Ill th with a change in kidney function

Patients with a change in renal function, with a history of acute and chronic diseases, should be considered as threatened with the development of acute renal failure in them. This determines the planning of blood transfusions, the selection of funds to fill the operating blood loss, tactics of postoperative therapy.

Preparation for the operation of patients with diabetes mellitus is usually carried out with the participation of the therapist-endocrinologist. At the same time, every time it is necessary to strive to achieve in the preoperative period normalization of carbohydrate metabolism. With compensated diabetes (with the help of sulfonyl amides or insulin suspensions), shortly before the operation, patients are “transferred” to simple insulin, distributing its dose in such a way that during dietary feeding the glycemia remains at the same level as in their normal state. In patients with severe diabetes, the selection of insulin dosage is carried out against the background of the correction of disorders in the acid-base status of the blood. For these purposes, infusions of 100— ml of 5% sodium bicarbonate solution, 400 ml of hemodez and 500 ml of 10% glucose solution with 20 IU of insulin or as a Laborie solution are used. Fats are temporarily excluded from the diet and lipotropic products are prescribed (oatmeal, cottage cheese), vitamins of complex B. The lower and more stable glycemic indicators can be achieved before surgery,the easier it is to be able to regulate the level of sugar in the operation and after it. Solving the question of the possibility of performing surgery in patients with severe diabetes mellitus, it was assumed that even acetonuria is not an absolute contraindication to intervention, and the level of sugar in the blood is allowed up to 10 mmol / l.

Finally, the issue of functional operability of the patient is solved after completion of the course of preoperative preparation, according to indications, repeating the necessary studies. At the same time, the functional status of the patient, his dynamics in the process of preoperative preparation, resistance to the therapy being carried out are assessed.

The decision on the feasibility of performing surgery, its technical features, the method of anesthesia and the control system for the main physiological parameters during the operation for each patient with advanced stages of lung cancer should be taken in a joint analysis of the available survey data by all participants in preoperative diagnosis and therapy, surgery treatment in the postoperative period.

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