MULTIMODAL ANESTHESIA AS AN IMPORTANT COMPONENT OF ERAS

V.I. Chernii
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Abstract

Introduction. The ideology of Fast Track-Surgery (FTS) and Enhanced Recovery After Surgery (ERAS) represents modern trends in global surgical practice. Anesthesiology aims to provide ideal and universal solutions for protecting patients from surgical aggression. A multimodal approach, which includes multilevel, multifaceted antinociception, is well-founded, where maximum effectiveness is combined with minimal side effects. The aim. To analyze the issue of multimodal pain management as an important component of ERAS (Enhanced Recovery After Surgery) from modern sources of literature for optimizing perioperative care in the minimally invasive surgery department. Materials and methods. Bibliosemantic, comparative, and systemic analysis methods were employed. The proposed recommendations were developed based on an analysis of modern literature, the results of randomized trials and meta-analyses, as well as our own studies dedicated to the study of perioperative pain issues. The results. It has been proven that the use of opioids in anesthesia practice is decreasing. New and modern methods of continuous monitoring of vital organs in patients are being introduced as supplements to classical monitoring protocols. These methods are used to avoid excessive or inadequate dosing of anesthetics, adjust the concentration of substances used, reduce post-anesthesia complications, and improve patient comfort. The method of perioperative energy monitoring significantly complements the "International Standards for Safe Anesthetic Practice", WFSA (2010), and enhances perioperative patient safety by detecting metabolic disturbances and implementing appropriate pathogenetic correction. The importance of regional anesthesia under ultrasound control, nociception-antinociception balance management, and the impact of these methods on opioid consumption, patient satisfaction, and postoperative recovery have been proven. Conclusions. The most commonly used combination of drugs for multimodal analgesia often includes acetaminophen and NSAIDs (strong recommendation). It has been proven that deep and prolonged sedation in intensive care unit (ICU) patients is associated with worse outcomes, longer mechanical ventilation duration, extended ICU and hospital stays, and higher rates of complications, including infections and sometimes even death.
多模式麻醉是时代的重要组成部分
导言。快速通道手术(FTS)和术后强化恢复(ERAS)的理念代表了全球外科实践的现代趋势。麻醉学旨在为保护患者免受手术侵犯提供理想的通用解决方案。多模式方法,包括多层次、多方面的抗疼痛治疗,是有充分依据的,在这种方法中,最大的有效性与最小的副作用相结合。目的是什么?从优化微创手术部门围手术期护理的现代文献资料中分析作为 ERAS(术后强化恢复)重要组成部分的多模式疼痛管理问题。材料与方法。采用了书义分析、比较分析和系统分析方法。根据对现代文献、随机试验和荟萃分析结果的分析,以及我们自己专门研究围手术期疼痛问题的研究,提出了建议。研究结果事实证明,麻醉实践中阿片类药物的使用正在减少。作为对传统监测方案的补充,目前正在采用新的现代方法对患者的重要器官进行持续监测。这些方法可用于避免麻醉剂剂量过大或过小,调整所用物质的浓度,减少麻醉后并发症,并提高病人的舒适度。围术期能量监测方法是对 WFSA(2010 年)"国际安全麻醉实践标准 "的重要补充,并通过检测代谢紊乱和实施适当的病理纠正来提高围术期患者的安全性。超声控制下的区域麻醉、痛觉-反痛觉平衡管理的重要性以及这些方法对阿片类药物消耗、患者满意度和术后恢复的影响已得到证实。结论。多模式镇痛最常用的药物组合通常包括对乙酰氨基酚和非甾体抗炎药(强烈推荐)。事实证明,对重症监护室(ICU)患者进行深度和长时间镇静与较差的治疗效果、较长的机械通气时间、较长的重症监护室和住院时间以及较高的并发症发生率(包括感染,有时甚至死亡)有关。
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