GENETIC DETERMINATION OF POSTOPERATIVE INTESTINAL PARESIS IN THE BACKGROUND OF PERITONITIS

Postoperative intestinal paresis remains an urgent problem of abdominal surgery, since it is one of the most common postoperative complications in terms of frequency. In most studies, the violation of the motor function of the intestine after surgery on the hollow organs of the digestive system is considered as a pathological process, is a consequence of postoperative peritonitis. The paper presents data on the relationship between the variants of the SERT gene, which regulates the reuptake of serotonin, with the concentration in the blood plasma and the likelihood of postoperative intestinal paresis and peritonitis. This made it possible not only to predict the occurrence of postoperative disorders of the motor-evacuation function of the intestine, but also to improve the algorithms for their prevention and pathogenetically justified treatment. It has been established that it is with the SS-genotype that postoperative disorders of the motor-evacuation function of the intestine occur more often, which lead to peritonitis. This leads to a change in treatment tactics in such patients. If these unfavorable genotype variants are found for surgery in such patients, we consider it expedient to expand the indications for intestinal intubation even without intraoperative manifestations of its paresis. We have proposed a technique in which nasointestinal intubation of the small intestine is first performed, which is necessary for the main stage of the operation. If it is necessary to withdraw the stoma, the indications for which in patients with unfavorable genotype variants are considered appropriate to expand, the intubation probe is cut off at the first opening, which is placed in the stomach, and the other end is withdrawn through the stoma. This greatly simplifies the technique of bowel intubation, avoids various complications associated with retrograde intubation, and, first of all, wound infection. Studies indicate a high risk of developing postoperative peritonitis in surgical patients who, after surgical interventions on the digestive organs, had pronounced disorders of the motor-evacuation function of the intestine. Improved algorithms for the treatment of such patients make it possible to significantly reduce the risk of developing postoperative intestinal paresis and peritonitis, and, if they occur, to effectively eliminate their manifestations.

Preoperative retrograde reintubation during partial tracheal resection and anastomosis in a cat with severe tracheal stenosis

A seven-month-old European shorthair cat was presented with dyspnoea and expiratory stridor due to a severe obstructive tracheal stenosis. Surgical resection of the stenotic area and anastomosis of the remaining parts of the trachea were performed. The anaesthetic management of a patient during tracheal resection is an anaesthetic challenge. Total intravenous anaesthesia with propofol and a continuous rate infusion of fentanyl were chosen to maintain a surgical anaesthetic depth and to ensure pain control. Endotracheal extubation was necessary at a specific time during the surgical procedure. However, subsequent oral reintubation was complicated, due to patient positioning and the presence of laryngeal spasms. Reintubation was only successful by means of a modified retrograde intubation technique. Recovery was satisfactory and uneventful.

Practical procedures

The final chapter provides instructions for practical procedures which support advice given in other sections. Techniques for managing difficult airways are explored including front of neck access (by surgical or needle cricothyroidotomy), intubating laryngeal mask insertion, awake fibreoptic intubation, lightwand-assisted airway management, and retrograde intubation. Meanwhile, techniques for chest drain insertion and one-lung ventilation are described. Methods of administering bronchodilators by in-circuit nebulization or metered dose inhaler are offered. Advanced access techniques for the circulation are also presented, including internal jugular catheters, femoral vein catheters, intraosseous needle insertion, and venous cut-down. Pacing is discussed within the contexts of initiating new pacing (internal and external) and providing anaesthesia for patients with pre-existing implantable pacing systems and cardioverter defibrillators. A final section gives guidance on transferring critically ill patients.

Retrograde fiberoptic intubation

This technical note aims to introduce a new approach for intubation of patients with restricted mouth opening in cases that conventional and fiberoptic-assisted endotracheal intubation are not possible. The proposed technique is a modification to the previously well-established retrograde intubation method. The main advantage of this new technique is the employment of fiberscope for direct visualization which eliminates the use of guide wire. The endotracheal tube enters through the nostril and is railroaded using the fiberscope as a guide. Using this new technique can prevent the complications of tracheostomy and the traditional retrograde intubation in patients that anterograde intubation is not feasible. The promising result of conducting the intubation with this approach can be considered the basis for future clinical investigation.