Advantages of epidural anesthesia in urological practice
Introduction. The safety of anesthetic management in endovascular surgery for cancer and prostate adenoma is an important factor for the successful surgery and postoperative period. The purpose of this study is the comparative study of perioperative hemodynamicchanges and the probability of developing postoperative cognitive dysfunction in the surgical treatment of prostate cancer and BPH using laparoscopic radical prostatectomy and laparoscopic adenomectomy, respectively, under conditions of general endotracheal and epidural anesthesia. The research method was the analysis of perioperative changes in central hemodynamics and the results of neuropsychological testing during the prostate cancer and BPH treatment using laparoscopic surgery in 166 patients of the St. Petersburg State Budgetary Healthcare Institution Clinical Hospital of St. Luke. Results. A key negative consequence of general endotracheal anesthesia and carboxyperitoneum in laparoscopic interventions is stroke volume decrease, that leads to myocardial ischemia, total peripheral vascular resistance and blood pressure increase - factors that form pressure overload and le ventricular heart failure. Hemodynamic instability, as well as the neurotoxic effects of general anesthetics, can cause postoperative cognitive deficits. Conclusion. The use of epidural anesthesia in the considered situations allows to increase the safety degree of surgical interventions in urology due to, first of all, preventing marked disorders in central hemodynamics through blocking autonomic effects on the vascular walls, reducing TPR (total peripheral resistance) and increasing venous return to the right heart departments, and the absence of pharmacological suppression of myocardial contractility. Secondly owing to the reduction of postoperative cognitive dysfunction probability in conditions with stable hemodynamics and the absence of neurotoxic effects of general anesthetics. Key words: laparoscopic radical prostatectomy, laparoscopic adenomectomy, general endotracheal anesthesia, decrease in stroke volume of the heart, increase in total peripheral vascular resistance, postoperative cognitive dysfunction, epidural anesthesia.