Наш подход к анестезиологическому сопровождению витреоретинальных вмешательств у пациентов с пролиферативной диабетической ретинопатией на фоне заместительной почечной терапии

Abstract

Purpose. Identification of the optimal type of anesthetic support and regional anesthesia, the timing of surgery after a hemodialysis session, and also methods of preventing complications in patients undergoing renal replacement therapy (RRT). Methods. The results of surgical treatment under local anesthesia with intravenous sedation of 20 patients with proliferative diabetic retinopathy who are on RRT were analyzed. Results. In all cases, it was possible to achieve improvement/stabilization of visual functions, avoid hemorrhagic complications, maintain nitrogen metabolism indicators, and minimize decompensation of glycemic status. Adequate anesthesia was achieved in 17 cases (85 %) with additional subtenon injection of 2 ml of 2 % lidocaine solution with the duration of surgical intervention of more than 120 minutes in 3 cases, convincing akinesia in 18 cases (90 %). In one case, after performing regional anesthesia we have fixed a lowering in blood pressure to 60/40 mm Hg and decrease in heart rate to 37 beats per minute. Conclusions. The described stereotype in vitreoretinal surgery provided confident akinesia and optimal anesthesia for the duration of surgery and early postoperative period and also allowed minimizing decompensation of the glycemic status. Intervention in18–20 hours after hemodialysis session and correct choice of anticoagulants helped to reduce the risk of hemorrhagic complications. Key words: proliferative diabetic retinopathy; local anesthesia; hemodialysis.