medalphabetМедицинский алфавитMedical alphabet2078-56312949-2807ООО «Альфмед»10.33667/2078-5631-2023-35-28-37medalphabet-3496Research ArticleСтатьиСовременные подходы к периоперационному ведению пациентов при проведении каротидной эндартерэктомии в остром периоде ишемического инсультаModern approaches to perioperative management of patients undergoing carotid endarterectomy in acute period of ischemic strokehttps://orcid.org/0000-0002-0368-3914НазаренкоМ. Б.NazarenkoМ. B.

Назаренко Михаил Борисович, к.м.н., зав. отделением анестезиологии- реанимации № 341

 

Nazarenko Mikhail B., PhD Med, head of Dept of Anesthesiology and Resuscitation No. 34

Moscow

https://orcid.org/0000-0001-9191-6169МалышевА. А.MalyshevA. A.

Малышев Анатолий Анатольевич, к.м.н., зав. отделением анестезиологии- реанимации № 621

Malyshev Anatoliy A., PhD Med, head of Dept of Anesthesiology and Resuscitation No. 62

Moscow

https://orcid.org/0000-0002-3852-8877РодионовЕ. П.RodionovЕ. P.

Родионов Евгений Петрович, к.м.н., зам. гл. врача по анестезиологии- реаниматологии; доцент кафедры анестезиологии и неотложной медицины

Москва

Rodionov Evgeniy P., PhD Med, deputy chief physician (Anesthesiology and Resuscitation); associate professor at Dept of Anesthesiology and Emergency Medicine

Moscow

https://orcid.org/0000-0002-8633-7012КомароваА. Г.KomarovaA. G.

Комарова Анна Григорьевна, к.м.н., зам. гл. врача по медицинской части

 

Komarova Anna G., PhD Med, deputy chief physician (head of Regional Vessel Centre)

Moscow

https://orcid.org/0000-0003-4535-2563ВласенкоА. В.VlasenkoA. V.

Власенко Алексей Викторович, д.м.н., проф., зав. отделением анестезиологии-реанимации № 32; зав. кафедрой анестезиологии и неотложной медицины

Москва

Vlasenko Aleksei V., DM Sci (habil.), professor, head of Dept of Anesthesiology and Resuscitation No. 32; head of Dept of Anesthesiology and Emergency Medicine

Moscow

https://orcid.org/0009-0006-6992-6575КарабачЮ. В.KarabachYu. V.

Карабач Юрий Валериевич, зав. отделением сосудистой хирургии № 54

Karabach Yuriy V., head of Department of Vascular Surgery No. 54

Moscow

https://orcid.org/0000-0002-3614-6971ЛевиковД. И.LevikovD. I.

Левиков Дмитрий Ильич, к.м.н., зав. отделением анестезиологии-реанимации № 52

Levikov Dmitriy I., PhD Med, head of Dept of Anesthesiology and Resuscitation No.52

Moscow

ГБУЗ г. Москвы «Городская клиническая больница имени С. П. Боткина Департамента здравоохранения города Москвы»РоссияCity Clinical Hospital n.a. S. P. BotkinRussian FederationГБУЗ г. Москвы «Городская клиническая больница имени С. П. Боткина Департамента здравоохранения города Москвы»; ФГБОУ ДПО «Российская медицинская академия непрерывного профессионального образования» Минздрава РоссииРоссияCity Clinical Hospital n.a. S. P. Botkin; Russian Medical Academy of Continuing Professional EducationRussian Federation202318012024035Кардиология. Неотложная медицина (4)2837Copyright © Назаренко М.Б., Малышев А.А., Родионов Е.П., Комарова А.Г., Власенко А.В., Карабач Ю.В., Левиков Д.И., 20242024Назаренко М.Б., Малышев А.А., Родионов Е.П., Комарова А.Г., Власенко А.В., Карабач Ю.В., Левиков Д.И.Nazarenko М.B., Malyshev A.A., Rodionov Е.P., Komarova A.G., Vlasenko A.V., Karabach Y.V., Levikov D.I.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.med-alphabet.com/jour/article/view/3496

В данной статье приведен опыт применения в ГБУЗ «ГКБ имени С. П. Боткина ДЗМ» методики обезболивания в виде сочетания общей и регионарной анестезии поверхностного шейного сплетения при проведении операции каротидной эндартерэктомии, выполняемой пациентам в остром периоде ишемического инсульта атеротромботического генеза. Результатом надежной антиноцицептивной защиты организма от активации симпатоадреналовой системы на фоне хирургических манипуляций явилось предупреждение эпизодов критической гипертензии и обеспечение нормализации показателей системной гемодинамики. В результате уменьшения необходимости применения опиоидов ускоряется пробуждение пациентов, уменьшается время их пребывания в операционной. Кроме того, снижается потребность в послеоперационном обезболивании, сокращается время необходимого наблюдения в палате реанимации и интенсивной терапии в ближайший послеоперационной период. Указанные выше факторы, а также мультидисциплинарный подход к лечению пациентов позволили не только обеспечить надежную профилактику повторных сосудистых инцидентов в острой фазе ишемического инсульта, но и улучшить неврологические результаты их лечения.

This article presents the Moscow Botkin Hospital experience of using combination of general and superficial cervical plexus regional anesthesia during carotid endarterectomy performed in patients in the acute period of atherothrombotic genesis ischemic stroke. The result of reliable antinociceptive protection of the body from the activation of the sympatho-adrenal system against the background of surgical manipulations was the prevention of episodes of critical hypertension and ensuring normalization of systemic hemodynamics. By reducing the need for opioids, patients’ awakening is accelerated, and their time in the operating room is minimized. In addition, the time of necessary observation in the intensive care unit and the need for anesthesia at the immediate postoperative period, is also reduced. The above factors, as well as a multidisciplinary approach to the patient, allowed not only to provide reliable prevention of recurrent vascular incidents in the acute period of ischemic stroke, but also to improve the neurological outcomes.

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The authors declare that there are no conflicts of interest present.