Application of Accelerated Activation in Retroperitoneal Video Endoscopic Adrenalectomy for Cushing Syndrome
Purpose. To improve the immediate results of surgical treatment of endogenous hypercorticism throughoptimizing the perioperative management of patients using accelerated rehabilitation protocols.Materials and methods. A randomized prospective study of 53 patients with a body mass index 35 kg/m2 was...
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Federal Research and Clinical Center of Intensive Care Medicine and Rehabilitology, Moscow, Russia
2019-07-01
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| Series: | Общая реаниматология |
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| Online Access: | https://www.reanimatology.com/rmt/article/view/1772 |
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| author | M. I. Neimark R. V. Kiselev |
| author_facet | M. I. Neimark R. V. Kiselev |
| author_sort | M. I. Neimark |
| collection | DOAJ |
| description | Purpose. To improve the immediate results of surgical treatment of endogenous hypercorticism throughoptimizing the perioperative management of patients using accelerated rehabilitation protocols.Materials and methods. A randomized prospective study of 53 patients with a body mass index 35 kg/m2 was carried out. In the control group (n=27), TIVA based on propofol was used with postoperative analgesia by systemic administration of opioids. In the accelerated rehabilitation protocol group (n=26), we used anesthesia based on low-flow inhalation of desflurane with sympatholytic mixture infusion in intra- and postoperative periods, multimodal postoperative analgesia, and use of accelerated rehabilitation protocol in the perioperative period. The time of patients' achievement of BIS90 index, time of extubation, time of achievement of 10 points by the Aldrete scale and 0 points by the Bidway test, duration of stay in the in-patient hospital, number of postoperative complications were assessed. Effectiveness of analgesia was evaluated by the time of the first analgesia requirement, consumption of narcotic analgesic, VAS and Verbal Descriptor scale.Results. The study revealed that the time of awakening and reaching 10 points by the Aldrete scale in patients of group 2 was significantly shorter than in group 1: 3 (2; 6) and 6.5 (3.5; 9) min respectively (P=0.046). They had fewer postoperative complications, shorter hospitalization time — 58 (39; 71) hours compared to the control group with 74.5 (58.5; 87) hours (P=0.032).Conclusion. Perioperative management of obese patients after retroperitoneal video endoscopic adrenalectomy with the use of accelerated rehabilitation protocols contributed to earlier mobilization, reduction of the number of complications in the early postoperative period, reduction of the duration of stay in the in-patient hospital, which together facilitates improving the immediate results of surgical treatment of endogenous hypercorticism. |
| format | Article |
| id | doaj-art-a2a7c538147045de8ca091e0a91d8a28 |
| institution | DOAJ |
| issn | 1813-9779 2411-7110 |
| language | English |
| publishDate | 2019-07-01 |
| publisher | Federal Research and Clinical Center of Intensive Care Medicine and Rehabilitology, Moscow, Russia |
| record_format | Article |
| series | Общая реаниматология |
| spelling | doaj-art-a2a7c538147045de8ca091e0a91d8a282025-08-20T03:18:49ZengFederal Research and Clinical Center of Intensive Care Medicine and Rehabilitology, Moscow, RussiaОбщая реаниматология1813-97792411-71102019-07-01153193010.15360/1813-9779-2019-3-19-301687Application of Accelerated Activation in Retroperitoneal Video Endoscopic Adrenalectomy for Cushing SyndromeM. I. Neimark0R. V. Kiselev1Altai State Medical University, Ministry of Health of RussiaAltai State Medical University, Ministry of Health of RussiaPurpose. To improve the immediate results of surgical treatment of endogenous hypercorticism throughoptimizing the perioperative management of patients using accelerated rehabilitation protocols.Materials and methods. A randomized prospective study of 53 patients with a body mass index 35 kg/m2 was carried out. In the control group (n=27), TIVA based on propofol was used with postoperative analgesia by systemic administration of opioids. In the accelerated rehabilitation protocol group (n=26), we used anesthesia based on low-flow inhalation of desflurane with sympatholytic mixture infusion in intra- and postoperative periods, multimodal postoperative analgesia, and use of accelerated rehabilitation protocol in the perioperative period. The time of patients' achievement of BIS90 index, time of extubation, time of achievement of 10 points by the Aldrete scale and 0 points by the Bidway test, duration of stay in the in-patient hospital, number of postoperative complications were assessed. Effectiveness of analgesia was evaluated by the time of the first analgesia requirement, consumption of narcotic analgesic, VAS and Verbal Descriptor scale.Results. The study revealed that the time of awakening and reaching 10 points by the Aldrete scale in patients of group 2 was significantly shorter than in group 1: 3 (2; 6) and 6.5 (3.5; 9) min respectively (P=0.046). They had fewer postoperative complications, shorter hospitalization time — 58 (39; 71) hours compared to the control group with 74.5 (58.5; 87) hours (P=0.032).Conclusion. Perioperative management of obese patients after retroperitoneal video endoscopic adrenalectomy with the use of accelerated rehabilitation protocols contributed to earlier mobilization, reduction of the number of complications in the early postoperative period, reduction of the duration of stay in the in-patient hospital, which together facilitates improving the immediate results of surgical treatment of endogenous hypercorticism.https://www.reanimatology.com/rmt/article/view/1772obesitycushing syndromemultimodal analgesia |
| spellingShingle | M. I. Neimark R. V. Kiselev Application of Accelerated Activation in Retroperitoneal Video Endoscopic Adrenalectomy for Cushing Syndrome Общая реаниматология obesity cushing syndrome multimodal analgesia |
| title | Application of Accelerated Activation in Retroperitoneal Video Endoscopic Adrenalectomy for Cushing Syndrome |
| title_full | Application of Accelerated Activation in Retroperitoneal Video Endoscopic Adrenalectomy for Cushing Syndrome |
| title_fullStr | Application of Accelerated Activation in Retroperitoneal Video Endoscopic Adrenalectomy for Cushing Syndrome |
| title_full_unstemmed | Application of Accelerated Activation in Retroperitoneal Video Endoscopic Adrenalectomy for Cushing Syndrome |
| title_short | Application of Accelerated Activation in Retroperitoneal Video Endoscopic Adrenalectomy for Cushing Syndrome |
| title_sort | application of accelerated activation in retroperitoneal video endoscopic adrenalectomy for cushing syndrome |
| topic | obesity cushing syndrome multimodal analgesia |
| url | https://www.reanimatology.com/rmt/article/view/1772 |
| work_keys_str_mv | AT mineimark applicationofacceleratedactivationinretroperitonealvideoendoscopicadrenalectomyforcushingsyndrome AT rvkiselev applicationofacceleratedactivationinretroperitonealvideoendoscopicadrenalectomyforcushingsyndrome |