ANAESTHETIC ASPECTS OF IMPROVING CONDITIONS OF ENDOSCOPIC GASTRECTOMY IN PATIENTS WITH MORBID OBESITY

Abstract

The OBJECTIVE of the study is to improve in the surgical condition of endoscopic longitudinal gastroplasty in patients with morbid obesity. MATERIAL AND METHODS. The prospective randomized controlled research of 68 patients who underwent endoscopic sleeve gastroplasty. The 1st group (n=23) – neuromuscular blockade (NMB) was performed by bolus injection of rocuronium, the patients on the operating table were in a flat position. The 2nd group (n=23) – NMB was maintained by intravenous infusion of rocuronium, patients on the operating table were in the Trendelenburg position. The 3rd group (n=22) – basic anesthesia in combination with prolonged epidural analgesia (PEA), NMB were maintained at a deep level by intravenous infusion of rocuronium, patients on the operating table were in the «beach chair» position. Neuromuscular monitoring, monitoring of central and peripheral hemodynamics were performed. The elasticity of the anterior abdominal wall (E), intra-abdominal pressure (IAP), intra-abdominal volume (IAV) were calculated. RESULTS. During the analysis of the dynamics of the average level of intra-abdominal volume and pressure, it was found that the mean IAV level in the 3rd group was significantly higher at all stages of the study than in the 1st and the 2nd groups, and the IAP level was significantly lower in the 3rd group at all stages of the study than in the 1st and the 2nd groups. CONCLUSION. The maintaining of muscle relaxation at a deep level under the regime of continuous infusion, the inclusion of ropivacaine in the anesthetic regimen of PEA, the use of the «beach chair» position for the patient on the operating table contribute to the improvement of surgical condition during the endoscopic gastrectomy in patients with morbid obesity.

Keywords

• morbid obesity
• endoscopic gastrectomy
• intra-abdominal pressure
• intra-abdominal volume