COMPARATIVE CHARACTERISTICS OF THE HEMOSTASIS SYSTEM, BLOOD ASID-BASE STATUS, AND CORTISOL LEVEL IN PARTIENTSP WITH PURULENT-SEPTIC DISEASSES OF THE CHEST
Keywords:
purulent-inflammatory diseases of the chest, ultrasound-guided regional anesthesia (USG), cortisol, lactate, acid–base balance, hemostasisAbstract
Objective: To improve the outcomes of anesthetic management in the perioperative and postoperative periods for patients with purulent-inflammatory diseases of the chest through the development and implementation of a standardized multimodal analgesia algorithm. Materials and Methods: This study was conducted at the Intensive Care Unit of the Multidisciplinary Clinic of Tashkent State Medical University. A total of 134 patients who underwent surgery for purulent-inflammatory diseases of the chest were included in the analysis. The retrospective control group consisted of 66 patients (49.3%) treated between 2018 and 2025 who received conventional balanced general anesthesia. The prospective study group included 68 patients (50.7%) treated between 2021 and 2025, in whom a newly developed algorithm for multimodal analgesia was implemented. The algorithm incorporated an ultrasound-guided erector spinae plane block (ESPB) as part of the perioperative analgesic strategy. Results: Among the evaluated parameters, serum cortisol concentration was the most clinically significant anesthesiological indicator, reflecting the magnitude of the endocrine stress response to surgery. In the control group, cortisol levels increased from 486 ± 96 nmol/L preoperatively to 528 ± 104 nmol/L postoperatively. In the study group, cortisol concentrations increased from 478 ± 92 nmol/L to 503 ± 98 nmol/L. Although the increase was less pronounced in the multimodal analgesia group, the difference between the groups did not reach statistical significance (p = 0.214). Conclusion: Postoperative changes in hematological parameters followed a similar pattern in both study groups. A moderate decrease in hemoglobin concentration was observed in the control group (from 118.6 ± 13.4 g/L to 114.2 ± 12.9 g/L) as well as in the study group (from 119.8 ± 12.7 g/L to 116.9 ± 11.8 g/L; p = 0.274). These findings are likely attributable to the combined effects of intraoperative blood loss, perioperative fluid therapy, and hemodilution. Overall, the multimodal analgesia strategy incorporating ultrasound-guided ESPB was associated with a more favorable attenuation of the surgical stress response while maintaining comparable hematological stability.
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