Анестезия в отделении хирургии одного дня. Обзор литературы
№ 4 (2020) , ИЗБРАННЫЕ ВОПРОСЫ АНЕСТЕЗИОЛОГИИ
№ 4 (2020)
ИЗБРАННЫЕ ВОПРОСЫ АНЕСТЕЗИОЛОГИИ

Анестезия в отделении хирургии одного дня. Обзор литературы

https://doi.org/10.21320/1818-474X-2020-4-88-98
Опубликован 16.11.2020
Владимир Николаевич Куклин
Университетская клиника Ахюс, Осло, Норвегия
https://orcid.org/0000-0003-4686-1773
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Ключевые слова

амбулаторная
хирургия
анестезия
анальгезия

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Куклин В.Н. Анестезия в отделении хирургии одного дня. Обзор литературы. Вестник интенсивной терапии имени А.И. Салтанова. 2020;(4):88–98. doi:10.21320/1818-474X-2020-4-88-98.
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Аннотация

Выписка пациента из медицинского учреждения в день выполнения хирургической операции предъявляет высокие требования к профессионализму персонала отделения хирургии одного дня. По мере развития данного отделения поступательно расширяется как список хирургических операций, так и их сложность. Отбор пациентов для лечения в хирургии одного дня базируется на физическом состоянии пациента и стабильности течения хронических заболеваний. При поступлении в отделение дневной хирургии скандинавских стран не требуется наличие у пациента биохимического исследования крови, электрокардиограммы или рентгенограммы грудной клетки. Опросники, заполняемые пациентом, помогают врачу-анестезиологу выявить практически всю патологию, имеющую влияние на анестезиологическое пособие, а дополнительные методы обследования используются только лишь по показаниям после осмотра врача. Многокомпонентная премедикация — основа для постоперационной анальгезии. Седативные препараты в премедикации показаны в основном детям. Для безопасного лечения пациента намного важнее правильная и логическая организация работы отделения, чем тип анестезии, применяемый в данном отделении. Однако выбор типа анестезии может существенно влиять на проявления побочных эффектов анестетиков, скорость восстановления нормального функционального состояния пациента и в конечном счете на время пребывания пациента в отделении. Спинальная анестезия — безопасна и проста в исполнении, но ее применение может приводить к задержке выписки пациента, а порой и к необходимости госпитализации. Ингаляционные анестетики значительно увеличивают количество пациентов (до 30 %) с жалобами на послеоперационную тошноту, рвоту и озноб. Поэтому тотальная внутривенная анестезия пропофолом и ремифентанилом наиболее часто применяется в отделениях дневной хирургии скандинавских стран. Регионарная анестезия под контролем ультразвука обеспечивает продолжительное и достаточное послеоперационное обезболивание. При возникновении острой послеоперационной боли рекомендуется использовать небольшие дозы опиоидов внутривенно. Применение клофелина в качестве адъюванта в послеоперационном обезболивании помогает усилить анальгетический эффект опиоидов. Выписка пациента домой осуществляется на основе установленных в отделении критериев.
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