The analysis of our own experience, literary sources and pathophysiological features of laparoscopic operations allows us to recommend anesthetic management in the form of intravenous general multicomponent and epidural anesthesia for endoscopic surgery. Anesthesia for laparoscopic interventions is fundamentally the same as for laparotomy. LO are low-traumatic in terms of surgical aggression, but are unsafe in terms of manifestation of reflex reactions and consequences of pneumoperitoneum. The components of anesthesia can be represented schematically: * Amnesia (sleep, inhibition of mental perception) * * * * * * * * Regulation * * Hyporeflexia (inhibition of vegetative reflexes) of blood circulation * * * * * * * * Regulation of breathing * * Analgesia (blockade of pain impulses) (maintaining adequate * * gas exchange) * * * * * * * * Muscle relaxation (elimination of motor activity) The following sequence of actions is necessary to achieve adequate anesthesia. Premedication. Premedication can be therapeutic or prophylactic. Therapeutic premedication is prescribed several days before surgery. Its purpose is to administer medications to correct concomitant pathologies. Preventive premedication is administered within 24 hours for elective surgeries and 40-60 minutes before for urgent surgeries. Its purpose is to: a) prevent reflex reactions during anesthesia; b) achieve psychological calm in the patient; c) prevent apaphylactic reactions. Both therapeutic and prophylactic premedication are used during laparoscopic surgeries. The latter is used in all patients. For this purpose, antihistamines, hypnotics, and tranquilizers are prescribed in tablet form (usually) the evening before surgery. The dosage and specific choice of medication depend on the patient's emotional state, nervous system type, age, and body weight. In the morning, on the day of surgery, the medications used in the evening can be repeated, but this should be decided on an individual basis. Forty minutes before transporting the patient to the operating room, the following are administered parenterally: an anticholinergic (usually atropine), an antihistamine (diphenhydramine, suprastin, proprasin, or others), and a central analgesic (morphine, promedol, or other drugs from this group). In urgent surgeries, if there is no time to administer premedication within 40 minutes, these drugs may be administered intravenously on the operating table. In emergency surgeries, prophylactic premedication is administered only intravenously on the operating table. An infusion of solutions is established in the operating room via an intravenous needle or catheter beforehand. If puncture of a peripheral vein in the upper extremities is unsuccessful, venesection of the great saphenous vein in the lower extremity is performed. If this method is impossible (which is extremely rare), catheterization of the superior vena cava is performed through the subclavian or jugular vein. This sequence of establishing an intravenous infusion system is completely justified, as it reduces the risk of complications from superior vena cava catheterization. Preinduction. This is accomplished using small or large tranquilizers. The former include drugs from the diazepam group (seduxen, relanium, apaurin), while the latter includes the alpha-adrenergic blocker droperidol. These drugs achieve hyporeflexia, one of the main components of general anesthesia. These drugs can be used initially along with premedications (40 minutes before transporting the patient to the operating room), especially when administering anesthesia using the classic neuroleptanalgesia method. Induction of anesthesia (induction of anesthesia). This can be accomplished using various drugs. Here are some of the drugs used for induction of anesthesia and their brief characteristics. Ketamine (ketalar, ketanit, ketament, calypsol, C1-581). It is the only anesthetic that is non-irritating to tissues, regardless of the route of administration (intravenous, intramuscular, or rectal). Ketamine is typically administered intravenously in endoscopic surgeries. The induction dose is typically 2 mg per kilogram of patient body weight. Sleep and the surgical phase of anesthesia occur within a few minutes. Peak plasma concentrations occur within one minute, and after five minutes with intramuscular administration (the ketamine dose is 6-8 mg per kilogram of body weight). Initially, ketamine distributes to well-perfused organs (primarily the brain), where its concentration is 4-6 times higher than in plasma. It then redistributes to less perfused organs. The duration of ketamine's anesthetic effect is determined by its redistribution time within the body and ranges from 7-11 minutes with intravenous administration. Ketamine is metabolized in the liver, and this process, including excretion of the drug, takes 2-3 hours. After ketamine anesthesia wears off (i.e., after 7-11 minutes when administered intravenously), most of the drug remains unchanged in the body. This contributes to the cumulative and potentiating effects of ketamine when used in combination with other narcotics. Ultra-short-acting barbiturates (sodium thiopental and hexenal) can also be used for induction of anesthesia. These drugs are recommended for use in elective endosurgery in patients undergoing appropriate evaluation. Acidosis and low plasma albumin levels can lead to undesirable deepening of anesthesia and impaired hepatic blood flow. Laparoscopic surgeries are often performed for diseases of the liver and biliary tract. It should be remembered that ultra-short-acting barbiturates do not have a hepatotoxic effect, as was previously believed. It is advisable to limit barbiturate use to induction of anesthesia. For this purpose, they are used at a dose of 300-500 mg in a 1-2% solution. In our opinion, sodium oxybutyrate (GHB) is one of the best drugs for induction (as well as general) anesthesia. This drug is administered intravenously for induction of anesthesia, administered slowly (over at least 15 minutes), at a dose of 90-100 mg per kilogram of body weight. This induction is a "graceful" and slow process, which is perfectly acceptable for planned general anesthesia. Sodium oxybutyrate must be administered with a preliminary dose of droperidol sufficient to achieve grade 2 neurolepsy. Rapid administration of sodium oxybutyrate during induction of anesthesia is unacceptable. The drug, at the recommended dosage, only produces a hypnotic effect lasting approximately two hours. Sodium oxybutyrate is broken down in the body into natural metabolites. It has very pronounced antihypoxic properties and, in this regard, is a pathogenetically justified agent for the anesthetic management of general anesthesia. During laparoscopic surgery, sodium oxybutyrate and ketamine provide basic anesthesia, or the first component of general anesthesia—amnesia. The second component of anesthesia—hyperreflexia—is achieved, as noted above, by major (droperidol) and minor (seduxen, relanium) tranquilizers. Anticholinergics also participate in the inhibition of somatic and autonomic reflexes. Analgesia is the third component of anesthesia. Nociceptive impulses are blocked by central analgesics (morphine, promedol, fentanyl, norphine, and other agents in this group). When performing biliary tract surgery, it should be remembered that morphine causes spasm of the sphincter of Oddi. If basic anesthesia is achieved with ketamine, the dose of central analgesics is reduced, as the anesthetic has a pronounced analgesic effect, but not sufficient to achieve complete blockade of nociceptive impulses. The fourth component of general anesthesia is muscle relaxation. It is implemented according to the general principles accepted in anesthesiology: - precurarization with antidepolarizing drugs at a dose of 0.25-0.2 times the clinical dose; - after 3-5 minutes, depolarizing muscle relaxants are administered at a dose of 3 mg per kilogram of body weight, which ensures conditions for tracheal intubation; - competitive muscle relaxants are reintroduced at a dose necessary to ensure total curarization. Maintaining adequate gas exchange during LO is the most important component of anesthesia. Mechanical ventilation is performed with an oxygen-air mixture in a hyperventilation mode, which is achieved by increasing the respiratory rate. The sixth component of general anesthesia - regulation of blood circulation - is an integral indicator. Correct achievement of the previous five components contributes to stable hemidynamics. However, when performing LO, there are several hidden factors, the pathogenesis of which is described above (pneumoperitoneum, postural reactions), which the anesthesiologist must anticipate. Epidural anesthesia (PA). It should be administered by a physician experienced in this type of pain relief. For lower abdominal and pelvic anesthesia, PA is administered with spontaneous breathing and oxygen administered through an anesthesia mask. In all cases, patients must be induced to light sleep or completely unconscious. For upper abdominal surgery, PA is administered with mechanical ventilation under conditions of total muscle relaxation. In this case, PA provides the second (hyporeflexia) and third (analgesia) components of anesthesia.