Pub Date : 2024-06-14DOI: 10.24884/2078-5658-2024-21-3-99-108
Yu. V. Bykov, A. N. Obedin, A. P. Vorobyova, J. A. Kushkhova
The objective was to describe a case of cerebral edema (CE) in an adolescent patient with type 1 diabetes mellitus (DM) complicated with diabetic ketoacidosis (DKA), and to perform an analysis and review of publications devoted to this topic.Materials and methods. We describe the rare clinical case of CE complicated with DKA in the 14-year-old adolescent patient, including the dynamics of the patient’s clinical condition and laboratory test results. The topic of interest was researched through analysis of publications found in the Cochrane Library, PubMed, eLibrary.ru and Medscape databases using the following search terms: diabetic ketoacidosis, children and adolescents, cerebral edema, intensive therapy. A total of 38 publications in Russian and English were selected for being fully compliant with the purpose of this work. The features of the reported clinical case were analyzed and compared with information obtained from the current scientific literature.Results: This case demonstrates specific features presenting in the course of CE and describes aspects of the intensive treatment provided to the patient. Manifestations of severe hypokalemia and hypernatremia have been recorded as rare electrolyte disturbances in CE in the adolescent with DKA. The report demonstrates that the steps and specific parameters of the provided intensive treatment are unlikely to have triggered the development of CE in the clinic in this particular clinical case. It cannot be ruled out that the development of this complication was triggered by the delayed initiation of treatment (caused by the patient) at the prehospital stage, including the patient’s rude noncompliance with the prescribed insulin treatment scheme.Conclusions. CE is the rare but severe (with a high fatality rate) complication of DKA in patients with type 1 DM. Timely initiation of emergency care for CE may reduce risks associated with this complication and improve treatment outcomes and patient prognosis.
目的是描述1型糖尿病（DM）青少年患者并发糖尿病酮症酸中毒（DKA）的脑水肿（CE）病例，并对有关该主题的出版物进行分析和回顾。我们描述了 14 岁青少年患者并发糖尿病酮症酸中毒的罕见临床病例，包括患者的临床病情动态和实验室检查结果。通过分析 Cochrane 图书馆、PubMed、eLibrary.ru 和 Medscape 数据库中的出版物，使用以下检索词对相关主题进行了研究：糖尿病酮症酸中毒、儿童和青少年、脑水肿、强化治疗。共选取了 38 篇完全符合本研究目的的俄文和英文出版物。分析了所报告临床病例的特征，并将其与从当前科学文献中获得的信息进行了比较：结果：该病例显示了 CE 病程中出现的特殊特征，并描述了为患者提供的强化治疗的各个方面。严重的低钾血症和高钠血症在患有 DKA 的青少年 CE 中表现为罕见的电解质紊乱。报告显示，在这个特殊的临床病例中，强化治疗的步骤和具体参数不太可能引发 CE。不能排除这一并发症的发生是由于患者在入院前阶段延迟开始治疗（由患者引起），包括患者粗暴地不遵守规定的胰岛素治疗方案而引发的。CE是1型糖尿病患者DKA罕见但严重（致死率高）的并发症。针对 CE 及时启动急救可降低与该并发症相关的风险，改善治疗效果和患者预后。
{"title":"Cerebral edema in an adolescent patient with diabetic ketoacidosis: a case report with a review of literature","authors":"Yu. V. Bykov, A. N. Obedin, A. P. Vorobyova, J. A. Kushkhova","doi":"10.24884/2078-5658-2024-21-3-99-108","DOIUrl":"https://doi.org/10.24884/2078-5658-2024-21-3-99-108","url":null,"abstract":"The objective was to describe a case of cerebral edema (CE) in an adolescent patient with type 1 diabetes mellitus (DM) complicated with diabetic ketoacidosis (DKA), and to perform an analysis and review of publications devoted to this topic.Materials and methods. We describe the rare clinical case of CE complicated with DKA in the 14-year-old adolescent patient, including the dynamics of the patient’s clinical condition and laboratory test results. The topic of interest was researched through analysis of publications found in the Cochrane Library, PubMed, eLibrary.ru and Medscape databases using the following search terms: diabetic ketoacidosis, children and adolescents, cerebral edema, intensive therapy. A total of 38 publications in Russian and English were selected for being fully compliant with the purpose of this work. The features of the reported clinical case were analyzed and compared with information obtained from the current scientific literature.Results: This case demonstrates specific features presenting in the course of CE and describes aspects of the intensive treatment provided to the patient. Manifestations of severe hypokalemia and hypernatremia have been recorded as rare electrolyte disturbances in CE in the adolescent with DKA. The report demonstrates that the steps and specific parameters of the provided intensive treatment are unlikely to have triggered the development of CE in the clinic in this particular clinical case. It cannot be ruled out that the development of this complication was triggered by the delayed initiation of treatment (caused by the patient) at the prehospital stage, including the patient’s rude noncompliance with the prescribed insulin treatment scheme.Conclusions. CE is the rare but severe (with a high fatality rate) complication of DKA in patients with type 1 DM. Timely initiation of emergency care for CE may reduce risks associated with this complication and improve treatment outcomes and patient prognosis.","PeriodicalId":506088,"journal":{"name":"Messenger of ANESTHESIOLOGY AND RESUSCITATION","volume":"45 13","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-06-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141339746","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 : 2024-06-14DOI: 10.24884/2078-5658-2024-21-3-34-41
T. N. Semenkova, A. M. Nikonov, A. A. Smetkin, V. Kuzkov, M. Kirov
The objective was to assess the disease rate, prevalence of risk factors, diagnostic and management methods as well as outcomes in patients with acute mesenteric ischemia (AMI).Materials and methods. During 10 months in 2022-2023, the study included all patients with probable or confirmed diagnosis of AMI, in whom we recorded the presence of known risk factors, clinical and laboratory manifestations of AMI, methods of its diagnosis, management and outcomes within one year.Results. Totally, 705 patients from 32 centers were included in the work, among whom 418 patients were diagnosed with AMI. In Arkhangelsk, 39 patients (mean age – 73 years) were included into the study. According to results of the center in Arkhangelsk, the diagnosis of AMI was confirmed in 69% of patients, while the incidence among all hospitalized was 0.13%. None of the known risk factors (smoking, atrial fibrillation, atherosclerosis, arterial hypertension, previous myocardial infarction and thromboembolic complications) demonstrated a significant statistical association with the development of AMI. Among clinical manifestations, patients with confirmed AMI more likely developed signs of shock compared to patients with unconfirmed AMI (p = 0.028). Laboratory parameters did not differ significantly in both groups; however, in AMI non-survivors, we observed higher blood lactate concentrations. In most cases with confirmed AMI, the diagnosis was established during surgery. In 72% of cases, the situation was assessed as incurable; in 24% of patients, intestinal resection was performed. Mortality in patients with confirmed AMI was 78%.Conclusion. The lack of clear predictors of the disease, specific clinical signs of AMI and available laboratory tests often leads to delay in diagnosis and appropriate management, which causes significant mortality. Further analysis of the data is necessary to improve diagnosis and the results of treatment of the patients with AMI.
{"title":"The prospective multicenter observational study of acute mesenteric ischemia (AMeSI): the results of the Arkhangelsk center","authors":"T. N. Semenkova, A. M. Nikonov, A. A. Smetkin, V. Kuzkov, M. Kirov","doi":"10.24884/2078-5658-2024-21-3-34-41","DOIUrl":"https://doi.org/10.24884/2078-5658-2024-21-3-34-41","url":null,"abstract":"The objective was to assess the disease rate, prevalence of risk factors, diagnostic and management methods as well as outcomes in patients with acute mesenteric ischemia (AMI).Materials and methods. During 10 months in 2022-2023, the study included all patients with probable or confirmed diagnosis of AMI, in whom we recorded the presence of known risk factors, clinical and laboratory manifestations of AMI, methods of its diagnosis, management and outcomes within one year.Results. Totally, 705 patients from 32 centers were included in the work, among whom 418 patients were diagnosed with AMI. In Arkhangelsk, 39 patients (mean age – 73 years) were included into the study. According to results of the center in Arkhangelsk, the diagnosis of AMI was confirmed in 69% of patients, while the incidence among all hospitalized was 0.13%. None of the known risk factors (smoking, atrial fibrillation, atherosclerosis, arterial hypertension, previous myocardial infarction and thromboembolic complications) demonstrated a significant statistical association with the development of AMI. Among clinical manifestations, patients with confirmed AMI more likely developed signs of shock compared to patients with unconfirmed AMI (p = 0.028). Laboratory parameters did not differ significantly in both groups; however, in AMI non-survivors, we observed higher blood lactate concentrations. In most cases with confirmed AMI, the diagnosis was established during surgery. In 72% of cases, the situation was assessed as incurable; in 24% of patients, intestinal resection was performed. Mortality in patients with confirmed AMI was 78%.Conclusion. The lack of clear predictors of the disease, specific clinical signs of AMI and available laboratory tests often leads to delay in diagnosis and appropriate management, which causes significant mortality. Further analysis of the data is necessary to improve diagnosis and the results of treatment of the patients with AMI.","PeriodicalId":506088,"journal":{"name":"Messenger of ANESTHESIOLOGY AND RESUSCITATION","volume":"40 2","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-06-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141339935","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 : 2024-06-14DOI: 10.24884/2078-5658-2024-21-3-93-98
O. Pulkina, D. V. Nizolin, Zh. Zh. Sholahov, A. A. Zhaigalov, A. V. Kim, G. N. Kasenova, O. O. Shmeleva
The objective was to demonstrate the possibility of performing awake craniotomy in a child.Materials and methods. The 9-year-old child with a dysembrioplastic neuroepithelial tumor in the left temporal lobe was planned and performed awake craniotomy. During awakening, the child performed a naming test, object designation tests, word repetition and spontaneous speech, and Luria’s test.Results. During psychological tests and intraoperative neuromonitoring, it was possible to successfully identify the speech zone and motor areas of the face, which helped to safely remove brain formation without complications. This clinical case was also interesting because the child’s native language was Kazakh, so an interpreter was presented during the intraoperative awakening.Conclusions. The case demonstrates the possibility of performing awake craniotomy in a child, which depends not only on the somatic and psychological state, but also on the professionalism of the operating team, including surgeons, anesthesiologists, neurophysiologist, neuropsychologist and a large number of nursing staff who are able to clearly interact with each other.
{"title":"Experience of awake craniotomy in a child (clinical case)","authors":"O. Pulkina, D. V. Nizolin, Zh. Zh. Sholahov, A. A. Zhaigalov, A. V. Kim, G. N. Kasenova, O. O. Shmeleva","doi":"10.24884/2078-5658-2024-21-3-93-98","DOIUrl":"https://doi.org/10.24884/2078-5658-2024-21-3-93-98","url":null,"abstract":"The objective was to demonstrate the possibility of performing awake craniotomy in a child.Materials and methods. The 9-year-old child with a dysembrioplastic neuroepithelial tumor in the left temporal lobe was planned and performed awake craniotomy. During awakening, the child performed a naming test, object designation tests, word repetition and spontaneous speech, and Luria’s test.Results. During psychological tests and intraoperative neuromonitoring, it was possible to successfully identify the speech zone and motor areas of the face, which helped to safely remove brain formation without complications. This clinical case was also interesting because the child’s native language was Kazakh, so an interpreter was presented during the intraoperative awakening.Conclusions. The case demonstrates the possibility of performing awake craniotomy in a child, which depends not only on the somatic and psychological state, but also on the professionalism of the operating team, including surgeons, anesthesiologists, neurophysiologist, neuropsychologist and a large number of nursing staff who are able to clearly interact with each other.","PeriodicalId":506088,"journal":{"name":"Messenger of ANESTHESIOLOGY AND RESUSCITATION","volume":"33 36","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-06-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141340364","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 : 2024-06-14DOI: 10.24884/2078-5658-2024-21-3-26-33
M. A. Tyo, N. O. Kamenshchikov, Y. Podoksenov, A. Mukhomedzyanov, L. N. Maslov, I. V. Kravchenko, E. A. Churilina, B. N. Kozlov
The objective was to study the effect of the delivery of exogenous nitric oxide on the severity of apoptosis, pyroptosis, and necroptosis of the renal parenchyma after simulating cardiopulmonary bypass and cardiopulmonary bypass with circulatory arrest.Materials and Methods. 24 Altai breed rams were randomized into 4 equal groups. In the CPB and CPB+NO groups, we simulated cardiopulmonary bypass without circulatory arrest. In the CPB+CA and CPB+CA+NO groups, we simulated cardiopulmonary bypass with circulatory arrest. In the CPB+NO, CPB+CA+NO groups, NO was given perioperative in concentration of 80 ppm. In the CPB, CPB+CA groups, we supplied a standard oxygen-air mixture without NO.Results. In the CPB+CA+NO group, the TNF-α concentration was statistically significantly lower: 899 [739; 1019] ng/g compared to the CPB+CA group 1716 [1284; 2201] ng/g, p = 0.026. The remaining markers of programmed cell death did not differ between groups.Conclusions. Perioperative nitric oxide delivery reduces the expression of the extrinsic pathway of apoptosis of renal parenchyma cells in simulating operations with artificial circulation and circulatory arrest. Perioperative nitric oxide delivery at a dose of 80 ppm does not increase the processes of apoptosis, pyroptosis, and necroptosis in renal parenchyma.
{"title":"The influence of nitric oxide delivery on the processes of apoptosis, necroptosis and pyroptosis in the renal parenchyma after simulating cardiopulmonary bypass: an experimental study","authors":"M. A. Tyo, N. O. Kamenshchikov, Y. Podoksenov, A. Mukhomedzyanov, L. N. Maslov, I. V. Kravchenko, E. A. Churilina, B. N. Kozlov","doi":"10.24884/2078-5658-2024-21-3-26-33","DOIUrl":"https://doi.org/10.24884/2078-5658-2024-21-3-26-33","url":null,"abstract":"The objective was to study the effect of the delivery of exogenous nitric oxide on the severity of apoptosis, pyroptosis, and necroptosis of the renal parenchyma after simulating cardiopulmonary bypass and cardiopulmonary bypass with circulatory arrest.Materials and Methods. 24 Altai breed rams were randomized into 4 equal groups. In the CPB and CPB+NO groups, we simulated cardiopulmonary bypass without circulatory arrest. In the CPB+CA and CPB+CA+NO groups, we simulated cardiopulmonary bypass with circulatory arrest. In the CPB+NO, CPB+CA+NO groups, NO was given perioperative in concentration of 80 ppm. In the CPB, CPB+CA groups, we supplied a standard oxygen-air mixture without NO.Results. In the CPB+CA+NO group, the TNF-α concentration was statistically significantly lower: 899 [739; 1019] ng/g compared to the CPB+CA group 1716 [1284; 2201] ng/g, p = 0.026. The remaining markers of programmed cell death did not differ between groups.Conclusions. Perioperative nitric oxide delivery reduces the expression of the extrinsic pathway of apoptosis of renal parenchyma cells in simulating operations with artificial circulation and circulatory arrest. Perioperative nitric oxide delivery at a dose of 80 ppm does not increase the processes of apoptosis, pyroptosis, and necroptosis in renal parenchyma.","PeriodicalId":506088,"journal":{"name":"Messenger of ANESTHESIOLOGY AND RESUSCITATION","volume":"30 10","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-06-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141344125","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 : 2024-06-14DOI: 10.24884/2078-5658-2024-21-3-56-63
I. S. Kochoyan, E. K. Nikitina, A. Obukhova, Z. Zaripova
The objective was to assess the possibility of using breathing reserve (BR) to evaluate the individual risk of postoperative pulmonary complications (PPC) in patients who underwent open surgery for lung cancer.Materials and methods. The study involved 185 patients who underwent open surgery for lung cancer in the clinic of the Pavlov University in 2018–2020. All patients underwent cardiopulmonary exercise testing (CPET) in the preoperative period to determine the BR. All patients were retrospectively divided into 2 groups depending on the presence of PPC during 7 days after the surgery. To assess the information content of BR for predicting PPC and their outcome, the data were statistically processed: the Mann–Whitney U-test, Fisher’s exact test, Youden index and linear regression method were used.Results. PPC developed in 7 patients (3.8%), in 3 of them (42.9% of the group with PC and 1.6% of the total group) they were accompanied by acute respiratory failure (ARF), requiring reintubation and mechanical ventilation; these patients died. At the anaerobic threshold (AT), there were significant differences in BR (p = 0.003). A direct correlation was found between BR at the AT not only at the peak load but also during the unloaded cycling (UC) (closeness of connection on the Chaddock scale BR (AT) – BR (peak) ρ = 0.724, BR (AT) – BR (UC) ρ = 0.734, p < 0.001). The chances to develop PC changed as follows: in the group of patients with BR (UC) < 72.025% were 21.4 times higher (95% CI: 2.499 – 182.958); with BR (AT) < 44.136% were 27.2 times higher (95% CI: 4.850 – 152.167); with BR (peak) < 36.677% were 7.6 times higher (95% CI: 1.426 – 40.640).Conclusions. Dynamic measurement of the BR is informative at all stages of CPET. The risk of PPC and their unfavorable outcome increases when the BR is below 72.025% at the unloaded cycling, below 44.136% at the anaerobic threshold and below 36.377% at the peak load. BR can be used as a marker of the development of PPC in patients undergoing lung cancer surgery.
{"title":"Breathing reserve as a predictor of postoperative pulmonary complications in patients with lung cancer","authors":"I. S. Kochoyan, E. K. Nikitina, A. Obukhova, Z. Zaripova","doi":"10.24884/2078-5658-2024-21-3-56-63","DOIUrl":"https://doi.org/10.24884/2078-5658-2024-21-3-56-63","url":null,"abstract":"The objective was to assess the possibility of using breathing reserve (BR) to evaluate the individual risk of postoperative pulmonary complications (PPC) in patients who underwent open surgery for lung cancer.Materials and methods. The study involved 185 patients who underwent open surgery for lung cancer in the clinic of the Pavlov University in 2018–2020. All patients underwent cardiopulmonary exercise testing (CPET) in the preoperative period to determine the BR. All patients were retrospectively divided into 2 groups depending on the presence of PPC during 7 days after the surgery. To assess the information content of BR for predicting PPC and their outcome, the data were statistically processed: the Mann–Whitney U-test, Fisher’s exact test, Youden index and linear regression method were used.Results. PPC developed in 7 patients (3.8%), in 3 of them (42.9% of the group with PC and 1.6% of the total group) they were accompanied by acute respiratory failure (ARF), requiring reintubation and mechanical ventilation; these patients died. At the anaerobic threshold (AT), there were significant differences in BR (p = 0.003). A direct correlation was found between BR at the AT not only at the peak load but also during the unloaded cycling (UC) (closeness of connection on the Chaddock scale BR (AT) – BR (peak) ρ = 0.724, BR (AT) – BR (UC) ρ = 0.734, p < 0.001). The chances to develop PC changed as follows: in the group of patients with BR (UC) < 72.025% were 21.4 times higher (95% CI: 2.499 – 182.958); with BR (AT) < 44.136% were 27.2 times higher (95% CI: 4.850 – 152.167); with BR (peak) < 36.677% were 7.6 times higher (95% CI: 1.426 – 40.640).Conclusions. Dynamic measurement of the BR is informative at all stages of CPET. The risk of PPC and their unfavorable outcome increases when the BR is below 72.025% at the unloaded cycling, below 44.136% at the anaerobic threshold and below 36.377% at the peak load. BR can be used as a marker of the development of PPC in patients undergoing lung cancer surgery.","PeriodicalId":506088,"journal":{"name":"Messenger of ANESTHESIOLOGY AND RESUSCITATION","volume":"25 6","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-06-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141340922","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 : 2024-06-14DOI: 10.24884/2078-5658-2024-21-3-6-16
I. Kozlov, D. A. Sokolov, P. A. Lyuboshevsky
The objective was to study the occurrence of perioperative cardiovascular complications (CVС) and clinical and laboratory cardioprotection signs in patients treated with phosphocreatine infusion in intraoperative period of vascular surgery.Materials and methods. The study involved 204 patients with high cardiac risk (revised cardiac risk index > 2, risk of perioperative myocardial infarction or cardiac arrest > 1%) who underwent elective vascular surgery. The patients were randomly divided into two groups. Group I patients received intraoperative infusion of phosphocreatine at a dose of 75.9 [69.8–85.7] mg/kg during 120.0 [107.1–132.0] min. Group II was a control group. The occurrence of CVC, the blood level of the cardiospecific troponin I (cTnI) and N-terminal segment of natriuretic B-type prohormone (NT-proBNP) were analyzed. The data were statistically processed, using the Fisher’s exact test, Mann–Whitney test and logistic regression.Results. Perioperative CVС were recorded in 5 (4.9%) patients in group I and in 18 (17.6%) patients in group II (p = 0.007). Intraoperative administration of phosphocreatine was associated with a reduced risk of CVС: OR 0.2405, 95% CI 0.0856–0.6758, p = 0.007. The cTnI level in patients of groups I and II was 0.021 [0.016–0.030] and 0.019 [0.011–0.028] ng/ml (p = 0.102) before surgery, 0.025 [0.020–0.036] and 0.022 [0.015–0.039] ng/ml (p = 0.357) after surgery, 0.025 [0.020–0.031] and 0.028 [0.018–0.033] ng/ml (p = 0.531) before discharge from the hospital. At the same stages, the level of NT-proBNP was 233.5 [195.0–297.5] and 237.8 [171.3–310.1] pg/ml (p = 0.404), 295.5 [257.3–388.0] and 289.0 [217.5–409.5] pg/ml (p = 0.226), 265.5 [204.8–348.5] and 259.6 [171.0–421.6] pg/ml (p = 0.369).Conclusion. In patients with high cardiac risk undergoing vascular surgery, intraoperative phosphocreatine infusion at a total dose of 75.9 [69.8–85.7] mg/kg reduces the risk of perioperative CVC per 24%. Administration of phosphocreatine to patients with high cardiac risk during vascular surgery does not affect perioperative cTnI and NT-proBNP blood levels.
{"title":"The effectiveness of phosphocreatine cardioprotection during vascular surgery in high cardiac risk patients","authors":"I. Kozlov, D. A. Sokolov, P. A. Lyuboshevsky","doi":"10.24884/2078-5658-2024-21-3-6-16","DOIUrl":"https://doi.org/10.24884/2078-5658-2024-21-3-6-16","url":null,"abstract":"The objective was to study the occurrence of perioperative cardiovascular complications (CVС) and clinical and laboratory cardioprotection signs in patients treated with phosphocreatine infusion in intraoperative period of vascular surgery.Materials and methods. The study involved 204 patients with high cardiac risk (revised cardiac risk index > 2, risk of perioperative myocardial infarction or cardiac arrest > 1%) who underwent elective vascular surgery. The patients were randomly divided into two groups. Group I patients received intraoperative infusion of phosphocreatine at a dose of 75.9 [69.8–85.7] mg/kg during 120.0 [107.1–132.0] min. Group II was a control group. The occurrence of CVC, the blood level of the cardiospecific troponin I (cTnI) and N-terminal segment of natriuretic B-type prohormone (NT-proBNP) were analyzed. The data were statistically processed, using the Fisher’s exact test, Mann–Whitney test and logistic regression.Results. Perioperative CVС were recorded in 5 (4.9%) patients in group I and in 18 (17.6%) patients in group II (p = 0.007). Intraoperative administration of phosphocreatine was associated with a reduced risk of CVС: OR 0.2405, 95% CI 0.0856–0.6758, p = 0.007. The cTnI level in patients of groups I and II was 0.021 [0.016–0.030] and 0.019 [0.011–0.028] ng/ml (p = 0.102) before surgery, 0.025 [0.020–0.036] and 0.022 [0.015–0.039] ng/ml (p = 0.357) after surgery, 0.025 [0.020–0.031] and 0.028 [0.018–0.033] ng/ml (p = 0.531) before discharge from the hospital. At the same stages, the level of NT-proBNP was 233.5 [195.0–297.5] and 237.8 [171.3–310.1] pg/ml (p = 0.404), 295.5 [257.3–388.0] and 289.0 [217.5–409.5] pg/ml (p = 0.226), 265.5 [204.8–348.5] and 259.6 [171.0–421.6] pg/ml (p = 0.369).Conclusion. In patients with high cardiac risk undergoing vascular surgery, intraoperative phosphocreatine infusion at a total dose of 75.9 [69.8–85.7] mg/kg reduces the risk of perioperative CVC per 24%. Administration of phosphocreatine to patients with high cardiac risk during vascular surgery does not affect perioperative cTnI and NT-proBNP blood levels.","PeriodicalId":506088,"journal":{"name":"Messenger of ANESTHESIOLOGY AND RESUSCITATION","volume":"46 9","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-06-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141340040","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 : 2024-06-14DOI: 10.24884/2078-5658-2024-21-3-64-75
E. V. Taranov, N. K. Pastukhova, V. Pichugin, S. A. Fedorov, Yu.D. Brichkin, S. N. Nezabudkin, S. A. ZhIlyaev, K. I. Nikitin
Introduction. To date, single studies have been published on the anesthesiological support of operations for acute pulmonary embolism. The issues of the influence of basic anesthetics on central hemodynamics and the functional state of lung tissue are not covered.The objective was to conduct a comparative assessment of the effect of anesthesia based on propofol, sevoflurane and desflurane on the parameters of central hemodynamics, myocardial contractility and functional state of the lungs during operations for acute pulmonary embolism.Materials and methods. The study included 75 patients (42 men and 33 women) aged 42.3 ± 14.3 years. All patients were operated for massive pulmonary embolism under cardiopulmonary bypass. The patients were randomized into three groups: in the first group (25 patients), propofol was used as the main anesthetic; in the secondgroup (25 patients) - sevoflurane; in the third group (25 patients) - desflurane. The indicators of central hemodynamics, myocardial contractile function and the functional state of the lungs during the operation were studied.Results. The comparative analysis of the anesthesia revealed that propofol had a more pronounced depressive effect on hemodynamics (a statistically significant decrease in blood pressure and EF LV), and desflurane had a moderate hyperdynamic effect (a statistically significant increase in heart rate). Anesthesia with propofol caused a statistically significant increase in the AAPO2 index (by 32.1%), a decrease in the PaO2/FiO2 index (by 24.1%) before cardiopulmonary bypass. After CPB, the oxygenation index decreased, intrapulmonary blood shunting increased, and pulmonary compliance decreased statistically significantly. The use of inhalation anesthetics (sevoflurane, desflurane) effectively preserved the functional parameters of the lungs: there were no statistically significant changes in the studied parameters.Conclusion. The inclusion of inhaled anesthetics (sevoflurane and desflurane) in the anesthesia regimen during surgery for acute pulmonary embolism ensures the stability of hemodynamic parameters and contractile function of the myocardium. The use of inhaled anesthetics maintains high lung function during surgery.
{"title":"Comparative assessment of the effect of anesthetics (propofol, sevoflurane, desflurane) on hemodynamics and gas exchange in the lungs during operations for acute pulmonary embolism","authors":"E. V. Taranov, N. K. Pastukhova, V. Pichugin, S. A. Fedorov, Yu.D. Brichkin, S. N. Nezabudkin, S. A. ZhIlyaev, K. I. Nikitin","doi":"10.24884/2078-5658-2024-21-3-64-75","DOIUrl":"https://doi.org/10.24884/2078-5658-2024-21-3-64-75","url":null,"abstract":"Introduction. To date, single studies have been published on the anesthesiological support of operations for acute pulmonary embolism. The issues of the influence of basic anesthetics on central hemodynamics and the functional state of lung tissue are not covered.The objective was to conduct a comparative assessment of the effect of anesthesia based on propofol, sevoflurane and desflurane on the parameters of central hemodynamics, myocardial contractility and functional state of the lungs during operations for acute pulmonary embolism.Materials and methods. The study included 75 patients (42 men and 33 women) aged 42.3 ± 14.3 years. All patients were operated for massive pulmonary embolism under cardiopulmonary bypass. The patients were randomized into three groups: in the first group (25 patients), propofol was used as the main anesthetic; in the secondgroup (25 patients) - sevoflurane; in the third group (25 patients) - desflurane. The indicators of central hemodynamics, myocardial contractile function and the functional state of the lungs during the operation were studied.Results. The comparative analysis of the anesthesia revealed that propofol had a more pronounced depressive effect on hemodynamics (a statistically significant decrease in blood pressure and EF LV), and desflurane had a moderate hyperdynamic effect (a statistically significant increase in heart rate). Anesthesia with propofol caused a statistically significant increase in the AAPO2 index (by 32.1%), a decrease in the PaO2/FiO2 index (by 24.1%) before cardiopulmonary bypass. After CPB, the oxygenation index decreased, intrapulmonary blood shunting increased, and pulmonary compliance decreased statistically significantly. The use of inhalation anesthetics (sevoflurane, desflurane) effectively preserved the functional parameters of the lungs: there were no statistically significant changes in the studied parameters.Conclusion. The inclusion of inhaled anesthetics (sevoflurane and desflurane) in the anesthesia regimen during surgery for acute pulmonary embolism ensures the stability of hemodynamic parameters and contractile function of the myocardium. The use of inhaled anesthetics maintains high lung function during surgery.","PeriodicalId":506088,"journal":{"name":"Messenger of ANESTHESIOLOGY AND RESUSCITATION","volume":"15 2","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-06-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141343381","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 : 2024-04-17DOI: 10.24884/2078-5658-2024-21-2-27-38
N. V. Ermokhina, A. Kuzovlev, D.V. Davydov, A. Grechko, P. A. Polyakov, P. Ryzhkov, T. S. Serkova, E. A. Lukyanova, D. V. Belokopytov, V. V. Moroz
The objective was to determine the prognostic value of predictors of early postoperative cognitive disorders in traumatological patients to assess the development of the main clinical outcomes (postoperative delirium and delayed neurocognitive recovery).Materials and methods. A two-center prospective cohort observational study of patients aged 45–74 years after planned traumatological operations (endoprosthetics of large joints of the lower extremities, spinal fusion surgery, transpedicular fixation of vertebrae) under general anesthesia with tracheal intubation was conducted in the period from March 2021 to June 2022. Before the operation, demographic indicators, concomitant diseases, background therapy, laboratory tests and testing (ASA, MoCA, AUDIT, CFS, HADS-A, RASS). At the end of the operation after extubation and in the postoperative period, patients were analyzed according to the scales RUS, CAM- ICU and CAM-ICU-7, NRS and BPS. Statistical analysis was carried out using the software SPSS Statistics 27.0.1.0.Results. The study included 200 patients. Early postoperative cognitive disorders (ePCD) (agitation and emergence delirium (ED)) 61 (30.5%) patients were diagnosed, 139 (69.5%) patients had adequate awakening in the operating room. Independent predictors of the development of ePCD were the age of patients (≥ 60), glucose level ≥ 5.6 and a high score on the Clinical Frailty Scale (≥ 4). The prevalence of postoperative delirium (POD) was 11% (22 patients). The independent risk factors for POD were the duration of hypotension and the presence of hyperactive ED. Delayed neurocognitive recovery after surgery and anesthesia was observed in 115 patients (57.8%). At the same time, a statistically significant predictor of this condition was the duration of hypotension for more than 15 minutes (sensitivity 59.18%, specificity 65.85%).Conclusion. When comparing the influence of the study group (patients with ePCD) with the control group, it was determined that ePCD is an independent risk factor for the development of POD (p < 0.001).
{"title":"Prognostic significance of predictors of early postoperative cognitive disorders in patients after traumatic surgeries (prospective cohort study)","authors":"N. V. Ermokhina, A. Kuzovlev, D.V. Davydov, A. Grechko, P. A. Polyakov, P. Ryzhkov, T. S. Serkova, E. A. Lukyanova, D. V. Belokopytov, V. V. Moroz","doi":"10.24884/2078-5658-2024-21-2-27-38","DOIUrl":"https://doi.org/10.24884/2078-5658-2024-21-2-27-38","url":null,"abstract":"The objective was to determine the prognostic value of predictors of early postoperative cognitive disorders in traumatological patients to assess the development of the main clinical outcomes (postoperative delirium and delayed neurocognitive recovery).Materials and methods. A two-center prospective cohort observational study of patients aged 45–74 years after planned traumatological operations (endoprosthetics of large joints of the lower extremities, spinal fusion surgery, transpedicular fixation of vertebrae) under general anesthesia with tracheal intubation was conducted in the period from March 2021 to June 2022. Before the operation, demographic indicators, concomitant diseases, background therapy, laboratory tests and testing (ASA, MoCA, AUDIT, CFS, HADS-A, RASS). At the end of the operation after extubation and in the postoperative period, patients were analyzed according to the scales RUS, CAM- ICU and CAM-ICU-7, NRS and BPS. Statistical analysis was carried out using the software SPSS Statistics 27.0.1.0.Results. The study included 200 patients. Early postoperative cognitive disorders (ePCD) (agitation and emergence delirium (ED)) 61 (30.5%) patients were diagnosed, 139 (69.5%) patients had adequate awakening in the operating room. Independent predictors of the development of ePCD were the age of patients (≥ 60), glucose level ≥ 5.6 and a high score on the Clinical Frailty Scale (≥ 4). The prevalence of postoperative delirium (POD) was 11% (22 patients). The independent risk factors for POD were the duration of hypotension and the presence of hyperactive ED. Delayed neurocognitive recovery after surgery and anesthesia was observed in 115 patients (57.8%). At the same time, a statistically significant predictor of this condition was the duration of hypotension for more than 15 minutes (sensitivity 59.18%, specificity 65.85%).Conclusion. When comparing the influence of the study group (patients with ePCD) with the control group, it was determined that ePCD is an independent risk factor for the development of POD (p < 0.001).","PeriodicalId":506088,"journal":{"name":"Messenger of ANESTHESIOLOGY AND RESUSCITATION","volume":" 100","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-04-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140692484","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 : 2024-04-17DOI: 10.24884/2078-5658-2024-21-2-18-26
A. D. Lifanova, A. A. Grazhdankin, P. Mironov, I. Lutfarakhmanov
The objective was to study the safety and efficacy of a personalized opioid-sparing pain relief protocol in the context of enhanced rehabilitation after advanced robot-assisted pelvic surgery.Materials and methods. The prospective study included 19 patients who underwent surgery under combined thoracic epidural anesthesia/analgesia: general anesthesia was administered with propofol or sevoflurane/desflurane with ketamine + 6–8 ml/hour of 0.25% ropivacaine, in the postoperative period 0.125% bupivacaine was administered at a rate of 8–15 ml/hour. In the comparison group (n = 21), opioids were used as a component of general anesthesia and multimodal analgesia. Intra- and postoperative opioid consumption, pain severity, opioid-related side effects, and timing of postoperative rehabilitation were evaluated.Results. In the study group, the median milligram equivalents of morphine were significantly lower than in the control group (103 versus 148 and 91 versus 404, respectively; p = 0.001 for both comparisons). The values of the numerical pain scale did not differ significantly between the groups. Side effects were significantly lower in the treatment group (26% vs. 62%; p = 0.026). There were significant differences in the timing of intestinal function recovery, initiation of regular diet and transfer from the recovery room in favor of opioid-sparing pain relief (p = 0.037; p = 0.046; and p = 0.023; respectively).Conclusions. The use of a personalized opioid-sparing pain relief protocol in the context of enhanced rehabilitation of patients underwent the advanced robot-assisted pelvic surgery helped to reduce opioid consumption, side effects, and postoperative rehabilitation without affecting the severity of pain.
{"title":"Personalized opioid-sparing pain relief protocol for advanced robot-assisted pelvic surgery","authors":"A. D. Lifanova, A. A. Grazhdankin, P. Mironov, I. Lutfarakhmanov","doi":"10.24884/2078-5658-2024-21-2-18-26","DOIUrl":"https://doi.org/10.24884/2078-5658-2024-21-2-18-26","url":null,"abstract":"The objective was to study the safety and efficacy of a personalized opioid-sparing pain relief protocol in the context of enhanced rehabilitation after advanced robot-assisted pelvic surgery.Materials and methods. The prospective study included 19 patients who underwent surgery under combined thoracic epidural anesthesia/analgesia: general anesthesia was administered with propofol or sevoflurane/desflurane with ketamine + 6–8 ml/hour of 0.25% ropivacaine, in the postoperative period 0.125% bupivacaine was administered at a rate of 8–15 ml/hour. In the comparison group (n = 21), opioids were used as a component of general anesthesia and multimodal analgesia. Intra- and postoperative opioid consumption, pain severity, opioid-related side effects, and timing of postoperative rehabilitation were evaluated.Results. In the study group, the median milligram equivalents of morphine were significantly lower than in the control group (103 versus 148 and 91 versus 404, respectively; p = 0.001 for both comparisons). The values of the numerical pain scale did not differ significantly between the groups. Side effects were significantly lower in the treatment group (26% vs. 62%; p = 0.026). There were significant differences in the timing of intestinal function recovery, initiation of regular diet and transfer from the recovery room in favor of opioid-sparing pain relief (p = 0.037; p = 0.046; and p = 0.023; respectively).Conclusions. The use of a personalized opioid-sparing pain relief protocol in the context of enhanced rehabilitation of patients underwent the advanced robot-assisted pelvic surgery helped to reduce opioid consumption, side effects, and postoperative rehabilitation without affecting the severity of pain. ","PeriodicalId":506088,"journal":{"name":"Messenger of ANESTHESIOLOGY AND RESUSCITATION","volume":" 21","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-04-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140690599","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 : 2024-04-17DOI: 10.24884/2078-5658-2024-21-2-39-45
P. Mironov, Y. Aleksandrovich, R. G. Idrisova, E. D. Galimova, E. I. Gilmanova, R. Z. Bogdanova
Introduction. To date, reliable information about the “ideal” infusion therapy regimen for critically ill preterm infants in the early neonatal period is not known.The objective was to determine the indications for the transition to restrictive tactics of infusion therapy in critically ill preterm infantsMaterials and methods. The design was a prospective, observational study. The development included 110 newborns < 32 weeks of gestation (birth weight less than 1500 grams). 11 of them died.Results. In deceased newborns, right ventricular mean pressure (RVMP) was higher in the first 3 days of intensive care and the left ventricular ejection fraction (LVEF) was higher by the third day of treatment they had a higher vasoactive inotropic index. The critical threshold value of RVMP was 29.0 mmHg. The “separation point” regarding the risk of death depending on the volume of infusion therapy was 100 ml/kg/day. The threshold value of the nSOFA score regarding the need to limit the volume of infusion therapy based on ROC analysis was 5.0 points.Conclusion. Preterm infants with a high risk of death (nSOFA score > 5 points) require restrictive infusion therapy. The critical threshold value for the volume of fluid administered may be 100 ml/kg/day.
{"title":"Determination of indications for the transition to restrictive tactics of infusion therapy in critically ill preterm infants in the early neonatal period","authors":"P. Mironov, Y. Aleksandrovich, R. G. Idrisova, E. D. Galimova, E. I. Gilmanova, R. Z. Bogdanova","doi":"10.24884/2078-5658-2024-21-2-39-45","DOIUrl":"https://doi.org/10.24884/2078-5658-2024-21-2-39-45","url":null,"abstract":"Introduction. To date, reliable information about the “ideal” infusion therapy regimen for critically ill preterm infants in the early neonatal period is not known.The objective was to determine the indications for the transition to restrictive tactics of infusion therapy in critically ill preterm infantsMaterials and methods. The design was a prospective, observational study. The development included 110 newborns < 32 weeks of gestation (birth weight less than 1500 grams). 11 of them died.Results. In deceased newborns, right ventricular mean pressure (RVMP) was higher in the first 3 days of intensive care and the left ventricular ejection fraction (LVEF) was higher by the third day of treatment they had a higher vasoactive inotropic index. The critical threshold value of RVMP was 29.0 mmHg. The “separation point” regarding the risk of death depending on the volume of infusion therapy was 100 ml/kg/day. The threshold value of the nSOFA score regarding the need to limit the volume of infusion therapy based on ROC analysis was 5.0 points.Conclusion. Preterm infants with a high risk of death (nSOFA score > 5 points) require restrictive infusion therapy. The critical threshold value for the volume of fluid administered may be 100 ml/kg/day.","PeriodicalId":506088,"journal":{"name":"Messenger of ANESTHESIOLOGY AND RESUSCITATION","volume":" 25","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-04-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140692744","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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