Diagnostics and treatment of abdominal complications after gynecological endoscopic operations

The objective: to analyze the results of repeated laparoscopy in gynecological patients with suspected intraperitoneal postoperative complications.Materials and methods. The study involved 42 patients (mean age 46±11,3 years), in whom postoperative abdominal complications after surgical treatment of various gynecological diseases required repeated operations. Depending on the method of re-intervention, the patients were divided into 2 groups: the main group (n=20) – women who only used laparoscopy to correct postoperative complications; control (n=22) – women who were given indications for relaparotomy to correct postoperative complications during diagnostic laparoscopy. Relaparotomy was performed in 8 patients of the control group. All patients underwent a comprehensive examination using clinical, instrumental and laboratory research methods. The groups were homogeneous in terms of age and structure of operations performed on the pelvic organs, and statistically comparable.Results. During the study, the results of repeated laparoscopy of 34 gynecological patients with suspected intraperitoneal postoperative complications were analyzed. In all patients of the main group (47,6%), laparoscopy was revealed as the only and final method of treatment of postoperative complications, while in 7 women repeated relaparoscopy was used from 2 to 4 times, and in 13 women laparoscopy was performed once. In the control group (53,3%), 10 patients during diagnostic laparoscopy were exposed to indications for relaparotomy, in 4 patients the capabilities of the operating team and laparoscopic technique allowed performing some elements of the operation and completing it with a minilaparotomy approach, and 8 patients underwent relaparotomy immediately.Peritonitis and intraperitoneal bleeding prevail in the structure of early abdominal complications. The use of the video laparoscopic technique made it possible in 28,6% of patients with diffuse peritonitis to successfully eliminate the developed complication, eliminate its source and sanitize the abdominal cavity. Laparoscopic hemostasis was successfully performed in 7 patients.Compared with the standard, the use of video endoscopic technique allowed improving the indicators of diagnostic value: to increase the sensitivity level by 1,07 times, specificity by 1,39 times and diagnostic accuracy by 1,11 times.Conclusion. In general, in the early postoperative period, 47 relaparoscopies were performed for suspected complications, which is explained by programmed abdominal sanitization and the use of dynamic laparoscopy to control the course of intraperitoneal complications. Based on the analysis of the material under study, we proposed general indications and contraindications for relaparoscopy in the early postoperative period in order to diagnose and treat postoperative complications. Justifying each of the points, we were guided by the real possibilities of the method in general clinical practice, which in some cases are inferior in their effectiveness to relaparotomy.

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Clinical justification of the device for the prevention of post-operating eventration

Clinical anatomy and operative surgery ◽

10.24061/1727-0847.19.1.2020.13 ◽

2020 ◽

Vol 19 (1) ◽

pp. 78-83

Author(s):

I. K. Morar

Keyword(s):

Postoperative Complications ◽

Postoperative Period ◽

Malignant Tumors ◽

Abdominal Cavity ◽

Surgical Techniques ◽

Early Postoperative Period ◽

Main Group ◽

Abdominal Pressure ◽

Non Invasive ◽

Significant Difference

Postoperative surgery is one of the most dangerous complications, especially in patients with malignant tumors of the abdominal cavity, where secondary immunodeficiency, cachexia, anemia, etc. occur. Today, there are many ways to prevent postoperative surgery in patients at high risk for this complication, but all of them, along with their advantages, have a number of disadvantages that greatly limit their use. Developing an effective, non-invasive device for preventing postoperative surgery may to some extent solve this problem. The purpose of the study is to substantiate the effectiveness of the device for the prevention of postoperative events, by studying the frequency of development of postoperative complications in patients with malignant tumors of the abdominal organs. Material and methods. We have proposed a device for the prevention of postoperative surgery, the use of which does not require additional surgical techniques during surgery, and also allows the use of the latter in the event of the incomplete (subcutaneous) event (patent No. 120209 from 25.10.2017). The device consists of 5 soft plates lined with soft cloth and connected to each other by the widest parts. The central plate is adjustable depending on the width of the back surface of the patient's torso. The two side plates at the free edges have 11 lacing loops. To substantiate the effectiveness of the use of this device, we investigated 107 operated patients with malignant tumors of the abdominal cavity. The comparison group consisted of 60 people who did not use the proposed device. The main group consisted of 47 patients who used the above device in the early postoperative period. Results of the study and their discussion. The results obtained indicate a significant predominance of the incidence of postoperative events in patients in the main group. It should be noted that there is no significant difference in the frequency of development of "systemic" and other "local" postoperative complications between the two study groups of patients, which indicates the representativeness of the sample since "local" postoperative complications lead to the development of eventration. Patients in the main group, starting from day 2 after surgery, had a markedly lower intra-abdominal pressure during the first 12 days of the early postoperative period. Conclusion. The use of the proposed device for the prevention of postoperative surgery allows a non-invasive way to prevent the development of the latter, as well as the occurrence of the incomplete event to prevent the development of full, without significantly affecting the level of intra-abdominal pressure, compared with conventional use of the bandage.

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METHOD OF STOMA FORMATION IN PATIENTS WITH ACUTE INTESTINAL OBSTRUCTION

Ulyanovsk Medico-biological Journal ◽

10.34014/2227-1848-2021-1-98-104 ◽

2021 ◽

pp. 98-104

Author(s):

A.L. Charyshkin ◽

E.A. Keshyan

Keyword(s):

Intestinal Obstruction ◽

Postoperative Period ◽

Comparison Group ◽

Abdominal Cavity ◽

Early Postoperative Period ◽

Main Group ◽

Acute Intestinal Obstruction ◽

Control Group ◽

Drain Tube ◽

Stoma Formation

Surgery is the main method to treat obstructive intestinal obstruction. Stoma formation is desirable in emergency colon surgery. The aim of the study was to compare the results of the newly developed and traditional stoma formation techniques according to the number of wound purulent-inflammatory complications in the early postoperative period in patients with acute intestinal obstruction. Materials and Methods. The authors examined 62 patients with acute intestinal obstruction. The patients were divided into two groups according to the method of stoma formation. The comparison group consisted of 30 patients, who underwent traditional colostomy after obstructive resection of the sigmoid colon (rectosigmoid part of the colon). The main group included 32 patients in whom a stoma was formed using a newly developed method (patent No. 2704477). In patients of the main group, the paracolostomy space was isolated from the abdominal cavity, the preperitoneal and subgaleurotic zones of the paracolostomy space were drained. During the postoperative period local anesthetics and antibacterial drugs were administered through the drain tube. Results. Patients of the comparison group demonstrated more purulent-inflammatory complications of the median postoperative and paracolostomy wounds than those of the control group, 20.2 % (p=0.047) and 23.6 % (p=0.024), respectively. Conclusion. The proposed method of stoma formation helps to reduce wound purulent-inflammatory complications and can be used in the surgical treatment of patients with intestinal obstruction. Keywords: colon cancer, acute intestinal obstruction, postoperative complications, new method of stoma formation. Основным методом лечения обтурационной кишечной непроходимости является оперативное вмешательство. В экстренной хирургии толстого кишечника показано формирование колостомы. Цель исследования – сравнение результатов применения разработанной и традиционной методик наложения колостомы по количеству раневых гнойно-воспалительных осложнений в раннем послеоперационном периоде у больных с острой обтурационной кишечной непроходимостью. Материалы и методы. Клинический материал составили 62 пациента с острой обтурационной кишечной непроходимостью, которые в зависимости от способа формирования колостомы были разделены на две группы. Группу сравнения составили 30 больных, у которых после обструктивной резекции сигмовидной кишки (ректосигмоидного отдела ободочной кишки) выполняли традиционное наложение колостомы. В основную группу были включены 32 пациента, у которых колостома наложена разработанным способом (патент № 2704477). Суть способа состоит в изоляции от брюшной полости параколостомического пространства, дренировании предбрюшинной и подапоневротической зоны параколостомического пространства, введении местных анестетиков, антибактериальных препаратов по дренажу в послеоперационном периоде. Результаты. В группе сравнения гнойно-воспалительных осложнений срединной послеоперационной и параколостомической ран было больше, чем в контрольной группе, на 20,2 % (р=0,047) и 23,6 % (р=0,024) соответственно. Выводы. Предложенный способ формирования колостомы способствует снижению раневых гнойно-воспалительных осложнений и может быть использован в хирургическом лечении больных с обтурационной кишечной непроходимостью. Ключевые слова: рак ободочной кишки, острая обтурационная кишечная непроходимость, послеоперационные осложнения, оригинальный способ формирования колостомы.

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Preoperative Preparation of Patients with Anemia before Shoulder Replacement

Messenger of Anesthesiology and Resuscitation ◽

10.21292/2078-5658-2021-18-3-53-57 ◽

2021 ◽

Vol 18 (3) ◽

pp. 53-57

Author(s):

S. V. Sokolov ◽

V. А. Gluschenko

Keyword(s):

Postoperative Period ◽

Recombinant Human Erythropoietin ◽

Early Postoperative Period ◽

Main Group ◽

Hemoglobin Level ◽

Control Group ◽

Preoperative Preparation ◽

Shoulder Replacement ◽

Preoperative Anemia ◽

Human Erythropoietin

The preoperative anemia in patients increases the risk of perioperative blood transfusion, myocardial infarction, ischemic stroke, acute kidney injury, and higher nosocomial and 30-day mortality, lengthens the duration of treatment, and increases the risk of re-hospitalization.The objective: to improve treatment results of patients after revision shoulder replacement through management of preoperative anemia.Subjects and methods. 170 medical files of patients who underwent revision shoulder replacement from 2014 to 2021 were retrospectively analyzed. On the day when they were examined by the physician, all patients had blood hemoglobin level below 130 g/l. The patients were divided into two groups that were comparable in their characteristics. Patients of the Main Group (n = 90) received preoperative preparation with iron carboxymaltate in combination with recombinant human erythropoietin 4 weeks before the expected date of surgery. Patients of the Control Group (n = 80) did not have any specific preparation.Results. The data obtained showed that the volume of intraoperative and postoperative drainage blood loss did not differ statistically between the groups; hemoglobin blood level in patients from the Main Group was statistically significantly higher both before the surgery and on the first day after it, and no hemotransfusion was indicated. In the Control Group, a statistically significantly greater decrease in hemoglobin level was observed in the postoperative period; 3 (3.8%) patients in the Control Group required RBC-transfusion. Complications in the early postoperative period (myocardial infarction, pulmonary embolism, and cardiac arrhythmia) were significantly less frequent in the Main Group versus the Control one (4.5% of cases vs. 8.8%; p < 0.05).Conclusion. The use of iron carboxymaltate at the dose of 1,000 mg once and, if necessary, repeatedly in 14 days in combination with recombinant human erythropoietin at the dose of 150 IU/kg allows preparing patients for revision shoulder replacement within the period from two weeks to one month. Preoperative management of anemia until the hemoglobin concentration reaches 130 g/l using the proposed regimen can significantly reduce the need for blood transfusion and frequency of somatic complications in the early postoperative period.

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Do We Have a Place for Non-Steroidal Anti-Inflammatory Drugs in Corneal Refractive Surgery?

Ophthalmology in Russia ◽

10.18008/1816-5095-2021-3-539-545 ◽

2021 ◽

Vol 18 (3) ◽

pp. 539-545

Author(s):

N. V. Maychuk ◽

I. A. Mushkova ◽

M. R. Obraztsova

Keyword(s):

Postoperative Period ◽

Analgesic Effect ◽

Refractive Surgery ◽

State Institution ◽

Early Postoperative Period ◽

Main Group ◽

Federal State ◽

Control Group ◽

Wide Range ◽

Corneal Refractive Surgery

Relevance. Corneal refractive surgery is a modern, dynamically developing segment of ophthalmology that provides highly predictable, safe and stable refractive results in patients with a wide range of ametropias. Corneal refractive surgery, usually is chosen by patients who lead an active lifestyle and need rapid medical and social rehabilitation, people with high requirements for the quality of life and showing increased expectations for the result of correction. Perhaps this is due to the fact that, according to a survey at the exit of the Department of refractive laser Surgery of the S.N. Fyodorov Eye Microsurgery Federal State Institution of the Russian Ministry of Health, Moscow, conducted after consulting a surgeon with a description of the course of the operation and the postoperative course, about 1 % of patients refuse surgery, fearing painful sensations in the postoperative period, and 23.4 % of the expected postoperative discomfort causes strong concerns.Purpose. To study the clinical efficacy and safety of Broxinac (0.09 % bromfenac solution) in the early postoperative period of corneal refractive surgery.Materials and methods. The study included 168 patients (168 eyes) with moderate and high myopia after PRK (24 eyes), FemtoLASIK (78 eyes) and ReLEx SMILE (66 eyes), divided into equal subgroups: in the main group, Broxinac was instilled once 30 minutes after the operation, and in the control group — placebo. In the PRK subgroup of the main group, daily instillations of Broxinac were continued until complete reepithelization. The severity of the indicators “eye pain”, “photophobia”, “lacrimation”, “foreign body sensation” was evaluated on a five-point scale, the state of the corneal epithelium when stained with fluorescein, and overall satisfaction with the operation.Results and discussion. It is established that the analgesic effect occurred on average after 4.4 ± 0.6 minutes. Broxinac had a rapid, pronounced analgesic effect in patients in the early postoperative period after keratorefractive surgery, without slowing of corneal reepithelization, and can be recommended for use in clinical practice for analgesia and relief of aseptic inflammatory reaction in the early postoperative period after FemtoLASIK and PRK. The ReLEx SMILE does not require pain relief.Conclusion. Analgesia of the early postoperative period increases patient satisfaction with the result of the operation, popularizes it and helps to attract patients who previously refused surgical correction of ametropia due to fear of painful sensations.

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Experience in the use of physical factors during the recovery of the renal parenchyma after percutaneous nephroscopy

Fizioterapevt (Physiotherapist) ◽

10.33920/med-14-2108-07 ◽

2021 ◽

pp. 68-71

Author(s):

V. N. Gornostaev ◽

R. A. Gurtskoy ◽

V. V. Shulzhenko

Keyword(s):

Postoperative Period ◽

Recovery Period ◽

Polarized Light ◽

Early Postoperative Period ◽

Main Group ◽

Renal Parenchyma ◽

Control Group ◽

Physical Factors ◽

Ozone Therapy ◽

Combined Use

The article reflects the results of the use of physical factors to restore the renal parenchyma in the early postoperative period after percutaneous nephroscopy in patients with urolithiasis. Material and methods: the study included 80patients with concretions of the renal pelvis after percutaneous nephroscopy (45men and 35women, average age — 46 years), who were divided into 2 comparable groups: groupI (main group) — 40 patients who underwent intravenous laser blood irradiation (ILBI) and ozone therapy — 6 procedures in the preoperative period, and polarized light and ILBI — 6 procedures in the early postoperative period; groupII (control group), which served as a background in the main group, were prescribed non-steroidal anti-inflammatory drugs after the surgery, taking into account bacterial urine culture. Inclusion criteria: patients with urolithiasis aged 28 to 62 years; indications for percutaneous nephroscopy. Exclusion criteria: concomitant diseases; compliance; pregnancy; acute inflammatory kidney diseases; abnormalities of the upper urinary tract. Results: The combined use of ILBI, ozone therapy and polarized light in the pre- and early postoperative period in patients with urolithiasis after percutaneous nephrolithotripsy allowed improving clinical, laboratory, subjective and objective indicators, as well as shortening the recovery period of the renal parenchyma, which was confirmed by the data of ultrasound studies in the dynamics in the form of a significant reduction in the recovery period of the index of renal vessels resistance and reduction of edema of the renal parenchyma. As a result of the application of the developed complex, the total bed-day of patients’ stay in the hospital decreased, and there was a rapid recovery of capacity to work. Conclusion: The developed method of the combined use of ILBI, ozone therapy and polarized light in the pre- and early postoperative period in patients with urolithiasis after percutaneous nephrolithiasis is pathogenetically justified and highly effective, which allows us to recommend it for wide use in urological practice.

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Comparative analysis of the results of computerized phonoenterography in patients with acute destructive appendicitis before surgery and in the postoperative period

I P Pavlov Russian Medical Biological Herald ◽

10.23888/pavlovj20173469-475 ◽

2017 ◽

Vol 25 (3) ◽

pp. 469-475

Author(s):

K. V. Philippova ◽

O. V. Zaitsev

Keyword(s):

Abdominal Pain ◽

Comparative Analysis ◽

Acute Appendicitis ◽

Postoperative Period ◽

Spectral Power ◽

Abdominal Cavity ◽

Pain Syndrome ◽

Acoustic Signals ◽

Early Postoperative Period ◽

Control Group

Using the method of computerized phonoenterography we made an analysis of motor-evacuation function of the gastrointestinal tract in 35 patients with acute destructive appendicitis before surgery and in the postoperative period and in 30 patients without abdominal pain syndrome and concomitant pathology of the organs of the abdominal cavity. The obtained results of computerized phonoenterography different in the group of patients with acute appendicitis before appendectomy in comparison with group of patients without acute abdominal pathology (control group). For patients after appendectomy statistically significant differences with the control group in the vast majority of bands wasn’t obtained. Given the fact that the densities of the spectral power of acoustic signals of the abdominal cavity to assess the motor-evacuation function of the intestine in these groups of patients, we showed a reduction of motor-evacuation function of the intestine in patients with acute destructive appendicitis before surgery in comparison with patients of control group and recover in the postoperative period. Thus, the method of computerized phonoenterography is advisable to apply for the diagnosis of lower motor function of the intestine in patients with acute appendicitis, and in the early postoperative period in patients with acute destructive appendicitis for monitoring recovery of intestinal motility.

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The effectiveness of piribedil for the treatment of cognitive disorders in patients with coronary heart disease: results of six-month observation

Clinical Medicine (Russian Journal) ◽

10.18821/0023-2149-2017-95-5-445-450 ◽

2017 ◽

Vol 95 (5) ◽

pp. 445-450

Author(s):

M. M. Petrova ◽

S. V. Prokopenko ◽

O. V. Eremina ◽

E. Yu. Mozhejko ◽

D. S. Kaskaeva ◽

...

Keyword(s):

Heart Disease ◽

Postoperative Period ◽

Bypass Surgery ◽

Cognitive Disorders ◽

Early Postoperative Period ◽

Main Group ◽

Control Group ◽

Psychomotor Activity ◽

Cognitive Deficiency ◽

Heart Bypass

Aim. The detection of cognitive deficiency after heart bypass surgery, the evaluation of the influence of piribedil on the higher cerebral function in the early postoperative period during the follow-up. Materials and methods. 64 patients with ischemic heart disease were examined. They were divided into two groups. Patients of the main group (n=32) were treated with pronoran (piribedil) at a daily dose of 50 mg for 3 months. 32 patients of the control group received standard therapy in the postoperative period. All patients had undergone heart bypass surgery. Cognitive functions were examined before operation, 10 days , three and six months after surgery. Results. Positive dynamics of all tested parameters was documented in the patients of the main group within 6 months after the onset of therapy. In control patients, cognitive disorders remained at the preoperative level based on the results of three tests. Conclusion. The positive results of piribedil therapy suggest that piribedil has positive effect on memory, attention and psychomotor activity of the patients

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Immediate and long-term results of treatment of abdominal complications after gynecological operations using endoscopic technologies

Reproductive health of woman ◽

10.30841/2708-8731.2.2021.232518 ◽

2021 ◽

Vol 2 ◽

pp. 22-26

Author(s):

V.I. Boyko ◽

V.A. Terekhov

Keyword(s):

Postoperative Complications ◽

Inpatient Treatment ◽

Average Duration ◽

Early Postoperative Period ◽

Long Term Results ◽

Control Group ◽

Abdominal Complications ◽

Pelvic Organs ◽

Group I

The objective: to give a comparative assessment of the immediate and long-term results of laparoscopic treatment of postoperative abdominal complications in patients with gynecological pathology.Materials and methods. We carried out a comparative study of the immediate results after repeated laparoscopies and relaparotomies in gynecological patients with postoperative intra-abdominal complications, during which 2 clinical groups of patients were identified. Group I (main) consisted of 62 patients (50,82%) with early postoperative complications who underwent video endoscopic interventions. Group II (control) included 60 (49,18%) patients who underwent traditional «open» laparotomy. The criteria for the course of the early postoperative period were chosen traditionally. At the same time, it was taken into account that after the repeated interventions, the patients of both the main and the control groups received similar intensive therapy aimed at correcting the main symptom complex of the disease.All patients were comprehensively examined using clinical, instrumental and laboratory research methods. The groups were homogeneous in age and structure of operations performed on the pelvic organs, and were statistically comparable.Long-term results were studied among 28 (45,1%) patients of the main group and 21 women from the comparison group (35%) in terms of one to five years after gynecological intervention.Results. In the patients of the control group, the pain syndrome persisted statistically significantly longer and required prescription of anesthetic drugs on average 2 days more. The use of laparoscopy in the treatment of postoperative complications most often (51,7%) made it possible to refuse analgesics, and non-steroidal anti-inflammatory drugs were used on demand only in the first 2–3 days. The average duration of inpatient treatment for patients of group I with postoperative intra-abdominal gynecological complications averaged 10±2,5 days versus 16±2,9 in II (control) (p>0,05). The average duration of inpatient treatment after open surgery was on average 6±1,9 days longer (p<0,05).Long-term results were assessed using a three-point system (the result is good, satisfactory, unsatisfactory) based on the data of clinical and instrumental examination. Good long-term results were found in 13 (46,4%) patients of the main group and in 6 (28,5%) patients from the control group. Satisfactory results in group I were found in 13 (46,4%) patients, in group II – in 13, which amounted to 61,9%. In 2 patients, the results were found unsatisfactory after relaparoscopic manipulations (7,2%), and in 2 (9,5%) – after relaparotomy. One patient, due to frequent, recurrent cramping pains, was operated on as planned (abdominal adhesions were dissected).The study revealed a direct relationship during the early postoperative period and long-term results in women operated traditionally and with the use of laparoscopy. Based on the study of the results of surgical treatment of early postoperative intraperitoneal complications, the high efficiency of the video-laparoscopic method was proved in comparison with the traditional one. Thus, the implementation of the proposed treatment tactics can significantly improve the quality of life of this category of patients. The study of long-term results of laparoscopic operations has shown that the use of diagnostic methods of surgical techniques in the practice of medical institutions will contribute to the improvement of the results of complex treatment of sick women with pathology of the pelvic organs.

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Stimulation of kidneys’ adaptive capabilities in patients with urolithiasis

Urologicheskie vedomosti ◽

10.17816/uroved9313-20 ◽

2019 ◽

Vol 9 (3) ◽

pp. 13-20

Author(s):

Olga S. Streltsova ◽

Dmitry P. Pochtin ◽

Tatiana A. Gorbunova ◽

Valery F. Lazukin ◽

Ilya L. Sidnev

Keyword(s):

Cystatin C ◽

Postoperative Period ◽

Significant Risk ◽

Early Postoperative Period ◽

Main Group ◽

Control Group ◽

Surgical Trauma ◽

Operative Trauma ◽

Adaptive Capabilities ◽

Inflammatory Changes

Inflammatory changes in the kidney that occurred in the early postoperative period due to surgical trauma, deterioration of microcirculation, hypoxia, are significant risk factors for the development of renal function violation. The aim of this work is to study the effect of the combined drug Uriclar (Asfarma-Ros) on the kidneys adaptive capability in the early postoperative period as a response to operative trauma of patients with complicated urolithiasis. The effect of surgical intervention percutaneous puncture nephrolithotripsy on the blood content of proteins of the acute phase of inflammation and cystatin C was studied. The results of examination of 35 patients (20 the main group and 15 the control group) were analyzed. The median age was 51 8.4 years. 20 patients of the main group began receiving Uriclar 2 capsules (430 mg) twice a day for 5 days before surgery and continued it for 1 month after surgery. Patients from the control group in the pre- and postoperative periods didnt receive Uriclar. The median age was 51 8.4 years. There was a statistically significant increase in the level of cystatin C and changes in biochemical markers in the patients of the main group only that indicates the presence of adaptogenic effect of Uriclar. Thus, the inclusion of a combined drug Uriclar in a complex treatment of patients with urolithiasis allows disturbed biological and adaptive functions of the kidneys to be corrected in the early postoperative period.

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Comparative analysis of the results of cochlear implantation under general and local anesthesiain patients with comorbid pathology

Consilium Medicum ◽

10.26442/20751753.2021.3.200603 ◽

2021 ◽

Vol 23 (3) ◽

pp. 250-255

Author(s):

Khassan M.A. Diab ◽

◽

Khassan M.A. Diab ◽

Nikolai A. Daikhes ◽

...

Keyword(s):

Hearing Loss ◽

Comparative Analysis ◽

General Anesthesia ◽

Local Anesthesia ◽

Postoperative Period ◽

Cochlear Implantation ◽

Early Postoperative Period ◽

Main Group ◽

Control Group ◽

Fourth Degree

The article is devoted to an urgent problem – the correction of hearing impairment in patients with concomitant diseases. The results of a comparative analysis of data from patients with somatic diseases who underwent cochlear implantation (CI) for severe to profound hearing loss hearing loss of the fourth degree and deafness under local and general anesthesia are presented. Materials and methods. On the basis of the National Medical Research Center for Otorhinolaryngology of the Federal Medical-Biological Agency of Russia, CI was performed under local anesthesia for 10 patients with concomitant diseases, which represented difficulties for the use of general anesthesia (main group). All patients in the preoperative stage precisely informed about each stage of the surgery and with the cue-cards (with questions) to maintain contact with them during CI. The control group consisted of 10 patients who underwent CI under general anesthesia. CI was performed according to a standard technique. After the operation, a survey of patients of both groups about subjective sensations during the operation and in the early postoperative period was carried out. Results. CI under local anesthesia takes an average of 18±5.2 min, taking into account the time of anesthesia, which is 15±5.3 min less than with general anesthesia (p<0.001). When performing CI under local anesthesia, clear thresholds for recording acoustic reflexes stapedial muscle are determined, since in this case the effect of muscle relaxants is excluded. Against the background of local anesthesia, the necessary effect was achieved rather quickly, there was no increase in blood pressure to high numbers, patients answered all the signs and questions by reading the information from the cue-cards. A survey of patients revealed a good tolerance to local anesthesia. The number of patients in the main group which had a complaints in the early postoperative period was less than in the control group (p<0.05). The duration of hospital staying in patients of the main group averaged 1.15 days (from 1 to 3 days), which is significantly less than in the control group – from 3 to 7 days, on average 4.05 days (p<0.05). When conducting CI under local anesthesia, none of the patients showed a destabilization of comorbidity pathology in the postoperative period. Conclusion. CI under local anesthesia in patients with concomitant pathology has several advantages over general anesthesia. The use of local anesthesia will increase the availability of CI for elderly comorbid patients and mitigate the risks of general anesthesia.

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