Pub Date : 2023-05-25DOI: 10.35401/2541-9897-2023-26-2-28-33
M. P. Ivanova, V. A. Koriachkin, M. D. Ivanov, Yu. P. Malyshev, V. A. Zhikharev
Background: 90% of C-sections are supported by spinal anesthesia, which is complicated by arterial hypotension in 60%-80% of cases. The perfusion index seems to be a significant prognostic tool for arterial hypotension. Objective: Тo confirm the value of perfusion index in predicting arterial hypotension associated with the spinal anesthesia. Materials and methods: The study included 105 female patients who underwent С-section under spinal anesthesia. A decrease in mean arterial pressure by ≤ 20% was considered as arterial hypotension. Baseline perfusion index was assessed with a pulse oximeter. Results: 68 patients (64.8%) developed arterial hypotension in the intraoperative period. In 37 (35.2%) parturient women there were no significant changes in blood pressure. A cut-off threshold of 3.1 with 75% sensitivity and 75% specificity was obtained with the ROC analysis. Arterial hypotension developed in 29.4% (n = 15) of parturient women with a perfusion index < 3.1 and in 72.2% (n = 39) of parturient women with a perfusion index > 3.1. Conclusions: We can use the perfusion index threshold of 3.1 to identify parturient women with an increased risk of arterial hypotension associated with the spinal anesthesia for C-section. The arterial hypotension rate is significantly higher in women with an initial perfusion index > 3.1 compared with those with an initial perfusion index < 3.1.
{"title":"Prediction of intraoperative arterial hypotension associated with the spinal anesthesia. Prospective observational study","authors":"M. P. Ivanova, V. A. Koriachkin, M. D. Ivanov, Yu. P. Malyshev, V. A. Zhikharev","doi":"10.35401/2541-9897-2023-26-2-28-33","DOIUrl":"https://doi.org/10.35401/2541-9897-2023-26-2-28-33","url":null,"abstract":"Background: 90% of C-sections are supported by spinal anesthesia, which is complicated by arterial hypotension in 60%-80% of cases. The perfusion index seems to be a significant prognostic tool for arterial hypotension. Objective: Тo confirm the value of perfusion index in predicting arterial hypotension associated with the spinal anesthesia. Materials and methods: The study included 105 female patients who underwent С-section under spinal anesthesia. A decrease in mean arterial pressure by ≤ 20% was considered as arterial hypotension. Baseline perfusion index was assessed with a pulse oximeter. Results: 68 patients (64.8%) developed arterial hypotension in the intraoperative period. In 37 (35.2%) parturient women there were no significant changes in blood pressure. A cut-off threshold of 3.1 with 75% sensitivity and 75% specificity was obtained with the ROC analysis. Arterial hypotension developed in 29.4% (n = 15) of parturient women with a perfusion index < 3.1 and in 72.2% (n = 39) of parturient women with a perfusion index > 3.1. Conclusions: We can use the perfusion index threshold of 3.1 to identify parturient women with an increased risk of arterial hypotension associated with the spinal anesthesia for C-section. The arterial hypotension rate is significantly higher in women with an initial perfusion index > 3.1 compared with those with an initial perfusion index < 3.1.","PeriodicalId":34355,"journal":{"name":"Innovatsionnaia meditsina Kubani","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-05-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"136346055","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-05-25DOI: 10.35401/2541-9897-2023-26-2-40-46
A. V. Pomortsev, K. A. Bagdasaryan, A. N. Sencha
Background: Despite the high prevalence of internal carotid artery (ICA) anomalies, there is still no consensus on which parameters should be used to evaluate their local hemodynamics and what significance each parameter holds. Objective: To determine the significance of various ultrasound parameters for evaluating the local hemodynamics of ICA anomalies. Materials and methods: In our cross-sectional observational study 427 outpatients underwent carotid ultrasound. To evaluate the significance of various ultrasound parameters for local hemodynamics assessment, we used a cluster analysis for the entire sample (n = 386), taking into account the deformation coefficient, angle of deformation, blood flow turbulence at the site of maximum deformation, and peak blood flow velocity at the site of maximum deformation. Based on the cluster analysis results, we did a discriminant function analysis. Results: During the clustering of patients from the total sample (n = 386), 3 clusters were formed. We did a discriminant function analysis to evaluate the indicators used. We found that all of them had a small Wilks’ Lambda indicating their greater discriminatory ability. The deformation coefficient was the most significant parameter as it had the smallest value (0.26). “Tolerance” analysis showed that the deformation coefficient is the most independent indicator (0.67). Conclusions: Our study showed that the most significant and independent parameter for evaluating the local hemodynamics of ICA anomalies is the deformation coefficient, with the blood flow turbulence being the least significant parameter.
{"title":"Ultrasound parameters for evaluating local hemodynamics of internal carotid artery anomalies","authors":"A. V. Pomortsev, K. A. Bagdasaryan, A. N. Sencha","doi":"10.35401/2541-9897-2023-26-2-40-46","DOIUrl":"https://doi.org/10.35401/2541-9897-2023-26-2-40-46","url":null,"abstract":"Background: Despite the high prevalence of internal carotid artery (ICA) anomalies, there is still no consensus on which parameters should be used to evaluate their local hemodynamics and what significance each parameter holds. Objective: To determine the significance of various ultrasound parameters for evaluating the local hemodynamics of ICA anomalies. Materials and methods: In our cross-sectional observational study 427 outpatients underwent carotid ultrasound. To evaluate the significance of various ultrasound parameters for local hemodynamics assessment, we used a cluster analysis for the entire sample (n = 386), taking into account the deformation coefficient, angle of deformation, blood flow turbulence at the site of maximum deformation, and peak blood flow velocity at the site of maximum deformation. Based on the cluster analysis results, we did a discriminant function analysis. Results: During the clustering of patients from the total sample (n = 386), 3 clusters were formed. We did a discriminant function analysis to evaluate the indicators used. We found that all of them had a small Wilks’ Lambda indicating their greater discriminatory ability. The deformation coefficient was the most significant parameter as it had the smallest value (0.26). “Tolerance” analysis showed that the deformation coefficient is the most independent indicator (0.67). Conclusions: Our study showed that the most significant and independent parameter for evaluating the local hemodynamics of ICA anomalies is the deformation coefficient, with the blood flow turbulence being the least significant parameter.","PeriodicalId":34355,"journal":{"name":"Innovatsionnaia meditsina Kubani","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-05-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"136345960","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-05-25DOI: 10.35401/2541-9897-2023-26-2-34-39
V. A. Lipatov, K. S. Tsilenko, A. A. Denisov, P. D. Kondakova
Introduction: In modern clinical practice, there is no common and effective hemostatic agent for solid organs of the abdomen. Local agents such as hemostatic sponges, membranes, powders seem promising. The main advantages of hemostatic powders include relatively high efficacy, portability, versatility, as well as simplicity and low cost of manufacturing. Objective: To study the hemostatic efficacy of hemostatic powders’ samples based on the sodium salt of carboxymethylcellulose (Na-CMC) in an acute in vivo experiment. Materials and methods: The study was based at Kursk State Medical University. Fifty male Wistar rats (weighing 220-239 g) were selected as test animals. They were evenly divided into 5 groups: ARISTA AH, Cutanplast Powder, and Na-CMC hemostatic powders with 3 different dynamic viscosities: low (50-200 cP), medium (400-800 cP) and high (1500-3000 cP). Under general inhalation anesthesia, median laparotomy was performed in Wistar rats, the middle lobe of the liver was removed into the wound, and then marginal tangential resection was performed. We applied hemostatic powders of each group to the resulting wound, and then estimated the bleeding time and the volume of blood loss. We used the Mann-Whitney test (P ≤ .05) to assess the statistical significance of differences between the study groups. Results: We recorded the minimum bleeding time and the smallest volume of blood loss for the samples based on the Na-CMC and found no statistically significant differences between the viscosities groups. Conclusions: With Na-CMC hemostatic powder the bleeding time and the volume of blood loss were reduced by 3.6 and 2.2 times, respectively, comparing to the control group. These results were considered statistically significant (P ≤ .05).
{"title":"Studying the Efficacy of Local Hemostatic Agents In Vivo","authors":"V. A. Lipatov, K. S. Tsilenko, A. A. Denisov, P. D. Kondakova","doi":"10.35401/2541-9897-2023-26-2-34-39","DOIUrl":"https://doi.org/10.35401/2541-9897-2023-26-2-34-39","url":null,"abstract":"Introduction: In modern clinical practice, there is no common and effective hemostatic agent for solid organs of the abdomen. Local agents such as hemostatic sponges, membranes, powders seem promising. The main advantages of hemostatic powders include relatively high efficacy, portability, versatility, as well as simplicity and low cost of manufacturing. Objective: To study the hemostatic efficacy of hemostatic powders’ samples based on the sodium salt of carboxymethylcellulose (Na-CMC) in an acute in vivo experiment. Materials and methods: The study was based at Kursk State Medical University. Fifty male Wistar rats (weighing 220-239 g) were selected as test animals. They were evenly divided into 5 groups: ARISTA AH, Cutanplast Powder, and Na-CMC hemostatic powders with 3 different dynamic viscosities: low (50-200 cP), medium (400-800 cP) and high (1500-3000 cP). Under general inhalation anesthesia, median laparotomy was performed in Wistar rats, the middle lobe of the liver was removed into the wound, and then marginal tangential resection was performed. We applied hemostatic powders of each group to the resulting wound, and then estimated the bleeding time and the volume of blood loss. We used the Mann-Whitney test (P ≤ .05) to assess the statistical significance of differences between the study groups. Results: We recorded the minimum bleeding time and the smallest volume of blood loss for the samples based on the Na-CMC and found no statistically significant differences between the viscosities groups. Conclusions: With Na-CMC hemostatic powder the bleeding time and the volume of blood loss were reduced by 3.6 and 2.2 times, respectively, comparing to the control group. These results were considered statistically significant (P ≤ .05).","PeriodicalId":34355,"journal":{"name":"Innovatsionnaia meditsina Kubani","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-05-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"136346058","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-05-24DOI: 10.35401/2541-9897-2023-26-2-13-20
N. V. Krepkogorskiy, R. A. Bredikhin
Objective: To study immediate and long-term results of the tibioperoneal trunk repair (plastic reconstruction or prosthetic repair) during femoropopliteal bypass. Materials and methods: In our retrospective cohort study we analyzed surgical treatment results of 109 patients with lower extremities atherosclerosis who were treated in the Vascular Surgery Unit of Interregional Clinical Diagnostic Center (Kazan, Russian Federation) from 2018 to 2020. 26 (23.8%) patients were hospitalized for stage IB-IIA acute arterial insufficiency with atherothrombosis, and 83 (76.1%) patients were admitted with critical limb ischemia (CLI) as a result of advanced atherosclerosis. Among the CLI patients, 43 (39.4%) of them had stage III chronic arterial insufficiency, and 40 (36.7%) patients had stage IV chronic arterial insufficiency. The study selection criteria included extensive femoral and popliteal arteries disease and significant stenosis or occlusion of the tibioperoneal trunk. TASC II type C lesions were detected in 2 (1.8%) patients, while 107 (98.2%) patients were diagnosed with TASC II type D lesions. Based on the GLASS classification, all 109 (100%) patients had FP grade 3-4 femoropopliteal lesions with concomitant IP grade 1-4 tibial lesion. The main group included 24 (22%) patients who underwent femoropopliteal bypass with plastic or prosthetic repair of the tibioperoneal trunk using an original technique. The control group included 85 (78%) patients who underwent bypass surgery without the tibioperoneal trunk repair. Isolated femorotibial bypass was performed in 7 (8.2%) patients, and 78 (91.7%) patients underwent femoropopliteal bypass with a reversed autogenous vein. Results: We followed up patients for 2 years after surgery. Immediate technical success was 97.24% (106/109). Graft thrombosis was reported in 3 cases. No difference between the groups was observed. Long-term graft patency was significantly higher in the main group (P = .044) and significantly associated with age (RR = 0.96; 95% CI of 0.92 to 1.00, P = .03), type 2 diabetes mellitus (RR = 2.10; 95% CI of 1.10 to 4.10, P = .03), and history of the tibioperoneal trunk repair (RR = 0.43; 95% CI of 0.18 to 1.00, P = .06). Variables associated with patency in the univariate regression at a significance level P ≤ .1 were included in a multivariate model that demonstrated the combined effect of predictors on the outcome. Conclusions: Femoropopliteal bypass with the tibioperoneal trunk repair improves treatment results in patients with extensive peripheral artery disease and immediately threatened limbs or a threat to a limb within 2 years.
{"title":"Results of the tibioperoneal trunk repair in patients with advanced atherosclerosis","authors":"N. V. Krepkogorskiy, R. A. Bredikhin","doi":"10.35401/2541-9897-2023-26-2-13-20","DOIUrl":"https://doi.org/10.35401/2541-9897-2023-26-2-13-20","url":null,"abstract":"Objective: To study immediate and long-term results of the tibioperoneal trunk repair (plastic reconstruction or prosthetic repair) during femoropopliteal bypass. Materials and methods: In our retrospective cohort study we analyzed surgical treatment results of 109 patients with lower extremities atherosclerosis who were treated in the Vascular Surgery Unit of Interregional Clinical Diagnostic Center (Kazan, Russian Federation) from 2018 to 2020. 26 (23.8%) patients were hospitalized for stage IB-IIA acute arterial insufficiency with atherothrombosis, and 83 (76.1%) patients were admitted with critical limb ischemia (CLI) as a result of advanced atherosclerosis. Among the CLI patients, 43 (39.4%) of them had stage III chronic arterial insufficiency, and 40 (36.7%) patients had stage IV chronic arterial insufficiency. The study selection criteria included extensive femoral and popliteal arteries disease and significant stenosis or occlusion of the tibioperoneal trunk. TASC II type C lesions were detected in 2 (1.8%) patients, while 107 (98.2%) patients were diagnosed with TASC II type D lesions. Based on the GLASS classification, all 109 (100%) patients had FP grade 3-4 femoropopliteal lesions with concomitant IP grade 1-4 tibial lesion. The main group included 24 (22%) patients who underwent femoropopliteal bypass with plastic or prosthetic repair of the tibioperoneal trunk using an original technique. The control group included 85 (78%) patients who underwent bypass surgery without the tibioperoneal trunk repair. Isolated femorotibial bypass was performed in 7 (8.2%) patients, and 78 (91.7%) patients underwent femoropopliteal bypass with a reversed autogenous vein. Results: We followed up patients for 2 years after surgery. Immediate technical success was 97.24% (106/109). Graft thrombosis was reported in 3 cases. No difference between the groups was observed. Long-term graft patency was significantly higher in the main group (P = .044) and significantly associated with age (RR = 0.96; 95% CI of 0.92 to 1.00, P = .03), type 2 diabetes mellitus (RR = 2.10; 95% CI of 1.10 to 4.10, P = .03), and history of the tibioperoneal trunk repair (RR = 0.43; 95% CI of 0.18 to 1.00, P = .06). Variables associated with patency in the univariate regression at a significance level P ≤ .1 were included in a multivariate model that demonstrated the combined effect of predictors on the outcome. Conclusions: Femoropopliteal bypass with the tibioperoneal trunk repair improves treatment results in patients with extensive peripheral artery disease and immediately threatened limbs or a threat to a limb within 2 years.","PeriodicalId":34355,"journal":{"name":"Innovatsionnaia meditsina Kubani","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-05-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135138764","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-05-24DOI: 10.35401/2541-9897-2023-26-2-5-12
D. A. Sokolov, A. L. Tymoshenko, Yu. V. Chervyakov, O. M. Lonchakova, P. A. Ljuboshevskij
Objective: To compare predictive accuracy of the American Society of Anesthesiologists (ASA) score and various cardiac risk indices for perioperative cardiovascular (CV) complications in patients undergoing noncardiac surgery. Materials and methods: We examined 243 patients (148 men and 95 women) aged 45 to 84 (66 [60-71] years) prior to their elective oncological and vascular surgery. We assessed patients using the ASA physical status classification system, Revised Cardiac Risk Index (RCRI), Gupta Myocardial Infarct or Cardiac Arrest (MICA) calculator, and Khoronenko cardiac risk index and analyzed perioperative CV complications. Results: We detected complications in 30 (12.3%) patients, with 3 (1.24%) of them having 2 concomitant CV complications. One death (0.41%) was registered. The MICA risk calculator had the highest predictive value (AUC ROC = 0.753). Risk scores over 0.95% discriminated patients with perioperative CV complications with sensitivity and specificity of 73.3% and 67.45%, respectively. Conclusions: We recommend using the MICA risk calculator to predict perioperative CV complications following elective oncological and vascular surgery.
{"title":"Predictive accuracy of cardiac risk indices for cardiovascular complications in patients undergoing noncardiac surgery","authors":"D. A. Sokolov, A. L. Tymoshenko, Yu. V. Chervyakov, O. M. Lonchakova, P. A. Ljuboshevskij","doi":"10.35401/2541-9897-2023-26-2-5-12","DOIUrl":"https://doi.org/10.35401/2541-9897-2023-26-2-5-12","url":null,"abstract":"Objective: To compare predictive accuracy of the American Society of Anesthesiologists (ASA) score and various cardiac risk indices for perioperative cardiovascular (CV) complications in patients undergoing noncardiac surgery. Materials and methods: We examined 243 patients (148 men and 95 women) aged 45 to 84 (66 [60-71] years) prior to their elective oncological and vascular surgery. We assessed patients using the ASA physical status classification system, Revised Cardiac Risk Index (RCRI), Gupta Myocardial Infarct or Cardiac Arrest (MICA) calculator, and Khoronenko cardiac risk index and analyzed perioperative CV complications. Results: We detected complications in 30 (12.3%) patients, with 3 (1.24%) of them having 2 concomitant CV complications. One death (0.41%) was registered. The MICA risk calculator had the highest predictive value (AUC ROC = 0.753). Risk scores over 0.95% discriminated patients with perioperative CV complications with sensitivity and specificity of 73.3% and 67.45%, respectively. Conclusions: We recommend using the MICA risk calculator to predict perioperative CV complications following elective oncological and vascular surgery.","PeriodicalId":34355,"journal":{"name":"Innovatsionnaia meditsina Kubani","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-05-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135141003","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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