Recently growth of chronic diseases is noted that becomes characteristic not only for the age population, but also for persons of working-age. This phenomenon is connected with increase of psychoemotional tension, deterioration in environmental safety, high rates of life of the modern person, errors in food and other factors. For example, growth of such diseases as coronary heart disease, an arterial hypertension, disturbances of a lipometabolism, chronic obstructive diseases of lungs and so on is noted.
On the other hand, need of the population for the planned and emergency surgical help increases that is also connected with many factors. Development low-invasive the technician in surgery made attractive to patients many interventions. The number of plastic and reconstructive surgeries which allow to improve quality of life of patients considerably grows. In parallel with growth of need for the surgical help also the injury of operations for the patient's organism grows that is in many respects connected with the high level of development of anesthesiology and resuscitation which gives the chance these interventions to implement and to carry out successfully in many cases.
Thus, on the one hand increase in number of patients with associated diseases, and with another is noted the injury of operative measures and the need for them grows.
Despite development of the out-patient and polyclinic help, carrying out mass medical examination of the population and distribution of modern diagnostic techniques, a considerable part of the accompanying pathology remains undetected that considerably increases perioperatsionny risks. It in particular concerns rare diseases with the erased clinical picture, allergies to medicines (which for the first time can be shown at the time of administration of this or that drug to the patient).
It should be noted that a considerable part of patients underestimates danger of the pathology which is available for them, is skeptical in the recommendations of the doctor, do not change a way of life and do not refuse addictions that considerably reduces efficiency of treatment. Especially it concerns the pathology demanding long or even lifelong intake of medicines (arterial hypertension, coronary heart disease, a diabetes mellitus and so on).
Perioperatsionny maintaining the patient with associated diseases begins with determination of completeness of its inspection at a pre-hospital stage and definitions of the list of additional inspections for the purpose of specification of operational and anesthesiology risk (in those situations when they are shown). Consultations of profile specialists can often be required. In the postoperative period joint maintaining the patient by the anesthesiologist, profile doctor and specialist doctor on the accompanying pathology can be carried out.
Below the most widespread types of the accompanying perioperatsionny pathology and the principles of tactics will be considered at them.
Arterial hypertension occupies one of the leading positions in the list of the accompanying pathology patients to whom operation is planned. Often it is not revealed before hospitalization, in other cases pathology is diagnosed earlier. Tactics comes down to maintenance of working arterial blood pressure in the perioperatsionny period. If the arterial hypertension reaches considerable figures and is not controlled, planned expeditious treatment has to be postponed until stabilization of a condition of the patient, in this case it is necessary to consider degree of need of operation and perioperatsionny risks. In the emergency and urgent cases make fast correction of arterial blood pressure and try to maintain it at operating level by means of drugs. Complications of uncontrollable arterial hypertension in the perioperatsiony period most often include acute disorders of cerebral and coronary circulation.
Coronary heart disease in the perioperatsiony period meets also rather often. If to speak about the IBS stable chronic forms, then at observance of all necessary requirements operation and anesthesia by these patients are transferred usually normally. Contrary to it, the IBS acute forms are characterized by rather high number of perioperatsionny complications and high lethality, especially if it is about performance of an operative measure in the acute period of a myocardial infarction.
The diabetes mellitus in the perioperatsiony period also occurs rather often among the accompanying pathology. Extent of compensation of a diabetes mellitus, glycemia level, existence or lack of need for an insulin therapy matters. In the perioperatsiony period carry out monitoring of a glycemia, without allowing its considerable deviations from sizes, normal for this patient.