THE SIGNIFICANCE OF CARDIAC SYMPTOMS IN THE CLINICAL MANAGEMENT OF PATIENTS WITH COEXISTING MEDICAL CONDITIONS

Аннотация

The article presents the results of preoperative preparation, anesthesia and surgical treatment of patients operated on for non-toxic nodular goiter. A new approach to preoperative preparation for thyroid surgery is described. The effectiveness in the preoperative period of using the modified method of preoperative preparation using sibazon and droperidol and anesthesia with the use of ketamine and the advantages of this method compared with other methods of general anesthesia are shown. Key words: modified preoperative preparation, anesthesia, thyroid gland, nontoxic nodular goiter Currently, there is a steady increase in the number of thyroid diseases worldwide. A significant number of population living in the territory of Uzbekistan have obvious or hidden functional disorders of the thyroid gland [6]. Diffuse non - toxic goiter is the most common pathology, which takes up to 60% of all cases of thyroid disease. In this pathology, the functions of the central nervous system and endocrine system, blood circulation and respiration, liver and kidneys, immunity and metabolism are impaired [5]. Often, this type of thyroid disease is the leading one in the group of endocrine diseases, the main method of treatment for which is surgery. It should be considered that during operations on the thyroid gland, it is important to use the optimal method of anesthesia, which would prevent the manifestations of pathological reactions https://scientific-jl.org/obr 4 8 3 Выпуск журнала №-70 Часть–8_ июня –2025 ОБРАЗОВАНИЕ НАУКА И ИННОВАЦИОННЫЕ ИДЕИ В МИРЕ 2181-3187 associated with the nature of the main and concomitant diseases. The high risk of intra - and postoperative complications associated with the anatomical features of the surgical intervention area justifies the relevance of the problem of optimizing the anesthetic allowance for thyroid surgery [2]. Analyzing of currently used methods of general anesthesia for thyroid diseases, we can assume that not all of them do fully prevent the negative effects and reactions that occur in the body to surgical stress and have many other serious drawbacks. These include: the use of narcotic analgesics and anesthetics, postoperative respiratory depression and rapid cessation of analgesia in the early postoperative period, a number of adverse hemodynamic changes at traumatic stages of surgery [1]. When choosing an anesthetic to maintain anesthesia for thyroid disease, the characteristics of the psychological and somatic status of patients, the nature of the influence of the disease on the circulatory system and the functional state of parenchymal organs, and the presence of concomitant diseases are guided [3]. Surgical treatment of thyroid pathology, including goiter under General anesthesia using neuroleptanalgesia (NLA) in the most traumatic moments of the operation is often accompanied by dangerous circulatory disorders in the form of tachycardia, arterial hypertension, and heart rhythm disorders [3]. If the patient also has concomitant diseases (CVS diseases and diabetes mellitus), then the complication during anesthesia becomes critical. In modern practical anesthesiology, much attention is paid to the blockage of pathological impulsion, which occurs under the influence of surgical trauma of the afferent and central nervous system during the medical preparation of the patient in the preoperative period. Anesthesiology does not yet know ideal and universal solutions to the problem of protecting the patient from surgical aggression. The most reasonable approach is a multi-modal approach that implies a multi-level, multi-purpose antinociception, in https://scientific-jl.org/obr 4 8 4 Выпуск журнала №-70 Часть–8_ июня –2025 ОБРАЗОВАНИЕ НАУКА И ИННОВАЦИОННЫЕ ИДЕИ В МИРЕ 2181-3187 which the maximum effect (due to synergy or summation of action) is combined with a minimum of side effects [6]. The appearance of modern drugs for anesthesia and improvement of surgical treatment results at the current stage of development of endocrine surgery is seen in the further improvement of preoperative preparation and intraoperative anesthesia. Objective: To choose the effective method of preoperative preparation and types of anesthesia on thyroid gland surgery. Material and methods: The research was conducted at Samarkand State Medical Institute clinic №1. 72 patients operated on non-toxic goiter were under observation. In accordance with the purpose and objectives of this study, patients were divided into two groups depending on the type of preoperative preparation and anesthesia. Among the examined patients there were 8 men (11.1%) and 64 women (88.9%) aged from 32 to 68 years. By age, the patients were distributed as follows: from 32-45 years – 13 people (18.05 %), 46- 60 years – 49 people (74.7 %), over 60 years – 10 people (7.2%). The length of anamnesis for goiter was on average 3.3 ± 2 years. Objective status according to the classification of the American society of anesthesiologists (ASA