilitation and ERAS protocols used in urologic practice is rare and not fully. Using elements of the ERAS Protocol in patients with bladder tumors does not require additional costs, reduces the time patients stay in the intensive care unit for 1-2 days.В структуре злокачественных новообразований (ЗНО) рак мочевого пузыря (РМП) в 2015 году составил 2,7%. За десять лет заболеваемость РМП остается примерно на одном уровне от 9,3 до 11,9 случаев на 100 тысяч населения. Более 90,0% пациентов в возрасте от 59 до 92 лет (средний возраст - 75,5+12,6). Значительное место в эффективности реабилитации занимает тактика послеоперационного ведения пациентов со стороны хирургов-онкологов и анестезиологов-реаниматологов. Проведение цистоскопии с биопсией опухоли на амбулаторном этапе, ранняя макро- и микроскопическая оценка опухоли позволяет оценить прогностические факторы риска и спланировать радикальное лечение. Возможности ранней реабилитации и ERAS-протоколы используются в онкоурологической практике редко и не в полном объеме. Применение элементов ERAS-протокола у больных с опухолями мочевого пузыря не требует дополнительных затрат, сокращает сроки пребывания пациентов в реанимационном отделении на 1-2 суток

Bladder cancer and the use of the fast track method in the early rehabilitation of oncological patients (literature review)

In the last 20 years, a concept of using multimodal programs of early rehabilitation of patients after surgical interventions – Enhanced Recovery After Surgery (ERAS) – has been developed in medicine. In oncological urology, the ERAS protocol is used only in treatment of bladder cancer. At the same time, not all available elements of this program are used despite the fact that in Russia 24.4 % of malignant tumors are urogenital tumors, and bladder cancer comprises one sixth (4.6 %) of them. Frequently, reconstructive plastic surgery is an integral part of bladder cancer treatment, and it’s accompanied by various complications many of which are associated with incorrect tactics of perioperative patient care. This situation can be dramatically improved by a more widespread use of the ERAS protocol. The immediate problem  of oncological urology is development of an effective, safe, and available for wide use algorithm of postoperative rehabilitation of patients with malignant tumors of the bladder after cystectomy with cystoplasty