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Abstract. Arthroscopic knee surgery (AKS) is one of the most common types of surgery in the world. But there is still a debate about the optimal type of anesthetic management for this type of orthopedic surgery. The purpose of the study was to improve the quality of anesthetic management of arthroscopic interventions on the knee joint by introducing personalized perioperative anesthesia management. Materials and methods: 142 patients, aged 18-78 years, who were planned for AKS, took part in the study. The patients were randomized into 2 groups according to the type of anesthesia chosen by the patient. In the first group (n1 = 82) patients underwent neuraxial anesthesia in combination with intravenous administration of dexmedetomidine, in the second group (n2 = 60) – multicomponent low-flow inhalation anesthesia with sevoflurane in combination with multimodal analgesia. Before the operation, the level of preoperative stress was assessed. During the first 24 hours after surgery, the level of postoperative pain was assessed by the VAS, the incidence of PONV, and overall patient satisfaction with the surgery. Results: the level of pain according to the VAS, the incidence of PONV, the level of satisfaction in the study groups did not differ significantly. Conclusions: Neuraxial and general anesthesia for arthroscopic knee surgery has advantages and disadvantages. The patient’s choice of one or another type of anesthetic aid was significantly influenced by the level of preoperative stress. Decision-making on the method of anesthesia should be based on the patient’s wishes and possible previous surgical experience.

åðaeàâíà íàóêîâà óñòàíîâà "Íàóêîâî-ïðàêòè÷íèé öåíòð ïðîô³ëàêòè÷íî¿ òà êë³í³÷íî¿ ìåäèöèíè" Äåðaeàâíîãî óïðàâë³ííÿ ñïðàâàìè, ì. Êè¿â, Óêðà¿íà Ðåçþìå. Ìåòà îö³íèòè äîö³ëüí³ñòü âïðîâàäaeåííÿ ìîäèô³êîâàíîãî ïðîòîêîëó ERAS äëÿ ëàïàðîñêîï³÷íèõ áàð³àòðè÷íèõ âòðó÷àíü, àëå ÿêèé âèêîðèñòîâóº áàçîâ³ ³ ñóòòºâ³ çì³íè ERAS-ìàëî³íâàçèâí³ñòü òà ìóëüòèìîäàëüí³ñòü. Ìàòåð³àëè ³ ìåòîäè. Ìè ïðîâåëè ðåòðîñïåêòèâíå äîñë³äaeåííÿ â îäí³é óñòàíîâ³ ó ïàö³ºíò³â, ÿê³ ïåðåíåñëè ëàïàðîñêîï³÷í³ áàð³àòðè÷í³ âòðó÷àííÿ ç 2011 ïî 2018 ð. Ïàö³ºíòè áóëè ðîçä³ëåí³ íà 2 ãðóïè: ãðóïà ERAS (n1=44) òà ãðóïà ñòàíäàðòíîãî âåäåííÿ (n2=24). Ïåðâèíí³ ê³íöåâ³ òî÷êè åôåêòèâíîñò³-ïðîòÿãîì ïåðøèõ 24 ãîäèí ï³ñëÿ îïåðàö³¿ â³äñóòí³ñòü íåîáõ³äíîñò³ â çíåáîëåíí³ íàðêîòè÷íèìè àíàëüãåòèêàìè, â³äñóòí³ñòü íåîáõ³äíîñò³ ïåðåáóâàííÿ â ÂÀ²Ò, â³äñóòí³ñòü åï³çîä³â ÏÎÍÁ, ìîá³ë³çàö³ÿ òà ïî÷àòîê åíòåðàëüíîãî ïðèéîìó ð³äèíè. Âòîðèííèé ðåçóëüòàò-ñêîðî÷åííÿ òåðì³íó ïåðåáóâàííÿ â ñòàö³îíàð³. Ðåçóëüòàòè. Ïðîòÿãîì ïåðøèõ 24 ãîäèí ï³ñëÿ îïåðàö³¿ íåîáõ³äí³ñòü ïåðåáóâàííÿ â ÂÀ²Ò, ÷àñòîòà åï³çîä³â ÏÎÍÁ áóëè ñòàòèñòè÷íî íèae÷³ â ãðóï³ ERAS. ×àñòîòà âèïàäê³â çíåáîëåííÿ íàðêîòè÷íèìè àíàëüãåòèêàìè áóëà ìàéaeå â 2 ðàçè âèùà â ãðóï³ ñòàíäàðòíîãî âåäåííÿ (58,3 vs 30 %, p=0,05).  ïðîäîâae ïåðøî¿ ï³ñëÿîïåðàö³éíî¿ äîáè âñ³ ïàö³ºíòè ãðóïè ERAS áóëè ìîá³ë³çîâàí³ òà ðîçïî÷àòî åíòåðàëüíèé ïðèéîì ð³äèíè. Ñåðåäíÿ òðèâàë³ñòü ãîñï³òàë³çàö³¿ áóëà äîñòîâ³ðíî êîðîòøà â ãðóï³ ERAS (4,4 ±0,15 vs 5,3 ±0,26, p<0,01). Âèñíîâêè. Âïðîâàäaeåííÿ ìîäèô³êîâàíîãî ERAS ïðîòîêîëó ïðè ëàïàðîñêîï³÷íèõ áàð³àòðè÷íèõ âòðó÷àííÿõ äîçâîëèâ çíà÷íî çíèçèòè îï³î¿äíå íàâàíòàaeåííÿ òà ñêîðîòèòè òåðì³í ïåðåáóâàííÿ â ñòàö³îíàð³. Êëþ÷îâ³ ñëîâà: ìîðá³äíå îaeèð³ííÿ, ìóëüòèìîäàëüíà ïîïåðåäaeóâàëüíà àíàëãåç³ÿ, ïðîòîêîë ïðèñêîðåíîãî ïåð³îïåðàö³éíîãî âåäåííÿ.

This clinical article presents clinical examples of the successful implementation of the program for accelerated management of the postoperative period in patients with morbid obesity after laparoscopic stomach longitudinal resection , using combined anesthesia based on intravenous administration of propofol, inhalation low flow anesthesia with sevoflurane, and peri operative multimodal analgesia.The objective. Was optimization of methods of general anesthesia of bariatric surgical interventions in patients with morbid obesity.Patients and methods. 26 patients with a BMI of 36-45 took part in the study, who underwent laparoscopic stomach longitudinal resection with the use of combined low flow anesthesia with sevoflurane and multimodal analgesia. All patients underwent the concept of minimally invasive intraoperative anesthetic monitoring and an accelerated postoperative rehabilitation program.Results. The dynamics of the values of central hemodynamics showed a high hemodynamic stability at all stages of the operation, with a tendency towards normalization of initially elevated blood pressure. The indices of the adequacy of oxygenation and ventilation (SpO2 and EtCO2) corresponded to normal values and did not differ from the level of stress norm. In all patients, recovery of spontaneous breathing occurred on average 8 minutes after the end of the operation. Extubation was performed on the operating table in 8±2 minutes (p=0,05), therefore, prolonged artificial ventilation was not required. At that, the level of postoperative pain on the operating table by VAS was minimal – 0–2 points. In the early postoperative period, the pain level according to the VAS in patients was on average 3±2 points (p=0.05). Accordingly, there was no need for narcotic analgesics. All patients were activated within the first 24 hours after the operation. Patients were discharged on 2,9±0,25 days after the operation (p=0,05).Conclusion. Inhalation low flow anesthesia based on sevoflurane with the use of multimodal analgesia during laparoscopic stomach longitudinal resection in patients with morbid obesity does not require prolonged ventilation and is a worthy alternative to combined epidural anesthesia. Rejection of invasive monitoring allows early activation of patients and a shortened stay in the hospital.

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