The adverse effect of general anesthesia in elderly patients during surgery requires monitoring of functions and processes to identify their dangerous abnormalities to prevent complications. The aim of the study. To establish the effectiveness of non-invasive regional brain oximetry with rSO2 determination during anesthetic support in laparoscopic cholecystectomy (LCE) to prevent postoperative cognitive dysfunction in elderly and senile patients. Material and methods. 84 elderly and senile patients with diagnosed gallstone disease, acute cholecystitis, who underwent LCE with sevofluran inhalational anesthesia and total intravenous anesthesia with propofol were examined. rSO2 was monitored. Cognitive functions were assessed using neuropsychological scales and the MMSE mental state examination scale. Results. rSO2 was found to be significantly decreased during the carbon dioxide insufflation as compared to before premedication: in LH (left hemisphere) – by 7.0 %, in RH (right hemisphere) – by 6.9 % (Group I); in LH – by 7.4 %, in RH – by 7.5 % (Group II). rSO2 was significantly increased during the surgery, particularly in the middle of the operation, as compared to before premedication: in LH – by 14.66 %, in RH – by 13.94 % (Group I); in LH – by 11.60 %, in RH – by 11.53 % (Group II). The day following the surgery, cognitive functions significantly decreased by 8.7 % on the Luria's test, by 6.0 % on the MMSE test (Group I); in Group II – by 10.1 % and 6.3 %, respectively, as compared to before premedication. On Day 5 after the surgery, cognitive functions decreased by 2.7 % on the Luria's test, by 0.35 % on the MMSE test (Group I); in Group II – by 2.7 % and 0.35 %, respectively, as compared to before premedication. Conclusions. A decrease in rSO2 can occur during LCE in the Trendelenburg position, despite the fact that other intraoperative indicators remain stable, which allows it to remain unrecognized. rSO2 monitoring in the perioperative period contributes to alertness and timely measures to prevent postoperative cognitive dysfunction.

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Харківська медична академія післядипломної освіти, м. Харків, Україна актуальність визначення глибини анестезії за допомогою індексу стану пацієнта при лапароскопічній холецистектомії у пацієнтів похилого та старечого віку Резюме. Актуальність. Сучасна концепція анестезіологічного забезпечення має на меті не тільки адекватне знеболювання, але й управління життєво важливими функціями організму пацієнта впродовж операції. Тому одним із найбільш значущих завдань сучасної анестезіології є об'єктивізація контролю адекватності загального знеболювання, що передбачає конт роль функцій та процесів, виявлення їх небезпечних відхилень для запобігання ускладненням під час анестезії. Мета: оцінити ефективність і значущість використання індексу стану пацієнта (Patient State Index -PSI) при введенні різних комбінацій анестетиків упродовж загальної анестезії у пацієнтів похилого та старечого віку під час лапароскопічної холецистектомії. Матері али та методи.

The aim. To investigate the dynamics of stress markers and the state of cognitive functions in the perioperative period during laparoscopic cholecystectomy in elderly patients. Materials and methods. We examined 84 patients aged 68.1 ± 0.6 years, with diagnosed gallstone disease, acute cholecystitis, who underwent laparoscopic cholecystectomy. Patients were randomized into 2 groups: Group I - inhalation anesthesia based on sevoflurane with mechanical ventilation; Group II - TBA based on propofol with mechanical ventilation. Hemodynamic parameters, dynamics of stress markers (cortisol, insulin, glucose) and cognitive function were investigated. Results. Glucose and insulin levels in both groups remained within normal limits at all stages of the study. The baseline cortisol level was higher than normal in both groups, but at 4, 5, 6 stages of the study decreased significantly compared with baseline values (p<0.001). In the study of cognitive functions by the Luria test and the MMSE scale, a significant decrease was found in both groups on the day after surgery. According to the Luria test, the score in group I significantly decreased the day after surgery against the period before premedication by 8.7% (p<0.001), in group II - by 10.1% (p<0.001); according to the MMSE scale, the score in group I significantly decreased on the day after surgery against the period before premedication by 6.0% (p<0.001), in group II - by 6.3% (p<0.001). On the fifth postoperative day, no significant differences in baseline values ​​between the Luria test and the MMSE scale were detected. Conclusions.  The comparative analysis of the dynamics of stress marker levels in both groups revealed some advantages of general sevoflurane-based anesthesia in antistress protection of patients in the perioperative period during laparoscopic cholecystectomy compared with total intravenous anesthesia based on propofol. However, the effectiveness of anti-stress protection of both types of anesthesia was sufficient. According to the correlation analysis, an inverse correlation was found between the state of cognitive functions in the postoperative period and the level of cortisol in the intraoperative period