pmjТихоокеанский медицинский журналPacific Medical Journal1609-1175TGMU10.34215/1609-1175-2023-1-11-18pmj-2464Research ArticleОБЗОРЫREVIEWSАнестезиологические аспекты робот-ассистированных оперативных вмешательствAnesthetic aspects of robot-assisted surgery (a review)БогдановР. Р.BogdanovR. R.

г. Уфа

Ufa

https://orcid.org/0000-0003-0481-5023НуриманшинА. Ф.NurimanshinA. F.

Нуриманшин Алмаз Флюсович – врач – анестезиолог-реаниматолог отделения анестезиологии-реанимации Клиники БГМУ

450083, Уфа, ул. Шафиева, 2

Almaz F. Nurimanshin, anesthesiologist of Department of Anesthesiology and Intensive Care, Clinic of BSMU

2 Shafieva str., Ufa, 450083

almaz.nurimanshin@mail.ruХусаеноваА. А.HusaenovaA. A.

г. Уфа

Ufa

ХасановА. Р.KhasanovA. R.

г. Уфа

Ufa

Башкирский государственный медицинский университет Минздрава РоссииРоссияBashkir State Medical UniversityRussian FederationГородская клиническая больница №21РоссияCity Clinical Hospital No. 21Russian Federation202313042023011118Copyright © Богданов Р.Р., Нуриманшин А.Ф., Хусаенова А.А., Хасанов А.Р., 20232023Богданов Р.Р., Нуриманшин А.Ф., Хусаенова А.А., Хасанов А.Р.Bogdanov R.R., Nurimanshin A.F., Husaenova A.A., Khasanov A.R.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.tmj-vgmu.ru/jour/article/view/2464

Внедрение новых методов робот-ассистированных и лапароскопических оперативных вмешательств позволяет расширить показания к операциям, а с другой – породило ряд специфических проблем, связанных с техническими особенностями малоинвазивного лечения. Последнее заставляет по-новому рассмотреть влияние хирургической агрессии на пациента. Детального анализа требует влияние пневмоперитонеума и положения пациента на венозный возврат, изменения регионального кровотока и сопутствующие сдвиги некоторых гомеокинетических систем. В обзоре описаны особенности анестезиологического обеспечения робот-ассистированных оперативных вмешательств. Антифизиологическое положение на операционном столе, напряженный карбоксиперитонеум и карбокситоракс оказывают влияние на сердечно-сосудистую и дыхательную системы, функцию почек, печени, кишечника, систему свертывания крови, иммунную систему и механизмы терморегуляции, особенно у пациентов с сопутствующими заболеваниями, а время операции и анестезии требует от врача кроме знаний патофизиологии умение прогнозировать ход событий и предпринимать действия, направленные на предотвращение развития осложнений. Робот-ассистированные оперативные вмешательства, несмотря на малотравматичность, обладают рядом особенностей, которые необходимо учитывать во время подготовки пациента к операции, выбора способа оперативного вмешательства и ведения в периоперационном периоде.

The introduction of modern robot-assisted and laparoscopic methods of surgical interventions have extended the range of surgical indications, at the same time as raising a number of specific problems related to the technical features of minimally invasive treatment. This fact makes us consider the effect of surgical aggression on the patient from a new perspective. In particular, the influence of pneumoperitoneum and the patient’s position on venous return, regional blood flow changes, and concomitant shifts of some homeokinetic systems require elucidation. This article reviews the available literature to describe the main features of anesthesia during robot-assisted surgical interventions. Recommendations from systematic reviews and meta-analyses were used. The search depth comprised the period of 12 years (2011–2022). Such factors as antiphysiological position on the operating table, tense carboxyperitoneum, and carboxythorax affect almost all organs and many regulatory mechanisms, thus having a pathological effect on the cardiovascular and respiratory systems, kidney, liver, intestines, blood coagulation system, immune system, and thermoregulation mechanisms. These effects are particularly pronounced in patients with concomitant diseases. In addition to knowledge in the field of pathophysiology, surgeons should be capable of predicting the course of events to take actions aimed at preventing the development of complications. Robot-assisted surgical interventions, although being less traumatic, are characterized by specific features that should be taken into account when preparing a patient to undergo surgery, selecting an optimal method of surgical intervention, and managing the patient in the intra- and postoperative period with rehabilitation.

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The authors declare that there are no conflicts of interest present.