The main feature of most general anesthetics is the ability to exert a direct and low-selective suppressive effect on all elements of the functional systems that are most intensely working in conditions of pathology. Such an orthodox way of protecting the body through global oppression of mandatory responses even in the realm of the supposed “stress norm” is, in our opinion, inexpedient, since it does not only prevent the development of postoperative energy-structural deficit, but also significantly limits the possibility of intensifying reparative processes. A more effective way to reduce the “cost” of compensation and adaptation is a strong multilevel blockade of nociceptive afferentation with simultaneous stimulation of endogenous defense mechanisms.

Such an approach, which became the basis for the operating and postoperative period intensive care system developed in the clinic, as well as the new technical and pharmacological capabilities of the controlled and highly selective

effects on various systems of the body significantly reduced the risk of operations on the lungs and significantly improved the immediate results of surgical interventions. So, for the analyzed period, postoperative mortality with extended combined resections of the lung decreased from 22.18% to%, and with combined resections from 41% to%.

The initial element of the system is psychological preparation, instructing the patient. The purpose of this work is to explain to the patient the real possibility of a successful outcome of treatment and the need for the active participation of the patient in the treatment process. In the preoperative period, training in breathing and other exercises, coughing with subsequent daily workouts is mandatory. Exercises not only reduce the vegetative manifestations of psycho-emotional stress caused by hospitalization and waiting for the operation, but also change their character, directing the body’s senselessly wasted energy to train the mechanisms of specific adaptation and the formation of its structural trace even before the operation. At the final stage of preparation, premedication is carried out, as a rule, facilitated — 5– mg of Radedorm and 25– mg of Dimedrol in the evening before the operation and on the morning of its execution. Even before the operation, such premedication causes moderate activation of the endogenous GABA-ergic mechanism with a corresponding decrease in the activity of adreno- and cholinergic systems. The combination of the sedative and vegetotropic effects of benzodiazepines makes these drugs the means of choice, unlike barbituates and narcotic analgesics, which inhibit the respiratory center and cause depression of the cardiorespiratory system.Therefore, drugs of these groups for premedication are not used.

Our experience shows that after the preoperative preparation, the vast majority of patients enter the operating room in a state of moderate sedation, and all the commands of the anesthesiologist quietly and consciously carry out. Blood circulation indices — heart rate, blood pressure, volumetric blood flow quenching, and total peripheral resistance — remain stable. Deviations from the initial values ​​determined 3 days before the operation do not exceed 10%. Only in 18% of mature patients and in 10% of elderly patients there are clear signs of ginerkatecholaminemia — hypertension, tachycardia, and spasm of peripheral vessels. Although these changes do not reach a critical level, it is obvious that such an excessive activation of the sympathoadrenal system is undesirable.because it can lead to the depletion of its reserve capabilities and to the deterioration of the course of the operative and postoperative periods.

At the same time, such violations can be predicted by studying changes in blood circulation parameters in the process of preoperative examination. As the day of the operation approaches, the increase in heart rate, blood flow velocity and total peripheral resistance at the background of the change in the nature of the reaction to the standard load with an adequate to an insufficient and inadequate or paradoxical evidence of an excessive voltage of the sympathoadrenal system with a real threat of disruption of the regulatory mechanisms. Therefore, in such patients, as well as in identifying signs of an anxiety-depressive state, the drug reaction begins 3-4 days before the operation, prescribing amitriptilline 25 mg 1–1 times a day. The combination of antidepressants and benzodiazepines provides a good sedative-tranquilizing effect, and the mobilization of neurohumoral regulation systems for the upcoming operation occurs with preservation and even increase in their reserve capacity (UsenkoV.V., 1994). The choice of drugs may be different, but premedication must necessarily include H2-blockers (cimetidine 200 mg or its analogs).

Directly in the operating sedation supplement the holding of events that prevent serious, often life-threatening complications and pathological effects of induction anesthesia and tracheal intubation. During lung operations, the risk of various circulatory and respiratory disorders during this period is especially high, not only because of the altered functional status of most patients, but also because of specific requirements for artificial lung ventilation, often involving endobronchial intubation with single lumen tubes, the use of broncho-obturators, hard bronchoscopy and etc. To prevent these disorders, 0.5–7.0 mg of atropine sulfate and 7.5– mg of droperidol are injected intravenously 5– minutes before tracheal intubation. Important to remember,that the stabilizing effect of droperidol (prevention of hypertension and tachycardia) is explained not by a decrease in the release of catecholamines, but by the blockade of their effects. As a result, with a relatively prosperous clinical picture, the maximum voltage of the sympathoadrenal system is noted, with a significant predominance of the adrenal level and the threat of disruption of its compensatory reserves. Therefore, before the introduction of anesthesia, droperidol can be used only in cases where the preoperative excessive increase in peripheral vascular resistance and a corresponding increase inTherefore, before the introduction of anesthesia, droperidol can be used only in cases where the preoperative excessive increase in peripheral vascular resistance and a corresponding increase inTherefore, before the introduction of anesthesia, droperidol can be used only in cases where the preoperative excessive increase in peripheral vascular resistance and a corresponding increase inafterload on the heart is a factor in limiting cardiac output. In eastern situations, direct blockade of afferent impulses by irrigation of the pharynx with local anesthetic solutions or intravenous administration of 1.5 mg / kg lidocaine is more appropriate. Most authors who use this method find it a reliable method of preventing a significant increase in blood pressure, tachycardia, arrhythmia of the heart rate in response to tracheal intubation e .

Of course, when using droperidol or lidocaine, there is a risk of severe depression of blood circulation, especially in patients with low compensatory reserves. In such a situation, benzodiazepines could be the drugs of choice (seduxen is administered 5– min before induction at a dose of 2.5—10 mg), but their use in pulmonary resections has so far remained limited because of the uncontrolled duration of action that prevents the timely postoperative recovery muscle tone and effective self-breathing. However, the appearance of benzodiazepine receptor ligands and, in particular, the results of the clinical use of flumazenil, which according to data provides a quick, within 5 minutes, recovery of consciousness in 75% of operated patients without any adverse reactions and increased pain,allow you to reconsider the attitude to ataralgesia and expand the indications for its use in thoracic surgery.