SPECIFIC FEATURES OF ORGANIZING THE ANESTHESIOLOGY SERVICE IN AN ONCOLOGICAL CLINIC DURING MAJOR UPPER ABDOMINAL SURGERY

Аннотация

Background. Major oncological surgeries involving the upper abdominal organs are associated with high surgical trauma, considerable risk of hemodynamic instability, and severe postoperative pain, which impose special requirements on the organization of anesthesiology services and the choice of multimodal techniques. Objective. To evaluate the clinical and organizational effects of a combined anesthetic approach (general anesthesia plus prolonged epidural block) compared with standard general anesthesia in patients undergoing major upper abdominal oncological surgery. Materials and Methods. A prospective comparative study was conducted at a national oncology hospital and a regional oncology clinic, including 200 patients. Group I: standard general anesthesia (n=103); Group II: general anesthesia combined with prolonged epidural block (n=97). Parameters assessed included hemodynamics, SpO₂, acid–base balance, intraoperative stress hormone levels (cortisol and catecholamines), postoperative pain intensity (VAS), need for opioid analgesics, as well as organizational indicators (quality of anesthetic records, resource utilization). Statistical analysis was performed using standard parametric and nonparametric methods, with significance set at p<0.05. Results. Compared with general anesthesia alone, the combined approach was associated with a lower incidence of intraoperative hypotension (17.5% vs. 34.0%) and arrhythmias (12.4% vs. 21.3%), fewer episodes of SpO₂ <92% (4.1% vs. 11.7%), reduced intraoperative stress hormone responses (mean cortisol increase +23% vs. +48%), and significantly lower postoperative pain scores (VAS day 1: 3.4±1.1 vs. 6.1±1.3). This was accompanied by decreased opioid consumption (14.4% vs. 39.8%) and improved quality of anesthetic documentation (errors 9.3% vs. 18.4%). Conclusions. The combination of general anesthesia with prolonged epidural block provides a more stable intraoperative course, attenuates the surgical stress response, and ensures superior postoperative analgesia, while simultaneously improving organizational aspects of anesthesiology practice. These findings are consistent with ERAS principles and support the implementation of standardized combined anesthesia protocols in oncological surgery.