USE OF COMBINED SPINAL-EPIDURAL ANESTHESIA IN SIMULTANEOUS GYNECOLOGICAL OPERATIONS

Purpose: To study the possibility of using and evaluating the effectiveness of combined spinal- epidural anesthesia in simultaneous gynecological surgeries. Methods:75 patients who underwent combined spinal-epidural anesthesia during simultaneous gynecological surgeries were studied. This study was conducted at the Multidisciplinary Clinic of Samarkand State Medical University, Uzbekistan, between 2020 and 2022. The CSEA was analyzed and compared with multicomponent general anesthesia. During the operation, the indices of central and peripheral hemodynamics were controlled by intraoperative monitoring: ECG, Sp02, pulse and BP (cardiac monitor "EDAN elteV6", Germany). The reaction of the sympathoadrenal system was estimated using the urinary norepinephrine excretion rate (immunoassay method, reagent #RE59261)[7]. The response of the hypothalamic-pituitary-adrenocortical system was evaluated by the level of cortisol in the blood serum by enzyme immunoassay using the reagent kit "Steroid ELISA-Cortisol -01" (norm = 150-660 nmol/mol). The level of glycemia was measured by the glucose oxide method using the "Photoglucose 2/4" reagent kit (norm=3.3-6.6 mmol/L). Results: The obtained data indicate that the application of the CSEA provides a reliable autonomic block, anti-stress protection, and preservation of compensatory-adaptive hemodynamic reactivity. The study of changes in hemodynamic indices revealed that at the beginning of the operation in the patients in the main group, the stroke volume (SV) significantly increased by 15% against the background of the decrease in the total peripheral vascular resistance (TPR) by 21%, while the cardiac output (CO) did not change significantly. There were no signs of depression in external respiratory function and no significant changes in SpO2 during the entire course of anesthesia. The absence of significant changes in norepinephrine, cortisol, and glucose levels confirms the efficacy of antinociceptive protection in CSEA, since segmental blockade is known to interrupt the development of excitation processes in the neurons of the posterior horns of the spinal cord at the initial part of the conductive pathways. Conclusions: The use of combined spinal-epidural anesthesia (CSEA) has a pronounced protective effect against surgical trauma and associated adverse neurohumoral, hemodynamic, and biochemical changes. Prolonged epidural analgesia effectively provides postoperative analgesia for simultaneous gynecological surgeries as well as creates conditions for the early activation of patients, preventing the development of postoperative complications