RESUMO
A few modern concepts of anesthesiological and resuscitation care during complicated surgical interventions are considered with special reference to multimodal anesthesia as a principal tool for the protection of the patient from a surgical trauma based on the rational combination of three-component epidural analgesia (ropivacaine, fentanyl, and adrenalin) with sevoflurane inhalation narcosis and extention of the same epidural analgesia to the early postoperative period. The basic principles of infusion-transfusion therapy for the treatment of massive intraoperative blood loss ensuring its tolerability by the patient are discussed. Special attention is given to the problem of hospital-acquired infections and sepsis in oncosurgery. Methods are proposed for the improvement of the management of septic shock including immunomodulation, respiratory support, infusion and anti-infective therapies. It is concluded that the use of these conceptual approaches permits to perform extensive surgical interventions in patients with the initially low reserve capacity of vital functions.
