Application of accelerated activation in retroperitoneal video endoscopic adrenalectomy for cushing syndrome

Abstract

Purpose. To improve the immediate results of surgical treatment of endogenous hypercorticism through optimizing the perioperative management of patients using accelerated rehabilitation protocols. Materials and methods. A randomized prospective study of 53 patients with a body mass index >35 kg/m2 was carried out. In the control group (n=27), TIVA based on propofol was used with postoperative analgesia by systemic administration of opioids. In the accelerated rehabilitation protocol group (n=26), we used anesthesia based on low-flow inhalation of desflurane with sympatholytic mixture infusion in intra- and postoperative periods, multimodal postoperative analgesia, and use of accelerated rehabilitation protocol in the perioperative period. The time of patients' achievement of BIS>90 index, time of extubation, time of achievement of 10 points by the Aldrete scale and 0 points by the Bidway test, duration of stay in the in-patient hospital, number of postoperative complications were assessed. Effectiveness of analgesia was evaluated by the time of the first analgesia requirement, consumption of narcotic analgesic, VAS and Verbal Descriptor scale. Results. The study revealed that the time of awakening and reaching 10 points by the Aldrete scale in patients of group 2 was significantly shorter than in group 1: 3 (2; 6) and 6.5 (3.5; 9) min respectively (P=0.046). They had fewer postoperative complications, shorter hospitalization time — 58 (39; 71) hours compared to the control group with 74.5 (58.5; 87) hours (P=0.032). Conclusion. Perioperative management of obese patients after retroperitoneal video endoscopic adrenalectomy with the use of accelerated rehabilitation protocols contributed to earlier mobilization, reduction of the number of complications in the early postoperative period, reduction of the duration of stay in the in-patient hospital, which together facilitates improving the immediate results of surgical treatment of endogenous hypercorticism.