The data on the etiology and pathogenesis of acute postoperative pancreatitis (APP) are analyzed. It is noted that in its pathogenesis, currently, the main attention is paid to the factors of aggression in the pancreas: the activation of proteolytic enzymes and autocatalytic reactions leading to damage of the acinous cells, microcirculation disturbance, and enhancement of free radical oxidation. This determines the prevention and treatment of acute postoperative pancreatitis with the use the inhibition of protease and exocrine secretion of pancreas, antioxidants and cytostatics. Biochemical mechanisms of resistance of the pancreas tissue to damage are given much less attention. The authors substantiate the proposition that organ tissue resistance, besides adequate microcirculation and oxygenation, is determined by the mechanisms of nerve tropism mediated through the sympathetic nervous system. Experimental and clinical data are presented that irritation of the reflexogenic pyloroduodenal zone, in particular during operations in conditions of inadequate anesthesia, leads to hyper activation of the sympathetic nervous system, increased release of the noradrenaline, subsequent depletion of its content in the pancreas tissues. Therefore adrenergic support of trophic (energy and plastic processes) in the pancreas is disrupted, contributing to the development of postoperative complications, including acute postoperative pancreatitis. Taking into account that epidural anesthesia performs afferent and efferent, including sympathetic, blockades; the substantiations are given for use epidural anesthesia for acute postoperative pancreatitis prevention in abdominal operations in combination with the components of general anesthesia.
The data on the factors of development of postoperative immunosuppression (PI) are presented. Among them, an important role in the development of PI belongs to hyperactivity during operations of the sympathetic nervous system (SNS) and hypothalamic-pituitary-adrenal system. It has been shown that PI is prevented by regional anesthesia, primarily epidural anesthesia and postoperative epidural analgesia, as well as prolonged ganglioplegia. It is concluded that the preventive action of regional anesthesia in relation to the development of PI is largely associated with the sympatholytic component of action.
The review of data on epidemiology, etiology and pathogenesis, methods of prevention and treatment of postoperative cognitive dysfunction (POCD) is presented. A comparative analysis of the influence on the development of POCD of general anesthesia (OA) and regional anesthesia (RA) was carried out. The substantiation of advantages of RA and its combination with components of OA against OA is given. (For citation: Strashnov VI, Zabrodin ON. To the mechanisms of the protective effects of regional anesthesia in relation to the development of postoperative cognitive dysfunction. Reviews on Clinical Pharmacology and Drug Therapy. 2018;16(2):62-68. doi: 10.17816/RCF16262-68).
The article presents data on the mechanisms of development of vascular thrombosis, in particular, thromboembolic complications: 1. endothelial inyury or endothelial dysfunction; 2. slowing the flow of blood and its stagnation; 3. violation of the coagulation and anticoagulation blood systems. In accordance with paragraphs 1–3 the effects of regional anesthesia – epidural anesthesia and spinal anesthesia on the prevention of postoperative thromboembolic complications are considered.
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