Optimization of anesthetic management of surgical treatment of colorectal cancer. Part II: morphological aspects.

• Main Authors: S. P. Novikov, L. A. Kirillova, N. S. Petruk, K. B. Frolov, I. V. Tverdokhleb
• Format: Article
• Language: Russian
• Published: Ministry of Health of Ukraine. Dnipropetrovsk Medical Academy 2016-06-01
• Series: Морфологія
• Subjects: колоректальний рак; низкопоточна анестезія; комбінована анестезія; електронна мікроскопія
• Online Access: http://morphology.dma.dp.ua/article/view/139640

Background. Interest in the study of the properties of sevoflurane, increased in recent years due to its influence on hemodynamics and morphological condition of the respiratory department of lungs, causes advisability of analyzing the structure of organs directly involved in the reactions of radical surgery for colorectal cancer. Objective. The purpose of the study is comparative analysis of tissue and cell ultrastructure in intraoperative biopsies of the colon in the conditions of application of the standard ataralgesia and combined anesthesia with epidural analgesia. Methods. It was performed a comparative analysis of morphological data of the colon using total intravenous anesthesia followed analgesia with opiates analgesics, and combined techniques using low-flow sevoflurane anesthesia and epidural analgesia, followed by prolonged epidural anesthesia. Results. The central link in the development of pathological changes in the colon wall at anesthesiology maintenance of surgical interventions in the treatment of colorectal cancer is the system of microcirculation. In carrying out radical intervention on the background of the standard total ataralgesia distrophic and destructive changes of endothelial cells organelles cause endothelial dysfunction expressed in microvessels and tissue displays considerable microcirculatory disorders apply to all shell wall of the colon near the affected area of colorectal. Combined low-flow sevoflurane inhalation anesthesia and epidural analgesia with bupivacaine during radical operations followed by containment of endothelial dysfunction by limiting the destructive and degenerative changes in the endothelial cell organelles, stabilization of membranes, preventing spasm of arterioles, stasis and erythrocyte sludge. Conclusion. Methods of epidural analgesia versus opioid analgesia leads to a significant reduction of the phenomena of infiltration, perivascular and interstitial edema in the composition of the intestinal wall in the area of surgical procedure.