Authors
Kapralov S.V., Prigorodov M.V., Masljakov V.V.
Saratov State Medical University named after V.I. Razumovsky, Saratov
Abstract
Rationale. In clinical observation, attention is drawn to solving problems of difficult airways, performing prolonged epidural anesthesia at the thoracic level in the treatment of a surgical oncological patient with Bekhterev’s disease (ankylosing spondylitis).
Purpose. Present the clinical observation of anesthesiological support and surgical and surgical treatment of an oncological patient with Bekhterev’s disease (ankylosing spondylitis).
Methods. A clinical observation of the peculiarities of surgical treatment and anesthesiological support of a patient with Bekhterev’s disease is presented.
Results. The peculiarities of this observation were the difficulties of access to the respiratory tract, which required a tracheostomy, the patient with Bekhterev’s disease to undergo epidural anesthesia at the thoracic level and the difficulties of surgical access due to severe spinal deformity and the patient’s forced position on the operating table. Despite the onset of pneumothorax for the first day after surgery associated with the technical difficulties of applying a tracheostoma, perioperative anesthetic support for a technically complex traumatic operation made it possible to discharge the patient on the 10th day after surgery.
Conclusion. Taking into account the peculiarities of the presented information, the following conditions and requirements must be met. Implement in full clinical recommendations, in particular, “Ensuring the patency of the upper respiratory tract in the hospital.” Protect the patient from surgical stress in traumatic surgeries with combined anesthesia. Constantly update and maintain the material and technical support of the anesthesiological, resuscitation and surgical service (including the availability of tracheostomy cannulas of various sizes). In particular, among the existing problems, the need to implement monitoring of the neuromuscular unit should be noted. It is necessary to coordinate the coordination of the work of the anesthesiological and operational team (the presence of the surgical team in the operating room before the start of anesthesia is necessary). Promptly identify and appropriately treat the developed critical incidents and complications (for example, pneumothorax), effectively carry out medical and diagnostic measures in the perioperative period (choose the optimal individual anesthesiological support).
Keywords: prolonged epidural anesthesia, Bekhterev’s disease, rectal extirpation.
References
1. Şanal Baş S, Güleç SM. Fluoroscopically guided transforaminal epidural catheterization of the ankylosing spondylitis. Agri. 2020; 32(3): 164-167. doi: 10.5505/agri.2018.37980.
2. Andreenko AA, Bratishhev IV, Gavrilov SV, Zajcev AJu, Pikovskij VJu, Stadler VV, Stamov VI. Ensuring the patency of the upper respiratory tract in the hospital: guidelines: third revision; Federation of Anesthesiologists and Resuscitators of Russia. Bulletin of Intensive Care named after A.I. Saltanova. 2021; 2: 17-81. (In Russ.) doi: 10.21320/ 1818-474X-2021-2-17-81.
3. Tran QS, Tran HH. Laparoscopic cholecystectomy for the treatment of acute cholecystitis in a Vietnamese male patient with ankylosing spondylitis combined with chronic obstructive pulmonary disease: A rare case report. Int. J. Surg. Case Rep. 2022; 90(106646): 1-6. doi: 10.1016.
4. Mikaelsdottir E, et al. Genetic variants associated with platelet count are predictive of human disease and physiological markers. Commun. Biol. 2021; 4(1): 1132. doi: 10.1038/ s42003-021-02642-9.
5. Balykova EV, Hachaturova JeA. The use of sevoflurane in combination with epidural anesthesia in laparoscopic colorectal surgery in elderly patients. Medical and biological sciences. 2014; 9(4): 52-60. (In Russ.)
6. Cumin SA, Gorbachev VI, Kuz’kov VV. Clinical protocol or standard operating procedure “catheterization of subclavian and other central veins” as an action option. Anesthesiology and resuscitation. 2018; 4: 5-14. (In Russ.)
7. Ovechkin AM, et al. Postoperative pain relief: clinical recommendations. Bulletin of intensive care named after A.I. Saltanova. 2019; 4: 9-33. (In Russ.) doi: 10.21320/1818-474X-2019-4-9-33.
8. Polushin JuS, Shlyk IV, Hrapov KN, Hrjapa AA, Shapovalov KG, Aleksandrovich JuA, Stepanenko SM. Anesthesiological support of surgical interventions, dressings and complex diagnostic and therapeutic manipulations: guidelines. M.: Medicine, 2019. 87 р. (In Russ.)
9. Garjaev RV. Evaluation of the efficacy and safety of prolonged epidural analgesia after oncological coloproctological interventions. Oncological coloproctology. Pelvic surgery and oncology. 2012; 2: 40-45. (In Russ.)
10. Tarasova IA, Chovrebov AT, Nikoda VV, Shestakov AL, Jetgpnger AP. Nutritional insufficiency in reconstructive interventions in the upper gastrointestinal tract and methods of its correction in the preoperative period. Evidence-based gastroenterology. 2017; 6(1): 3-8. (In Russ.)
11. Lubnin AYu, Yusupov RI, Kulikov AS, Shevchenko KV. Neuromuscular blockade in neuroanesthesiology. Case report and literature review. Russian Journal of Anaesthesiology and Reanimatology. 2022; 5: 60‑66. (In Russ.) doi: 10.17116/anaesthesiology202205160.
12. Leiderman IN, Gritsan AI, Zabolotskikh IB, Lebedinskii KM, Krylov KY, Mazurok VA, Yaroshetskiy AI. Metabolic monitoring and nutritional support following long-term mechanical ventilation. Russian Journal of Anaesthesiology and Reanimatology. 2022; 5: 6‑17. (In Russ.) doi: 10.17116/anaesthesiology20220516.
