RU2329799C1 - Anaesthesia method applied for adrenalectomy caused by epinephros pheochromocytoma - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: invention refers to medicine specifically to anaesthesiology and blood-saving techniques in anaesthesiology and resuscitation science, and can be used as anaesthetic management within adrenalectomy caused by epinephros pheochromocytoma. For this purpose operation is preceded with complex patient examination. Preanesthetic medication applied one day before and in the morning prior to operation implies introduction of tableted phenozepam dosed 0.0005-0.001 g, and 30 min before operation sybazone is injected intramuscularly in dosage 10 mg combined with Dimedrol in dose 10 mg. In operating theatre monitoring, puncture and catheterisation of central vein are performed. Then epidural cavity is punctured at height Th₇-L₁, catheterised so that catheter cap is being placed at height Th₅-Th₁₁ to provide following postoperative anaesthesia. Unassisted breathing is accompanied with oxygen inhalation through anaesthesia apparatus mask at rate 5-8 l/minute. Preanaesthetic medication is completed with intravenous bolus dosing of 0.1% atropine solution dosed 0.005-0.007 mg/kg. 5-10 minutes prior to surgical intervention patient blood is exfused in volume 1.0 litres in case arterial pressure is reduced lower than 140/90 mm m.c., and in volume 1.5 litres in case arterial pressure is reduced higher than 140/90 mm m.c. followed by drop-by-drop intravenous introduction of warmed to 37-42°C crystalloid solution either acesol, or trisol, or lactasol or Ringer's solution. Afterwards anaesthesia is added with intravenous bolus dosing to central vein of 2% thiopental sodium solution in dosage 4-5 mg/kg, 0.005% fentanyl solution dosed 0.0025-0.0035 mg/kg followed by intubation of trachea accompanied with precurarisation by introduction of either pipecuronium bromide (arduan) in dosage 1-2 mg or rocuronium bromide (esmerone) in dosage 10-20 mg and against muscular relaxation introduction of 2% suxamethonium iodide solution (dithylinum) in dosage 1.5-2 mg/kg, then patient is transferred to artificial pulmonary ventilation. Within epinephros central vein clipping and crossing for separation of pathologically modified epinephros complete or partial autoblood is reinfused until patient arterial pressure is completely stabilised at level 100-110/60-70 with following infusion crystalloids warmed up to 37-42°C. In case of partial autoblood reinfusion, repeated reinfusion of the rest autoblood volume is performed within the first days of early postoperative period. Anaesthesia management within all stages of surgical intervention is carried under artificial pulmonary ventilation by inhalation of mixed nitrogen monoxide and oxygen at ratio 2:1 to 3:1 using reversive breathing circuit of ventilation respiratory capacity 7-8 ml/kg at minute ventilation 100-120 ml/kg, intravenous introduction of fentanyl dosed 5-6 mkg/kg/h, as well as introduction of arduan in dosage 2-4 mg every 40-60 minutes of operation procedure or introduction of esmerone in dosage 10-20 mg every 25-35 minutes of operation procedure. Anaesthesia is completed at stage of operation termination by termination of intravenous introduction of fentanyl and relaxing agents against continuation of artificial pulmonary ventilation by oxygen-air mix with FiO₂ equal to 0.4-0.6. Method provides stabilisation of haemodynamics and cardiac activity during adrenalectomy without vasopressor application.

EFFECT: provided possibility of stabilisation of hemodynamics and cardiac activity during adrenalectomy without vasopressor application.

3 ex, 4 cl

Description

The invention relates to medicine, namely to methods of anesthesia during adrenalectomy for adrenal pheochromocytoma.

Surgical interventions for adrenalectomy for adrenal pheochromocytoma are accompanied by high hypertension before clipping of the adrenal vessels and a sharp drop in blood pressure and cardiac arrest after removal of the adrenal gland affected by the tumor.

The objective of the invention is to develop a method of anesthesia for adrenalectomy for adrenal pheochromocytoma.

The technical result is the achievement of minimal impaired hemodynamics and cardiac activity during adrenalectomy, a decrease in intraoperative risk, a decrease in postoperative mortality, a reduction in the duration of treatment in the intensive care unit, and a reduction in the postoperative period.

The technical result in the implementation of the invention is achieved by the fact that the proposed method of anesthesia during adrenalectomy for adrenal pheochromocytoma, including conducting a preoperative complex examination of the patient, premedication of the patient with the introduction of the tableted phenozepam at a dose of 0.0005-0.001 g the day before and on the morning of the operation, administration for 30 min before surgery intramuscularly sibazon in the amount of 10 mg and diphenhydramine in the amount of 10 mg, patient monitoring, puncture and catheterization of the central vein, puncture epi dural space at the level of Th ₇ -L ₁ , catheterization of the epidural space with the tip of the catheter at the level of Th ₅ -Th ₁₁ for subsequent postoperative analgesia, oxygen inhalation through the mask of the anesthesia apparatus at a rate of 5-8 l / min completion of premedication by the administration of an intravenous bolus of 0.1% atropine at a dose of 0.005-0.007 mg / kg, the induction of anesthesia by the administration of an intravenous bolus of a 2% sodium thiopental sodium solution at a dose of 4-5 mg / kg, as well as 0.005%, nogo ra a solution of fentanyl at a dose of 0.0025-0.0035 mg / kg, tracheal intubation against the background of precurarization with the introduction of pipecuronium bromide (arduana) in an amount of 1-2 mg or rocuronium bromide (esmeron) in an amount of 10-20 mg and against the background of muscle relaxation by 2% solution of suxamethonium iodide (dithilin) at a dose of 1.5-2 mg / kg, transferring the patient to artificial lung ventilation, performing 5-10 minutes before the start of surgical intervention, exfusion of the patient's blood in a volume of 1.0-1.5 liter followed by simultaneous infusion of crystalloids into the patient in a volume of 1.0-1.5 liters, then to the stage e clipping the central adrenal vein and its intersection to isolate a pathologically altered adrenal gland, complete or partial reinfusion of the autologous blood to the patient until the patient's blood pressure is completely stabilized at a level of 100-110 / 60-70, followed by crystalloid infusion, and the patient will undergo partial reinfusion of the patient with reinfusion the remaining volume of autologous blood is carried out during the first days of the early postoperative period, the implementation of maintenance anesthesia at all stages surgical intervention in conditions of artificial ventilation of the lungs by inhalation with a mixture of nitrous oxide and oxygen at a ratio of 2: 1 to 3: 1 using a reversible respiratory circuit with parameters of the respiratory volume of ventilation 7-8 ml / kg with a minute ventilation of 100-120 ml / kg by intravenous administration of fentanyl at a dose of 5-6 μg / kg / h, as well as by the introduction of 2-4 mg pipecuronium bromide (arduana) every 40-60 minutes, or by the introduction of rocuronium bromide (esmerone) every 25-35 minutes in an amount of 10-20 mg ticipate anesthesia completed in step closure operation termination intravenous fentanyl relaxants and continue on the background ventilation oxygen-air mixture with FiO ₂ equal to 0.4-0.6. In this case, the exfusion of the patient’s blood is carried out in a volume of 1.0 liter with a decrease in blood pressure in the patient to a level below 140/90 mm Hg and in a volume of 1.5 liters with a decrease in blood pressure in a patient to a level above 140/90 mm Hg In this case, the patient is administered, after exfusion of autologous blood, by drip intravenously heated to a temperature of 37-42 ° C of a crystalline solution of Acesol, or Trisol, or lactasol or Ringer's solution. In this case, the patient is administered, after partial or complete reinfusion of autologous blood, by drip intravenously heated to a temperature of 37-42 ° C of a crystalline solution of Acesol, or Trisol, or lactasol or Ringer's solution.

The method is as follows. Conduct a preoperative comprehensive examination of the patient. On the eve and morning of the day of surgery, the patient is sedated by administering tabletted phenozepam at a dose of 0.0005-0.001 g, then intramuscularly administration of sibazon in the amount of 10 mg 30 minutes before the operation and diphenhydramine in the amount of 10 mg. Monitor the patient. Puncture and catheterize the central vein. The puncture of the epidural space is carried out at the level of Th ₇ -L ₁ , and the catheterization of the epidural space is carried out with the location of the catheter tip at the level of Th ₅ -Th ₁₁ for subsequent postoperative analgesia.

Against the background of the patient's independent breathing, oxygen is inhaled through the mask of the anesthesia apparatus at a rate of 5-8 l / min. The patient’s premedication is completed by the administration of a bolus of 0.1% atropine at a dose of 0.005-0.007 mg / kg. Induction of anesthesia is performed by intravenously injecting a 2% sodium thiopental sodium solution at a dose of 4-5 mg / kg into the central vein, as well as introducing a 0.005% fentanyl solution at a dose of 0.0025-0.0035 mg / kg.

Tracheal intubation is performed against the background of precursorization by the introduction of pipecuronium bromide (arduana) in an amount of 1-2 mg or rocuronium bromide (esmeron) in an amount of 10-20 mg and against the background of muscle relaxation by the introduction of a 2% solution of suxamethonium iodide (dithilin) in a dose of 1, 5-2 mg / kg. Transfer the patient to mechanical ventilation.

5–10 min before the start of the surgery, exfusion of the patient’s blood is performed in a volume of 1.0-1.5 liters. In this case, exfusion of the patient’s blood is performed in a volume of 1.0 liter with a decrease in blood pressure in the patient to a level below 140/90 mm Hg and in a volume of 1.5 liters with a decrease in blood pressure in a patient to a level above 140/90 mm Hg Then immediately carry out the infusion of crystalloid into the patient in a volume of 1.0-1.5 liters. In this case, autologous blood is injected intravenously dropwise to a patient after an exfusion of autologous blood at a temperature of 37-42 ° C, a crystalline solution of Acesol, or Trisol, or lactasol, or Ringer's solution.

In the process of surgical intervention at the stage of clipping the central adrenal vein and its intersection to isolate a pathologically altered adrenal gland, complete or partial reinfusion of autologous blood to a patient is performed until the patient's blood pressure is completely stabilized at a level of 100-110 / 60-70. Moreover, when performing at this stage of surgical intervention partial reinfusion to the patient of autologous blood, repeated reinfusion of the remaining volume of autologous blood to him is carried out during the first days of the early postoperative period. Subsequent infusion of crystalloid into the patient is performed immediately in a volume of 1.6-2 liters. In this case, the patient is administered, after partial or complete reinfusion of autologous blood, by drip intravenously heated to a temperature of 37-42 ° C of a crystalline solution of Acesol, or Trisol, or lactasol or Ringer's solution.

At all stages of the surgical intervention, supportive anesthesia is performed under conditions of artificial lung ventilation by inhalation with a mixture of nitrous oxide and oxygen at a ratio of 2: 1 to 3: 1 using a reversible respiratory circuit with parameters of the respiratory volume of ventilation 7-8 ml / kg with minute ventilation 100-120 ml / kg, by intravenous administration of fentanyl in a dose of 5-6 μg / kg / h, as well as by the introduction of pipecuronium bromide (arduana) in an amount of 2-4 mg every 40-60 minutes or by administration every 25-35 minutes operations rocuronium bromide (esmeron) in an amount of 10-20 mg.

Anesthesia is completed at the end of the operation by stopping the intravenous administration of fentanyl and relaxants against the background of continued mechanical ventilation of the lungs with an oxygen-air mixture with FiO ₂ equal to 0.4-0.6.

Experimental studies of the proposed method of anesthesia during adrenalectomy of adrenal pheochromocytoma under clinical conditions have shown its high efficiency. Using all the essential features of the proposed technical solution during the surgical intervention, minimal hemodynamic and cardiac disturbances were observed in the patient. The intraoperative risk is significantly reduced without the use of intravenous doses of vasopressors. A reduction in postoperative mortality was achieved, the treatment time in the intensive care unit and intensive care unit was shortened, and the duration of the postoperative period was also reduced.

The implementation of the proposed method of anesthesia during an adrenalectomy for adrenal pheochromocytoma is illustrated by the following clinical examples.

Example 1. Patient K., 28 years old, was admitted to 3 TsVKG im A.A. Vishnevsky with a diagnosis of "Pheochromocytoma of the right adrenal gland." Using ultrasound, computed tomography, a pheochromocytoma lesion of the right adrenal gland was diagnosed. During biochemical studies revealed an increased content of adrenaline in the blood of 7.38 nmol / L, norepinephrine 10.62 mmol / L. The patient complained of frequent hypertensive crises with a rise in blood pressure to 240/120 mm Hg. with constant blood pressure in the range of 170-190 / 90-120 mm Hg

The patient received anesthesia during adrenalectomy of the adrenal pheochromocytoma on the right.

The patient was premedicated by administering a tablet of phenosepam at a dose of 0.0005 g the day before and on the morning of the operation. Intramuscular injection of 10 mg and diphenhydramine in an amount of 10 mg were introduced 30 minutes before the operation. Conducted monitoring of the patient. Puncture and catheterization of the central vein were performed. The epidural space was punctured at the level of Th ₇ -Th ₈ and the epidural space was catheterized with the tip of the catheter at the level of Th ₅ -Th ₆ for postoperative analgesia. Against the background of the patient's independent breathing, oxygen was inhaled through a mask of the anesthesia apparatus at a rate of 5 l / min. Premedication was completed by the administration of a bolus of 0.1% atropine at a dose of 0.005 mg / kg. Anesthesia was induced by the administration of a 2% sodium thiopental sodium solution at a dose of 5 mg / kg and a 0.005% fentanyl solution at a dose of 0.0025 mg / kg intravenously bolus into the central vein. Tracheal intubation was performed against the background of precursorisation with the introduction of 1 mg pipecuronium bromide (arduana) and muscle relaxation with the introduction of a 2% solution of suxamethonium iodide (ditylene) at a dose of 2 mg / kg. The patient was transferred to mechanical ventilation. 5 minutes before the start of the surgery, blood exfusion was performed in a volume of 1 liter. The patient's blood pressure was established at the level of 135/80 mm Hg. BCC was replenished by intravenous drip infusion of a crystalline Ringer solution heated to a temperature of 37 ° C in a volume of 1 liter.

Then, at the stage of clipping the central vein of the right adrenal gland and its intersection to isolate the pathologically altered adrenal gland, the patient was partially reinfused with autologous blood in a volume of 700 ml until the patient's blood pressure was completely stabilized at 100/60, followed by intravenous drip infusion of crystalline Ringer's solution heated to 37 ° C. in the amount of 1.6 liters.

At all stages of the operation, supportive anesthesia was performed under conditions of mechanical ventilation by inhalation with a mixture of nitrous oxide and oxygen at a ratio of 3: 1 using a reversible respiratory circuit with parameters of the respiratory ventilation volume of 7 ml / kg with a minute ventilation of 100 ml / kg. Fentanyl was administered intravenously at a dose of 5.7 μg / kg / h, as well as 2 mg of pipecuronium bromide (arduan) every 40 min.

Anesthesia was completed at the end of the operation by stopping the intravenous administration of relaxants and fentanyl. Continued artificial ventilation of the patient's lungs with an oxygen-air mixture with FiO ₂ equal to 0.4. The remaining 300 ml of autologous blood was reinfused to the patient during the first days of the early postoperative period in the intensive care unit.

The operating period is smooth. Postoperative analgesia was performed using a catheter pre-installed in the epidural space. Hemodynamics is stable, intraoperative fluctuation of blood pressure in the range of 100-150 / 60-90 mm Hg Pulse within 60-80 beats. in 1 min.

Example 2. Patient T., 64 years old, was admitted to 3 TsVKG im A.A. Vishnevsky with a diagnosis of Feochromocytoma of the left adrenal gland. Using ultrasound, computed tomography, a lesion of the left adrenal gland pheochromocytoma was diagnosed. During biochemical studies revealed an increased content of adrenaline in the blood 5.21 nmol / L, norepinephrine 11.11 mmol / L. The patient complained of frequent hypertensive crises with a rise in blood pressure to 210/120 mm Hg. with constant blood pressure in the range 160-190 / 90-120 mm Hg

Anesthesiological aid of the patient was carried out during adrenalectomy of adrenal pheochromocytoma on the left.

The patient was sedated by administering on the eve and morning of the day of the operation, tableted phenosepam at a dose of 0.001 g. Intravenous administration of sibazon in the amount of 10 mg and diphenhydramine in the amount of 10 mg was introduced 30 minutes before the operation. Patient was monitored. Puncture and catheterization of the central vein were performed. The epidural space was punctured at the level of Th ₈ -Th ₁₀ and the epidural space was catheterized with the tip of the catheter at the level of Th ₇ -Th ₈ for postoperative analgesia. Against the background of the patient's independent breathing, oxygen was inhaled through an anesthesia mask at a rate of 8 l / min. Premedication was completed by the administration of a bolus of 0.1% atropine at a dose of 0.007 mg / kg. Anesthesia was induced by the administration of a 2% sodium thiopental sodium solution at a dose of 4 mg / kg and a 0.005% fentanyl solution at a dose of 0.0035 mg / kg intravenously bolus into the central vein. Tracheal intubation was performed against the background of precursorisation with the introduction of 2 mg pipecuronium bromide (arduana) and muscle relaxation with the introduction of a 2% solution of suxamethonium iodide (ditylene) at a dose of 1.5 mg / kg. The patient was transferred to artificial lung ventilation. A blood exfusion of 1.5 liters was performed 10 minutes before the start of the surgical procedure. Blood pressure of the patient with 180/110 mm Hg decreased and established at the level of 130/80 mm Hg The bcc was replenished by intravenous drip infusion of the acesol crystalloid solution heated to a temperature of 42 ° C in a volume of 1.5 liters.

Then, at the stage of clipping the central vein of the left adrenal gland and its intersection in order to isolate the pathologically altered adrenal gland, the patient autologous blood was completely reinfused in a volume of 1.5 l until the patient's blood pressure was completely stabilized at 110/70, followed by intravenous drip infusion of crystalloid heated to 42 ° C. Acesol solution in a volume of 2 liters.

At all stages of the operation, supportive anesthesia was performed under conditions of artificial lung ventilation by inhalation with a mixture of nitrous oxide and oxygen at a ratio of 2: 1 using a reversible respiratory circuit with parameters of the respiratory ventilation volume of 8 ml / kg with a minute ventilation of 120 ml / kg. Fentanyl was administered intravenously at a dose of 6 μg / kg / h, as well as 4 mg of pipecuronium bromide (arduan) every 40 min.

Anesthesia was completed at the end of the operation by stopping the intravenous administration of relaxants and fentanyl. Continued artificial ventilation of the patient's lungs with an oxygen-air mixture with FiO ₂ equal to 0.6.

The operating period is smooth. Postoperative analgesia was performed using a catheter pre-installed in the epidural space. Hemodynamics is stable, intraoperative fluctuation of blood pressure in the range of 110-140 / 80-100 mm Hg Pulse within 60-80 beats. in 1 min.

Example 3. Patient L., 47 years old, was admitted to 3 TsVKG im A.A. Vishnevsky with a diagnosis of Feochromocytoma of the left adrenal gland. Using ultrasound, computed tomography, a lesion of the left adrenal gland pheochromocytoma was diagnosed. During biochemical studies revealed an increased content of adrenaline in the blood of 9.76 nmol / L, nradrenaline 21.20 mmol / L. The patient complained of frequent hypertensive crises with a rise in blood pressure to 260/140 mm Hg. with constant blood pressure in the range of 170-200 / 90-120 mm Hg

Anesthesiological aid of the patient was carried out during adrenalectomy of adrenal pheochromocytoma on the left.

The patient was sedated by administering on the eve and morning of the day of the operation, tableted phenosepam at a dose of 0.001 g. Intravenous administration of sibazon in the amount of 10 mg and diphenhydramine in the amount of 10 mg was introduced 30 minutes before the operation. Patient was monitored. Puncture and catheterization of the central vein were performed. The epidural space was punctured at the level of Th ₁₀ -L ₁ and the epidural space was catheterized with the tip of the catheter at the level of Th ₉ -Th ₁₁ for postoperative analgesia. Against the background of the patient's independent breathing, oxygen was inhaled through the mask of the anesthesia apparatus at a rate of 7 l / min. Premedication was completed by the administration of an intravenous bolus of 0.1% atropine at a dose of 0.006 mg / kg. Anesthesia was induced by the administration of a 2% sodium thiopental solution at a dose of 4 mg / kg and a 0.005% fentanyl solution at a dose of 0.0030 mg / kg intravenously bolus into the central vein. Tracheal intubation was performed against the background of precursorization with the introduction of rocuronium bromide (esmeron) in an amount of 20 mg and against the background of muscle relaxation with the introduction of a 2% solution of suxamethonium iodide (ditylene) at a dose of 2 mg / kg. The patient was transferred to artificial lung ventilation. A blood exfusion of 1.5 liters was performed 10 minutes before the start of the surgical procedure. Blood pressure of a patient with 210/120 mm Hg decreased and established at the level of 140/80 mm Hg The bcc was replenished by intravenous drip infusion of a crystalloid lactasol solution heated to a temperature of 40 ° C in a volume of 1.5 liters.

Then, at the stage of clipping the central vein of the left adrenal gland and its intersection in order to isolate the pathologically altered adrenal gland, the patient autologous blood was completely reinfused in a volume of 1.5 l until the patient's blood pressure was completely stabilized at 110/70, followed by intravenous drip infusion of a crystalloid heated to 40 ° C. lactasol solution in a volume of 2 liters.

At all stages of the operation, supportive anesthesia was performed under conditions of artificial lung ventilation by inhalation with a mixture of nitrous oxide and oxygen at a ratio of 3: 1 using a reversible respiratory circuit with parameters of the respiratory volume of ventilation 7 ml / kg with a minute ventilation of 110 ml / kg. Fentanyl was administered intravenously at a dose of 5 μg / kg / h, as well as every 25 minutes of the operation of rocuronium bromide (esmeron) in an amount of 15 mg.

Anesthesia was completed at the end of the operation by stopping the intravenous administration of relaxants and fentanyl. Continued artificial ventilation of the patient's lungs with an oxygen-air mixture with FiO ₂ equal to 0.6.

The operating period is smooth. Postoperative analgesia was performed using a catheter pre-installed in the epidural space. Hemodynamics is stable, intraoperative fluctuation of blood pressure in the range of 100-160 / 80-100 mm Hg Pulse within 70-90 beats. in 1 min.

Claims (4)

1. The method of anesthesia during adrenalectomy for adrenal pheochromocytoma, including conducting a preoperative comprehensive examination of the patient, premedication of the patient with the administration of tablet phenazepam at a dose of 0.0005-0.001 g on the day before and morning of the operation, the administration of sibazon 10 minutes intramuscularly 30 minutes before surgery mg and the diphenhydramine in amounts of 10 mg, monitoring patient puncture and central venous catheterization, epidural puncture at Th ₇ -L _1, epidural catheterization spaces with the location of the catheter tip at the level of ₅ Th -Th ₁₁ for subsequent post-operative analgesia holding a background self inhalation of the patient breathing oxygen through a mask anesthesia machine at a rate of 5-8 l / min, the completion of premedication bolus intravenous administration of 0.1% atropine at a dose of 0.005-0.007 mg / kg, induction of anesthesia by intravenous injection into the central vein of a 2% sodium thiopental solution at a dose of 4-5 mg / kg, as well as a 0.005% solution of fentanyl at a dose of 0.0025-0.0035 mg / kg, tracheal intubation on the background of precuralization the development of pipecuronium bromide (arduana) in an amount of 1-2 mg or rocuronium bromide (esmeron) in an amount of 10-20 mg and against the background of muscle relaxation by the introduction of a 2% solution of suxamethonium iodide (dithylin) in a dose of 1.5-2 mg / kg , transfer of the patient to artificial lung ventilation, execution in 5-10 minutes. prior to surgery, exfusion of the patient’s blood in a volume of 1.0-1.5 l, followed by simultaneous infusion of crystalloids in a volume of 1.0-1.5 l, then at the stage of clipping the central adrenal vein and its intersection to isolate a pathologically altered adrenal gland complete or partial reinfusion of autologous blood to a patient until the patient’s blood pressure is completely stabilized at a level of 100-110 / 60-70, followed by infusion of crystalloids, and repeated reinfusion of a partial blood reinfusion to a patient the remaining patient autologous blood volume is carried out during the first days of the early postoperative period, the implementation of maintenance anesthesia at all stages of the surgical intervention under mechanical ventilation by inhalation with a mixture of nitrous oxide and oxygen at a ratio of 2: 1 to 3: 1 using a reversible respiratory circuit with parameters of respiratory ventilation volume of 7-8 ml / kg with minute ventilation of 100-120 ml / kg, intravenous fentanyl at a dose of 5-6 μg / kg / h, as well as h every 40-60 min operation of pipecuronium bromide (arduana) in an amount of 2-4 mg or by the introduction of every 20-35 min operation of rocuronium bromide (esmeron) in an amount of 10-20 mg, completion of anesthesia at the end of the operation by stopping the intravenous administration of fentanyl and relaxants against the background of continued mechanical ventilation with an oxygen-air mixture with FiO ₂ equal to 0.4-0.6. 2. The method according to claim 1, comprising performing exfusion of the patient’s blood in a volume of 1.0 L while lowering the patient’s blood pressure to a level below 140/90 mm Hg. and in a volume of 1.5 l with a decrease in blood pressure in a patient to a level above 140/90 mm Hg 3. The method according to claim 1, comprising administering to the patient, after exfusion of autologous blood, an intravenous drip heated to a temperature of 37-42 ° C of a crystalline solution of Acesol, or Trisol, or lactasol or Ringer's solution. 4. The method according to claim 1, comprising administering to the patient, after partial or complete reinfusion of autologous blood, an intravenous drip heated to a temperature of 37-42 ° C of a crystalline solution of Acesol, or Trisol, or lactasol, or Ringer's solution.