Perioperative intensive therapy of patients with bladder cancer in the underdeveloped stage

Abstract

The tendency to increase the incidence of cancer occurring both in Ukraine and in the world and, accordingly, increasing the complexity and duration of surgical interventions, leads to the search for new and improved existing tactics of perioperative care in oncosurgery. The purpose of our study was to examine the relationship between the choice of anesthetic provision, the nutritional status of patients with local common metastatic bladder cancer (complicated by 46% of the major accompanying pathology) and the course of the early postoperative period. Materials, methods and results. A prospective study was conducted on the basis of the Department of Anesthesiology and Intensive Care of the National Cancer Institute (Kyiv). The study covered 46 patients operated under general inhalation anesthesia with sevoflurane in combination with intravenous fentanyl (at a dose of 2-3 мg / kg), divided into two groups. Patients in the 1st group also performed epidural analgesia, and in the early postoperative period (from the first day), parenteral nutrition was administered to a three-component mixture (proteins, carbohydrates, fat emulsions) in the order of 25 kcal/kg body weight per day. As a result of the study, it has been shown that in patients with bladder cancer there are violations of nutritional status, mainly in the form of obesity, which in the postoperative period leads to the development of insulin resistance and hyperglycemia. Conclusions. The use of multimodal analgesia on the basis of dexketoprofen and paracetamol with the epidural unit and the early onset of parenteral nutrition during radical cystectomy contribute to adequate anesthesia, stable hemodynamics, postoperative complications, early preservation of the native state, and a decrease in the duration of treatment for patients with bladder cancer in the onset stage, сomplicated by a signific ant accompanying pathology.