ROBOTIC ASSISTANCE IN SPINAL NEUROSURGERY

Аннотация

Is accompanied by an expansion of indications for surgical interventions previously considered impossible, in particular, in elderly and senile patients (Gorilovsky L.M., 1993; Kosachenko V.M., 2005, etc.) - According to epidemiological data from the Russian Federation, in recent years the proportion of gerontological patients undergoing hospital treatment has been significantly increasing, and according to UN forecasts, the number of elderly and senile people in the world by 2010 will amount to 15% of the total population (Burov N.E., 2000; Gorilovsky L.M., 1999; Seltsovsky A.P., 1999, etc.). In this regard, the problem of treatment and, in particular, anesthetic care for this category of patients is extremely urgent. It is well known that during the aging process, numerous involutional changes occur in the body, characterized by a decrease in the functional capabilities of organs and systems, a decrease, and in some cases, a perversion of metabolic processes, a decrease in the reactivity of the body and resistance (or resistance) to stress effects (Fedorovsky N.M., 2002; Folkes-Crabbe.D., 1993,etc.). In this regard, anesthesia in gerontological patients is associated with an increased surgical and anesthetic risk, complications in the early postoperative period, and, as a consequence, increased mortality(Buyanov V.M., 1983; Sviridov SV., 2000, etc.). Therefore, there are often cases when patients are denied surgical treatment, although it is technically possible to carry it out, or are offered palliative interventions that cannot radically cure the elderly from the disease (Igelnik A.M., 1992). The protocol for anesthesia in gerontological patients differs from that in other age groups due to altered metabolism of drugs, decreased sensitivity of organs and tissues to them, different distribution coefficient ofdrugs in altered water sectors, etc. (Ovechkin A.M., 2000; Fedorovsky N.M. et al., 2002,2003; Papin A.A., 1988; Hosking M.P. et al, 1989, etc.). Unfortunately, the initial status of the gerontological patient's body is not always taken into account by anesthesiologists and resuscitators when performinganesthesia and intensivecare (IT) in thepostoperative period (Craig B.D., 1987). Objectiveofthe study: To develop optimal methods of anesthesia, analgesia and corrective intensive care for elderly and senile urological patients, allowing to expand the indications for surgical 98,7:ROTCAFTCAPMI.SECNEICS LACIDEM,5202, yraurbeF,5emuloV gro.srehsilbupcimedaca.www treatment, improve its results, reduce the number of complications in the intra- and postoperativeperiod. Research objectives: 1. To develop algorithms for preoperative examination and preparation of elderly and senile patients depending on concomitant pathology, to assess the adequacy of preoperative preparation of gerontological patients based on the dynamics of the risk degree according to ASA. 2. Based on the identified homeostasis disorders of the gerontological contingent, to develop optimalmethods for anestheticcare depending onthe natureofthe surgical intervention. 3. Based on the individual characteristics of the aging organism, to develop tactics of qualitativeand quantitativeinfusion-transfusion therapy during anesthesiaand intheearly postoperativeperiod. 4. Optimize the technique of postoperative analgesia for gerontological patients depending onthenatureof theurological surgery. 5. Based on the obtained results, develop algorithms for IT at all stages of the study (before, during and after surgery) for elderly and senilepatients in urology for practical healthcare. 6. Conduct an analysis of the effectiveness of IT, postoperative complications and mortality ofgerontological patientsinurology Scientificnovelty ofthework: Based on our own research, algorithms for optimal preoperative examination and preparation of patients have been developed, allowing to reduce the degree of surgical and anestheticrisk in gerontological patients and expand theindications forsurgical treatment. Indications for the type of anesthesia depending on the nature of the urological operation havebeen determined. Algorithms for anesthesia, infusion therapy in the intra- and postoperative periods, a protocol for weaning the patient from a respirator in the postoperative period have been developed, taking intoaccount thegerontological stress norm. A method of postoperative analgesia without the use of narcotic analgesics has been developed, indications have been determined and the feasibility and effectiveness of using intrapleural analgesiahas beenproven. An algorithm for the treatment of postoperative gastrointestinal paresis in gerontological patients inurology has been proposed. Practical significance ofthework: 98,7:ROTCAFTCAPMI.SECNEICS LACIDEM,5202, yraurbeF,5emuloV gro.srehsilbupcimedaca.www Elderly patients are the most "severe" group of patients due to the presence of both age- related involutional changes in the body and severe intercurrent background. Th