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Comparative assessment of perioperative analgesia methods in retroperitoneoscopic adrenalectomy for aldosteronoma

https://doi.org/ 10.51350/1694-8068.2020.12.4.41
Comparative assessment of perioperative analgesia methods in retroperitoneoscopic adrenalectomy for aldosteronoma
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Abstract About the authors References

Abstract

Background. Anesthesiological provision for operations on the adrenal glands presents significant difficulties to date. This is due to the fact that the hormones of the cortex and adrenal medulla have a significant effect on the state of basic vital functions and systems. Often, the complexities of anesthesia are aggravated by concomitant obesity, steroid diabetes, secondary arterial hypertension, gross water-electrolyte disorders, which determines the need for careful choice of the tactics of perioperative management. Research objective. To study the influence of various variants of perioperative analgesia in retroperitoneoscopic adrenalectomy on the perioperative period. Materials and methods. A randomized examination of 57 aldosteroma patients who underwent retroperitoneoscopic adrenalectomy was performed. Depending on the method of perioperative analgesia, patients were divided into two groups. In group 1 (n-30), the operation was performed under the conditions of combined anesthesia based on low flow inhalation of desflurane, only systemic administration of opioids was used for perioperative analgesia; in group 2 (n-27), the operation was performed under the conditions of combined anesthesia based on low flow inhalation of desflurane in combination with blockade of the fascial space of the muscle straightening spine (ESP erector spinae plane) with 0.35% ropivacaine solution. The indicators of adequacy of anesthesia, central and peripheral hemodynamics were investigated, neuromuscular conductivity was monitored, the effectiveness of postoperative rehabilitation was evaluated, as well as the quality of postoperative analgesia, number of postoperative critical incidents. Results. It was revealed that surgical intervention with low flow inhalation anesthesia based on desflurane in combination with ESP ropivacaine blockade contributes to faster post-narcotic rehabilitation, effective postoperative analgesia and fewer complications in the early postoperative period compared to combined anesthesia with desflurane and systemic opioid perioperative analgesia. This contributed to significantly lower periods of hospitalization of patients in group 2 of 96 hours (95% CI 86-103) compared to group 1 of 125 hours (95% CI 115-133) (p=0.036). Conclusions. ESP blockade is an effective method of anesthesia in the perioperative period, it promotes faster post-narcotic rehabilitation and shortening the duration of hospitalization after retroperitoneoscopic adrenalectomy for aldosteroma compared to opioid analgesia.

About the authors

Неймарк Михаил Израилевич, д.м.н., профессор, заведующий кафедрой анестезиологии, реаниматологии и клинической фармакологии с курсом ДПО,ФГБОУ ВО АГМУ Минздрава России, Барнаул, Российская Федерация

Киселев Роман Владимирович, к.м.н., ассистент кафедры анестезиологии, реаниматологии и клинической фармакологии с курсом ДПО, ФГБОУ ВО АГМУ Минздрава России, Барнаул, Российская Федерация

Гончаров Евгений Владимирович, врач отделения анестезиологии и реанимации, ЧУЗ «Клиническая больница «РЖД-Медицина» города Барнаул», Барнаул, Российская Федерация

Neymark Mikhail Izrailevich, Doctor of Medical Sciences, Professor, Head of the Department of Anesthesiology, Resuscitation and Clinical Pharmacology with a course in DPO, FSBOU VO AGMU of the Ministry of Health of Russia,

Barnaul, Russian Federation

Kiselev Roman Vladimirovich, Candidate of Medical Sciences, Assistant of the Department of Anesthesiology, Resuscitation and Clinical Pharmacology with a course of DPO, FSBOU VO AGMU of the Ministry of Health of Russia, Barnaul, Russian Federation

Goncharov Evgeny Vladimirovich, doctor of the Department of Anesthesiology and Resuscitation, CHUZ "Clinical
Hospital "Russian Railways-Medicine" of the city of Barnaul, "Barnaul, Russian Federation

Неймарк Михаил Израилевич, медицина илимдеринин доктору, профессор, ФВЕ курсу менен анестезиология, реанимация жана клиникалык фармакология кафедрасынын башчысы, ФМБССМ ЖБМ АММУ Россия Саламаттык сактоо министрлиги, Барнаул, Россия Федерациясы

Киселев Роман Владимирович, медицина илимдеринин кандидаты, ФМБССМ ЖБМ АММУ Россия Саламаттык сактоо министрлиги, Россия Федерациясы курсу менен анестезиология, реаниматология жана клиникалык фармакология кафедрасынын ассистенти, Барнаул, Россия Федерациясы

Гончаров Евгений Владимирович, анестезиология жана реанимация бөлүмүнүн дарыгери, клиникалык
Россия Федерациясынын Барнаул шаарындагы Барнаул шаарындагы «РЖД-Медицина» ооруканасы

References

1. Huyghe E., Crenn G., Duly-Bouhanick B., Vezzosi D., Bennet A., Atallah F., Mazerolles M., Salloum A., Thoulouzan M., Delaunay B., Grunenwald S., Amar J., Plante P., Chamontin B., Caron P., Soulié M.: Retroperitoneoscopicadrenalectomy: comparison of retrograde and antegrade approach among a series of
279 cases. Urology. 2013;81(1):85-91.
2. He H.C., Dai J., Shen Z.J., Zhu Y., Sun F.K., Shao Y., Zhang R.M., Wang H.F., Rui W.B., Zhong S.: Retroperitoneal adrenalsparing surgery for the treatment of Cushing's syndrome caused by adrenocortical adenoma: 8-year experience with 87 patients.World J Surg. 2012;36(5):1182-8.
3. Shen W.T., Sturgeon C., Duh Q.Y.: From incidentaloma to adrenocortical carcinoma: the surgical management of adrenal tumors. J SurgOncol. 2005;89(3):186-92.
4. Walz M.K., Alesina P.F., Wenger F.A., et al: Posterior retroperitoneoscopicadrenalectomy results of 560 procedures in 520 patients. Surgery. 2006;140(6):943–8
5. Dekkers O.M., Horváth-Puhó E., Jørgensen J.O., Cannegieter S.C., Ehrenstein V., Vandenbroucke J.P., Pereira A.M., Sørensen H.T.: Multisystem morbidity and mortality in Cushing's syndrome: a cohort study.JClinEndocrinolMetab. 2013;98(6):2277-84.
6. Lonser R.R., Nieman L., Oldfield E.H.: Cushing's disease: pathobiology, diagnosis, and management. J. Neurosurg.
2017;126(2):404-417.
7. Chin K. J., Adhikary S., Sarwani N., Forero M. The analgesic efficacy of pre‐operative bilateral erector spinae plane (ESP) blocks in patients having ventral hernia repair. Anaesthesia . 2017 Apr;72(4):452-460. doi: 10.1111/anae.13814.
8. Avidan M. S., M.B., Zhang L., Burnside B. A., Kevin J. Finkel, M.D., Adam C. Searleman, B.S., Jacqueline A. Selvidge, B.S., Leif Saager, M.D., Michelle S. Turner, B.S., Srikar Rao, B.A., Michael Bottros, M.D., Charles Hantler, M.D., Eric Jacobsohn, M.B., Ch.B., Alex S. Evers, M.D. Anesthesia Awareness and the Bispectral Index. N Engl J of Med 2008; 11: 1097-1108.
9. Kopman A., Yee P., Neuman G. Relationship of the Train-offour Fade Ratio to Clinical Signs and Symptoms of Residual Paralysis in Awake Volunteers Anesthesiology. 86(4):765–771, 1997 PMID: 9105219.
10. Gaston-Johanson F., Albert M., Fagan E., Zimmerman L. Similarities in pain description of four different ethnic-culture groups. J.Pain Symptom Manage.1990; 5(2): 94-100.
11. Vadivelu N., Mitra S., Narayan D. Recent advances in postoperative pain management. Yale J. Biol. Med. 2010; 83(1):11–25.

1. Huyghe E., Crenn G., Duly-Bouhanick B., Vezzosi D., Bennet A., Atallah F., Mazerolles M., Salloum A., Thoulouzan M., Delaunay B., Grunenwald S., Amar J., Plante P., Chamontin B., Caron P., Soulié M.: Retroperitoneoscopicadrenalectomy: comparison of retrograde and antegrade approach among a series of
279 cases. Urology. 2013;81(1):85-91.
2. He H.C., Dai J., Shen Z.J., Zhu Y., Sun F.K., Shao Y., Zhang R.M., Wang H.F., Rui W.B., Zhong S.: Retroperitoneal adrenalsparing surgery for the treatment of Cushing's syndrome caused by adrenocortical adenoma: 8-year experience with 87 patients.World J Surg. 2012;36(5):1182-8.
3. Shen W.T., Sturgeon C., Duh Q.Y.: From incidentaloma to adrenocortical carcinoma: the surgical management of adrenal tumors. J SurgOncol. 2005;89(3):186-92.
4. Walz M.K., Alesina P.F., Wenger F.A., et al: Posterior retroperitoneoscopicadrenalectomy results of 560 procedures in 520 patients. Surgery. 2006;140(6):943–8
5. Dekkers O.M., Horváth-Puhó E., Jørgensen J.O., Cannegieter S.C., Ehrenstein V., Vandenbroucke J.P., Pereira A.M., Sørensen H.T.: Multisystem morbidity and mortality in Cushing's syndrome: a cohort study.JClinEndocrinolMetab. 2013;98(6):2277-84.
6. Lonser R.R., Nieman L., Oldfield E.H.: Cushing's disease: pathobiology, diagnosis, and management. J. Neurosurg.
2017;126(2):404-417.
7. Chin K. J., Adhikary S., Sarwani N., Forero M. The analgesic efficacy of pre‐operative bilateral erector spinae plane (ESP) blocks in patients having ventral hernia repair. Anaesthesia . 2017 Apr;72(4):452-460. doi: 10.1111/anae.13814.
8. Avidan M. S., M.B., Zhang L., Burnside B. A., Kevin J. Finkel, M.D., Adam C. Searleman, B.S., Jacqueline A. Selvidge, B.S., Leif Saager, M.D., Michelle S. Turner, B.S., Srikar Rao, B.A., Michael Bottros, M.D., Charles Hantler, M.D., Eric Jacobsohn, M.B., Ch.B., Alex S. Evers, M.D. Anesthesia Awareness and the Bispectral Index. N Engl J of Med 2008; 11: 1097-1108.
9. Kopman A., Yee P., Neuman G. Relationship of the Train-offour Fade Ratio to Clinical Signs and Symptoms of Residual Paralysis in Awake Volunteers Anesthesiology. 86(4):765–771, 1997 PMID: 9105219.
10. Gaston-Johanson F., Albert M., Fagan E., Zimmerman L. Similarities in pain description of four different ethnic-culture groups. J.Pain Symptom Manage.1990; 5(2): 94-100.
11. Vadivelu N., Mitra S., Narayan D. Recent advances in postoperative pain management. Yale J. Biol. Med. 2010; 83(1):11–25.

1. Huyghe E., Crenn G., Duly-Bouhanick B., Vezzosi D., Bennet A., Atallah F., Mazerolles M., Salloum A., Thoulouzan M., Delaunay B., Grunenwald S., Amar J., Plante P., Chamontin B., Caron P., Soulié M.: Retroperitoneoscopicadrenalectomy: comparison of retrograde and antegrade approach among a series of
279 cases. Urology. 2013;81(1):85-91.
2. He H.C., Dai J., Shen Z.J., Zhu Y., Sun F.K., Shao Y., Zhang R.M., Wang H.F., Rui W.B., Zhong S.: Retroperitoneal adrenalsparing surgery for the treatment of Cushing's syndrome caused by adrenocortical adenoma: 8-year experience with 87 patients.World J Surg. 2012;36(5):1182-8.
3. Shen W.T., Sturgeon C., Duh Q.Y.: From incidentaloma to adrenocortical carcinoma: the surgical management of adrenal tumors. J SurgOncol. 2005;89(3):186-92.
4. Walz M.K., Alesina P.F., Wenger F.A., et al: Posterior retroperitoneoscopicadrenalectomy results of 560 procedures in 520 patients. Surgery. 2006;140(6):943–8
5. Dekkers O.M., Horváth-Puhó E., Jørgensen J.O., Cannegieter S.C., Ehrenstein V., Vandenbroucke J.P., Pereira A.M., Sørensen H.T.: Multisystem morbidity and mortality in Cushing's syndrome: a cohort study.JClinEndocrinolMetab. 2013;98(6):2277-84.
6. Lonser R.R., Nieman L., Oldfield E.H.: Cushing's disease: pathobiology, diagnosis, and management. J. Neurosurg.
2017;126(2):404-417.
7. Chin K. J., Adhikary S., Sarwani N., Forero M. The analgesic efficacy of pre‐operative bilateral erector spinae plane (ESP) blocks in patients having ventral hernia repair. Anaesthesia . 2017 Apr;72(4):452-460. doi: 10.1111/anae.13814.
8. Avidan M. S., M.B., Zhang L., Burnside B. A., Kevin J. Finkel, M.D., Adam C. Searleman, B.S., Jacqueline A. Selvidge, B.S., Leif Saager, M.D., Michelle S. Turner, B.S., Srikar Rao, B.A., Michael Bottros, M.D., Charles Hantler, M.D., Eric Jacobsohn, M.B., Ch.B., Alex S. Evers, M.D. Anesthesia Awareness and the Bispectral Index. N Engl J of Med 2008; 11: 1097-1108.
9. Kopman A., Yee P., Neuman G. Relationship of the Train-offour Fade Ratio to Clinical Signs and Symptoms of Residual Paralysis in Awake Volunteers Anesthesiology. 86(4):765–771, 1997 PMID: 9105219.
10. Gaston-Johanson F., Albert M., Fagan E., Zimmerman L. Similarities in pain description of four different ethnic-culture groups. J.Pain Symptom Manage.1990; 5(2): 94-100.
11. Vadivelu N., Mitra S., Narayan D. Recent advances in postoperative pain management. Yale J. Biol. Med. 2010; 83(1):11–25.

Keywords
low flow anesthesia , postoperative analgesia , retroperitoneoscopic adrenalectomy , blockade of the fascial space of the muscle straightening spine
Для цитирования

М.И .Неймарк, Р.В. Киселев, Е.В. Гончаров.Сравнительная оценка методов периоперационной аналгезии при ретроперитонеоскопической адреналэктомии по поводу альдостеромы Научно-практический журнал «Здравоохранение Кыргызстана» 2020 № 4, стр.41; http://www.zdrav.kg/ журнал Здравоохранение Кыргызстана». https://doi.org/10.51350/1694-8068.2020.12.4.41
For citation

M.I. Neymark, R.V. Kiselev, E.V. Goncharov.Comparative evaluation of perioperative analgesia methods in retroperitoneoscopic adrenalectomy for aldosteroma. «Health Care of Kyrgyzstan reseach and practical journal» 2020, № 4 p.41 .; http://www.zdrav.kg/ «Kyrgyzstan Health Journal». https://doi.org/ 10.51350/1694-8068.2020.12.4.41
Цитата үчүн

М.И .Неймарк, Р.В. Киселев, Е.В. Гончаров. Альдостерома боюнча ретроперитоноскопилык адреналэктомияны периоперативдик анальгезия методдорун салыштырмалуу баалоо «Кыргызстандын Cаламаттык Cактоо» илимиий-пратикалык журналы, 2020-жылы, № 4, саны бетти 41 ; http://www.zdrav.kg/журнал « Кыргызстандын саламаттык сактоо». https://doi.org/10.51350/1694-8068.2020.12.4.41
Authors Neymark M.I. , Kiselev R.V., Goncharov E.V.
Link doi.org https://doi.org/ 10.51350/1694-8068.2020.12.4.41
Pages 41-49
Keywords low flow anesthesia, postoperative analgesia, retroperitoneoscopic adrenalectomy, blockade of the fascial space of the muscle straightening spine
Russian
Об авторах

Неймарк Михаил Израилевич, д.м.н., профессор, заведующий кафедрой анестезиологии, реаниматологии и клинической фармакологии с курсом ДПО,ФГБОУ ВО АГМУ Минздрава России, Барнаул, Российская Федерация

Киселев Роман Владимирович, к.м.н., ассистент кафедры анестезиологии, реаниматологии и клинической фармакологии с курсом ДПО, ФГБОУ ВО АГМУ Минздрава России, Барнаул, Российская Федерация

Гончаров Евгений Владимирович, врач отделения анестезиологии и реанимации, ЧУЗ «Клиническая больница «РЖД-Медицина» города Барнаул», Барнаул, Российская Федерация
Полный текст

PDF (RUS)
Список литературы

1. Huyghe E., Crenn G., Duly-Bouhanick B., Vezzosi D., Bennet A., Atallah F., Mazerolles M., Salloum A., Thoulouzan M., Delaunay B., Grunenwald S., Amar J., Plante P., Chamontin B., Caron P., Soulié M.: Retroperitoneoscopicadrenalectomy: comparison of retrograde and antegrade approach among a series of
279 cases. Urology. 2013;81(1):85-91.
2. He H.C., Dai J., Shen Z.J., Zhu Y., Sun F.K., Shao Y., Zhang R.M., Wang H.F., Rui W.B., Zhong S.: Retroperitoneal adrenalsparing surgery for the treatment of Cushing's syndrome caused by adrenocortical adenoma: 8-year experience with 87 patients.World J Surg. 2012;36(5):1182-8.
3. Shen W.T., Sturgeon C., Duh Q.Y.: From incidentaloma to adrenocortical carcinoma: the surgical management of adrenal tumors. J SurgOncol. 2005;89(3):186-92.
4. Walz M.K., Alesina P.F., Wenger F.A., et al: Posterior retroperitoneoscopicadrenalectomy results of 560 procedures in 520 patients. Surgery. 2006;140(6):943–8
5. Dekkers O.M., Horváth-Puhó E., Jørgensen J.O., Cannegieter S.C., Ehrenstein V., Vandenbroucke J.P., Pereira A.M., Sørensen H.T.: Multisystem morbidity and mortality in Cushing's syndrome: a cohort study.JClinEndocrinolMetab. 2013;98(6):2277-84.
6. Lonser R.R., Nieman L., Oldfield E.H.: Cushing's disease: pathobiology, diagnosis, and management. J. Neurosurg.
2017;126(2):404-417.
7. Chin K. J., Adhikary S., Sarwani N., Forero M. The analgesic efficacy of pre‐operative bilateral erector spinae plane (ESP) blocks in patients having ventral hernia repair. Anaesthesia . 2017 Apr;72(4):452-460. doi: 10.1111/anae.13814.
8. Avidan M. S., M.B., Zhang L., Burnside B. A., Kevin J. Finkel, M.D., Adam C. Searleman, B.S., Jacqueline A. Selvidge, B.S., Leif Saager, M.D., Michelle S. Turner, B.S., Srikar Rao, B.A., Michael Bottros, M.D., Charles Hantler, M.D., Eric Jacobsohn, M.B., Ch.B., Alex S. Evers, M.D. Anesthesia Awareness and the Bispectral Index. N Engl J of Med 2008; 11: 1097-1108.
9. Kopman A., Yee P., Neuman G. Relationship of the Train-offour Fade Ratio to Clinical Signs and Symptoms of Residual Paralysis in Awake Volunteers Anesthesiology. 86(4):765–771, 1997 PMID: 9105219.
10. Gaston-Johanson F., Albert M., Fagan E., Zimmerman L. Similarities in pain description of four different ethnic-culture groups. J.Pain Symptom Manage.1990; 5(2): 94-100.
11. Vadivelu N., Mitra S., Narayan D. Recent advances in postoperative pain management. Yale J. Biol. Med. 2010; 83(1):11–25.
Для цитирования

М.И .Неймарк, Р.В. Киселев, Е.В. Гончаров.Сравнительная оценка методов периоперационной аналгезии при ретроперитонеоскопической адреналэктомии по поводу альдостеромы Научно-практический журнал «Здравоохранение Кыргызстана» 2020 № 4, стр.41; http://www.zdrav.kg/ журнал Здравоохранение Кыргызстана». https://doi.org/10.51350/1694-8068.2020.12.4.41
English
About authors

Neymark Mikhail Izrailevich, Doctor of Medical Sciences, Professor, Head of the Department of Anesthesiology, Resuscitation and Clinical Pharmacology with a course in DPO, FSBOU VO AGMU of the Ministry of Health of Russia,

Barnaul, Russian Federation

Kiselev Roman Vladimirovich, Candidate of Medical Sciences, Assistant of the Department of Anesthesiology, Resuscitation and Clinical Pharmacology with a course of DPO, FSBOU VO AGMU of the Ministry of Health of Russia, Barnaul, Russian Federation

Goncharov Evgeny Vladimirovich, doctor of the Department of Anesthesiology and Resuscitation, CHUZ "Clinical
Hospital "Russian Railways-Medicine" of the city of Barnaul, "Barnaul, Russian Federation
References

1. Huyghe E., Crenn G., Duly-Bouhanick B., Vezzosi D., Bennet A., Atallah F., Mazerolles M., Salloum A., Thoulouzan M., Delaunay B., Grunenwald S., Amar J., Plante P., Chamontin B., Caron P., Soulié M.: Retroperitoneoscopicadrenalectomy: comparison of retrograde and antegrade approach among a series of
279 cases. Urology. 2013;81(1):85-91.
2. He H.C., Dai J., Shen Z.J., Zhu Y., Sun F.K., Shao Y., Zhang R.M., Wang H.F., Rui W.B., Zhong S.: Retroperitoneal adrenalsparing surgery for the treatment of Cushing's syndrome caused by adrenocortical adenoma: 8-year experience with 87 patients.World J Surg. 2012;36(5):1182-8.
3. Shen W.T., Sturgeon C., Duh Q.Y.: From incidentaloma to adrenocortical carcinoma: the surgical management of adrenal tumors. J SurgOncol. 2005;89(3):186-92.
4. Walz M.K., Alesina P.F., Wenger F.A., et al: Posterior retroperitoneoscopicadrenalectomy results of 560 procedures in 520 patients. Surgery. 2006;140(6):943–8
5. Dekkers O.M., Horváth-Puhó E., Jørgensen J.O., Cannegieter S.C., Ehrenstein V., Vandenbroucke J.P., Pereira A.M., Sørensen H.T.: Multisystem morbidity and mortality in Cushing's syndrome: a cohort study.JClinEndocrinolMetab. 2013;98(6):2277-84.
6. Lonser R.R., Nieman L., Oldfield E.H.: Cushing's disease: pathobiology, diagnosis, and management. J. Neurosurg.
2017;126(2):404-417.
7. Chin K. J., Adhikary S., Sarwani N., Forero M. The analgesic efficacy of pre‐operative bilateral erector spinae plane (ESP) blocks in patients having ventral hernia repair. Anaesthesia . 2017 Apr;72(4):452-460. doi: 10.1111/anae.13814.
8. Avidan M. S., M.B., Zhang L., Burnside B. A., Kevin J. Finkel, M.D., Adam C. Searleman, B.S., Jacqueline A. Selvidge, B.S., Leif Saager, M.D., Michelle S. Turner, B.S., Srikar Rao, B.A., Michael Bottros, M.D., Charles Hantler, M.D., Eric Jacobsohn, M.B., Ch.B., Alex S. Evers, M.D. Anesthesia Awareness and the Bispectral Index. N Engl J of Med 2008; 11: 1097-1108.
9. Kopman A., Yee P., Neuman G. Relationship of the Train-offour Fade Ratio to Clinical Signs and Symptoms of Residual Paralysis in Awake Volunteers Anesthesiology. 86(4):765–771, 1997 PMID: 9105219.
10. Gaston-Johanson F., Albert M., Fagan E., Zimmerman L. Similarities in pain description of four different ethnic-culture groups. J.Pain Symptom Manage.1990; 5(2): 94-100.
11. Vadivelu N., Mitra S., Narayan D. Recent advances in postoperative pain management. Yale J. Biol. Med. 2010; 83(1):11–25.
For citation

M.I. Neymark, R.V. Kiselev, E.V. Goncharov.Comparative evaluation of perioperative analgesia methods in retroperitoneoscopic adrenalectomy for aldosteroma. «Health Care of Kyrgyzstan reseach and practical journal» 2020, № 4 p.41 .; http://www.zdrav.kg/ «Kyrgyzstan Health Journal». https://doi.org/ 10.51350/1694-8068.2020.12.4.41
Kyrgyz
Авторлор жөнүндө

Неймарк Михаил Израилевич, медицина илимдеринин доктору, профессор, ФВЕ курсу менен анестезиология, реанимация жана клиникалык фармакология кафедрасынын башчысы, ФМБССМ ЖБМ АММУ Россия Саламаттык сактоо министрлиги, Барнаул, Россия Федерациясы

Киселев Роман Владимирович, медицина илимдеринин кандидаты, ФМБССМ ЖБМ АММУ Россия Саламаттык сактоо министрлиги, Россия Федерациясы курсу менен анестезиология, реаниматология жана клиникалык фармакология кафедрасынын ассистенти, Барнаул, Россия Федерациясы

Гончаров Евгений Владимирович, анестезиология жана реанимация бөлүмүнүн дарыгери, клиникалык
Россия Федерациясынын Барнаул шаарындагы Барнаул шаарындагы «РЖД-Медицина» ооруканасы
Шилтемелер

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Цитата үчүн

М.И .Неймарк, Р.В. Киселев, Е.В. Гончаров. Альдостерома боюнча ретроперитоноскопилык адреналэктомияны периоперативдик анальгезия методдорун салыштырмалуу баалоо «Кыргызстандын Cаламаттык Cактоо» илимиий-пратикалык журналы, 2020-жылы, № 4, саны бетти 41 ; http://www.zdrav.kg/журнал « Кыргызстандын саламаттык сактоо». https://doi.org/10.51350/1694-8068.2020.12.4.41
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