Anesteziologiia i reanimatologiia最新文献

This review presents the data of assessing antihypertensive efficacy and tolerability vasoselective high-lipophilic the 3d generations calcium channel blocker lercanidpine. The inhibition of the calcium ions flow through the membranes of smooth muscle cells of blood vessels causes peripheral, cerebral, renal and coronary vasodilation decreasing total peripheral vascular resistance and, consequently, blood pressure (BP) lowering and improve regional circulation. During reception of lercanidipine the level of norepinephrine remains the same even when using high doses of the drug. Negative inotropic effect does not occur therefore, lercanidipine can be used in the treatment of myocardial ischemia. Renal protection properties slow down the development and progression ofchronic renalfailure (CRF). The drug can be successfully used in patients with arterial hypertension, chronic renalfailure, diabetic and non-diabetic nephropathy. Lercanidpine also may be effectively used in the treatment of hypertension with associated clinical conditions: bronchial asthma, chronic obstructive pulmonary disease, bradiarrythmias, atrioventricular blockade 2-3 degree, sinus node dysfunction, peripheral arteries deseases with symptoms of the extremities ischemia, sleep disturbance, depression, dystonia, asthenic and cephalgic syndme in the frame of the cerebrovascular insufficiency manifestations. Therapy with lercanidpine, in addition to lowering blood pressure, can help to nephroprotection, neuroprotection, antianginal effect, the regression of left ventricular hypertrophy, improvement of lipid metabolism and glucose tolerance. With over 30 years experience in the application and modification of the molecular structure, slow the onset of action and superior long-lasting effect reception of letranidipine well-tolerated and provides a high adherence ofpatients to the treatment of hypertension.

Background: It is proved that levosimendan administration improves overall outcome and reduces mortality in high risk cardiac patients. However up to now there is no optimal scheme of its use in intraoperative settings.

The aim: To compare two approaches of levosimendan administration in patients with left ventricle ejectionfraction less than 35% who underwent cardiac surgery.

Materials and methods: After approval by the local ethics Committee, 40 patients older than 18 years with severe preoperative left ventricular dysfunction (left ventricle ejection fraction less than 35%), who were planned for cardiac surgery operation with cardiopulmonary bypass and cardioplegia were randomly assigned to two groups of 20 patients each. In group I (n=20) infusion of levosimendan started intraoperatively after induction of anesthesia, a loading dose of 6 mg/kg with subsequent injection of a dose of 0.1 μg/kg/minfor 24 hours. In group 2 (n=20) bolus of levosimendan 24 μg/kg was injected 15 min before aortic clamping. Anesthesia and methods of cardiopulmonary bypass in the groups did not differ Results. We got thefavorable clinical results in a group of 'full" levosimendan dose (12.5 mg as a daily infusion with an, initial bolus of 6 mg/kg just after the induction of anesthesia) in terms ofreduction of the total dose ofsympathomimetics andpostoperative troponin T level in comparison with the group where levosimendan was administered as a single bolus. (24 mg/kg) 15 minutes prior to aortic clamping.

Conclusion: Based on these data it can be assumed that the use of prolonged infusion of levosimendan in a dosage of 12.5 mg is preferable to a single bolus 24 μg/kg.

The article is devoted to the existence of the problem of intraoperative provide patients with concomitant diabetes mellitus: a disease is not diagnosed in time, it increases the probability of death in the performance of surgery by 50%, where as the timely prevention and preparation reduces the chance of developing specific complications to the level of patients with the general population. The paper discusses the recommendations developed by the British Association ofEndocrinologists 2011 and Russia in 2015, as well as the Association ofAnaesthetists of Great Britain and Ireland (2015), provides practical recommendations for the preoperative preparation, anesthetic and resuscitation provide patients with concomitant diabetes mellitus.

This article is dedicated to the problem ofwater and electrolyte disturbances in patient with acute severe head trauma. We present the case study of patient with severe head injury who consistently developed diabetes insipidus and cerebral salt wasting syndrome. His water and electrolyte disorders were successfully corrected by target-oriented intensive care. Constant tight monitoring and of intensive care allowed to avoid secondary ischemic injuries till the water and electrolytic homeostasis regulation mechanisms restoration.

Background Currently, one of the causes of high morbidity and mortality is injuries. Predict the outcome of injuries - it is an important task of the treating physician. Trauma is a stress factor so to predict the outcome, you can use markers of stress, the most accessible ofwhich is blood glucose.

The aim: to reveal the dynamics of the relationship between blood glucose levels and the outlook for the life ofpatients with thoracoabdominal injuries.

Materials and methods: A retrospective analysis of medical records of hospitalized patients were divided into two groups, depending on the outlook for the life of (favorable or unfavorable), and each of the groups - into two subgroups according to the presence or absence of signs of intoxication at admission. The subgroups were calculated and compared the mean blood glucose levels at different hours of hospital treatment.

Results: It was found that the average blood glucose levels at various hours of hospital stay were significantly higher in patients with poor outcome. The most noticeable was the difference in the first days of hospital treatment. Signs of intoxication was associated with lower values of glucose and a tendency to hypoglycaemia. In addition, among patients with high blood glucose ( 8 mg / dL) was observed over deaths in the first day of hospital stay.

Conclusion: High blood glucose levels ( 8,0 mmol / L) in the first day of hospital treatment is a predictor ofpoor outcome in patients with thoracoabdominal injuries.

The rapid development of medical science and health care practice, the need to improve the quality of health care, the ongoing modernization of education was the basis for scientfic rationale and implementation of the system of continuous medical education, which will be gradually expanded to cover individuals who have undergone 2016 accredited specialist.

The aim: analysis of the use of laryngeal mask in anesthesia for cochlear implantation.

Materials and methods: 10 patients aged from 1 year to 5 years were operated on according to the classical method KI with the use of laryngeal masks. As anesthesia was performed a balanced multimodal anesthesia by Sevoflurane and Fentanyl.

Results: The use of laryngeal masks in all 10 cases have gave the possible to avoid the use of muscle relaxants and to clear the threshold of detection of acoustic reflexes ofstapes musclestendon, and to reduce time of surgical intervention. A short time surgery provided rapid awakening of the patient, absence of nausea and vomiting in the early postoperative period.

Conclusion: use of laryngeal mask airway is reduces the time of surgery, minimize the patient's trauma, reduce input anesthetic drugs and get good results intraoperative audiological testing.