Anesteziologiia i reanimatologiia最新文献

Background: The difficult airways at children happen rarely, but can lead to serious complications.

Materials and methods: Results of studying of sensitivity, specificity and predictive importance of a scale of Mallampati at 379 children aged from 3 till 17 years (ASA physical status I-II), who underwent surgery in the nasal cavity and nasopharynx, are presented in this article. Depending on result of Mallampati's score children have been distributed on 2 groups. In the first group 20 children had predictions of the difficult intubation of a trachea, 19 of them had the 3rd degree by Mallampati, 1 child had the 4th degree by Mallampati. In the second group 370 children had 1-2 class on Mallampati scale. During direct laryngoscopy, 8 patients had 3 degree on Cormack & Lehane and the 382 patients had 1-2 degree on Cormack & Lehane. The degree of the laryngoscopy's difficulty determine by results of the Mallampati Samsoon & Young.

Results and conclusion: It is found out that sensitivity (Se) of a scale of Mallampati in modification of Samsoon & Young at children at operations in the nasal cavity and nasopharynx of 50%, specificity (Sp) of 96%, the positive predictive value (+VP) of 20%, the negative predictive value (-VP) of 99%.

165 patients over 18 years in the period from January 2014 to March 2015 were studied. The aim was to investigate the prognostic significance of known scale assessment of organ dysfunction in respect ofpostoperative hepatic failure. The development of acute liver failure was assessed on the basis of clinical and laboratory data, severity of the condition by scales MELD, Child-Turcotte-Pugh, Maddrey, Schindl, BILE score, SOFA. The paper identified the incidence offorms of acute liver failure (hepatic encephalopathy, hepatic coagulopathy, hepatorenal syndrome, systemic hemodynamic disorder mixed form) in patients after surgery on hepatobiliary system, and the dependence of the probability of their occurrence on the severity of the condition, calculated using a scales in the preoperative period. Calculated sensitivity and specificity in predicting scales investigatedforms of acute liver failure based on ROC-analysis. It was shown that the specialized rating scales have good predictive accuracy in respect of certain forms of hepatic insufficiency (Child-Tur-cotte-Pugh -for hemodynamic options and hepatic coagulopathy, MELD and SOFA scales -for hepatic encephalopathy SCHINDL -for hepatorenal syndrome and mixed forms of hepatic failure). None of the analyzed scales do not possess predictive value with respect to all forms of hepatic failure.

Introduction: One ofthe important goals of intraoperativefluid therapy in neonates is to ensure normal glycemic status. However there is no definitive guidance on the issue of intraoperative administration solutions containing glucose.

Materials and methods: a single-center study of intraoperative glycemic status in 60 newborns with congenital malformations was conducted. Age at the time of surgery amounted to Me 48 [24; 120] hours of life, the duration of surgery was 70 [60; 101] minutes. The children were divided into two groups: in group 1 (n = 30) intraoperative infusion therapy was only saline; in group 2 (n = 30) with salt solutions were simultaneously injected glucose in a dose of 2,3 mg/kg/ min. The glucose level in the blood was evaluated before operation, during operation every 30 minutes and at the end of surgical intervention, if it was necessary, was corrected.

Results: the study revealed high incidence of hypoglycemic conditions in children in group 1, especially during tracheal intubation and skin incision (40 episodes in 20 children). However the blood glucose level subsequently normalized and remained within the reference values. In group 2, the average glucose level in these stages was significantly greater than 4,4 [3,3; 5,2] mmol/l (p = 0,03), and did not go beyond normal values, remaining stable in all phases of the operation. There was a decrease in 2 times the frequency of episodes of hypoglycemia in group 2 (19 episodes in 12 patients). At the same time, more often fixed hyperglycemia in group 2.

Conclusions: intraoperative blood glucose in newborns is unstable indicator and requires a precise dosing of glucose in the infusion to avoid Hypo- and hyperglycemia.

Goal: To improve patient 's recovery after video-assisted thoracoscopic lobectomies (VATSL) by laryngeal mask using.

Methods: This is a comparative analysis of 74 patients underwent VATSL. In 37 patients anaesthesia consisted of sevoflurane and fentanyl, myorelaxant, respiratory support via independent ventilation of either lung. In another 37patient 's anaesthesia protocol included respiratory support performed via laryngeal mask, propofol infusion and epidural analgesia with ropivacaine 0,2% and fentanyl. During the operation in both groups we evaluated hemodynamic, arterial blood gases, leukocytes, glucose and cortisol blood level, time to consciousness restoration (Aldrete-score) and time to discharge from ICU and duration of hospital stay, frequency of complications.

Results: Patients with ventilation through laryngeal mask showed a statistically lower stress-reaction, avoided bronchoscopy with BAL and frequency of complications. Duration of inhospital stay in patients with laryngeal mask was 7±1,3 days; in intubated patients was 11±3,2 days.

Conclusion: In case of ventilation through the laryngeal mask hyper dynamic state of circulation, glycemia, leukocytes, cortisol blood level and arterial blood pH were lower, whereas Pa CO₂ increase. The number of bronchoscopy with BAL and time to discharge from ICU and from hospital not having risk of postoperative complications --lower.

The aim: To assess validity of EITL for mechanical ventilation optimization during GA.

Materials: 26 cardiac surgery patients participated in non-randomized comparative study. Everyone was ventilated with protective regimen: Vt - 6-8 ml/kg, breath rate - by normal EtCO2, i/e - 1.1,5. PEEP setting in group A (n = 15) was based on EITL data, in group B (n = 11, controls) - on the discretion of the anesthesiologist. We compared PEEP peak airway pressure (PAP), dynamic compliance, SpO2 and postoperative pulmonary complications. Bronchoscopy (FTBS) was performed after the onset of mechanical ventilation in 15 patients.

Results: Mask ventilation contributed redistribution of ventilation to ventral regions in 88,4% ofpatients. Ventilation by the end of surgery was remained un-changed more often in gr A than in gr B (86,6% vs. 36,6%, p = 0,026). PAP was higher in gr B by the end of surgery (19?1,4 vs. 17,3±2,2 cm H20; p = 0,03). Compliance by the end of surgery was not reduced below baseline's more frequently in gr A (73,3% in gr A vs. 27,2% in gr B, p = 0,053). After FTBS, ventilation after of mechanical ventilation renewal was comparable with baseline ' in 80%, deteriorated in 13,3% and improved in 6,6% ofpatients.

Conclusions: 1) EITL is a convenient toolfor ventilation dynamic evaluation during anesthesia; 2) EITL advances the mask ventilation, allows to set up appropriate PEEP during anesthesia and to evaluate safety of the disconnection during FTBS; 3) EITL contributes to professional education of anesthesiologists.

Background: A big number ofshort-time surgery performed in one-day pediatric department requires the permanent search of an ideal anesthetic for the maximum quickly children ' take home with the minimum ofpostoperation complications.

The aim: to compare the emergence and recovery characteristics ofsevoflurane and desflurane maintenance ofanesthe- sia in children undergoing ambulatory surgery.

Results and conclusion: There were no significant differences among the two groups in hemodynamic parameters, the incidence of postoperative vomiting and cough. But desflurane maintenance of anesthesia resulted in the fastest early emergence from anesthesia, the lack of incidence ofpostoperative agitation compared with sevoflurane.

There was a case in MRRIOG (Moscow Regional Research Institute of Obstetrics and Gynecology) in 2015 when pregnant patient with paroxysmal nocturnal hemoglobinuria(PNH) has successfully passed through a delivery process. This paper analyzes the medical history, clinical, laboratory and instrumental examination, particularly anesthesia tactics for the patients with complement-associated diseases during delivery. The presented clinical case demonstrates the need for and the importance of early diagnosis of PNH in pregnant women. Of course, women with PNH are one of the most complex contingent ofpregnant women, threatened by the development of obstetric and anesthetic complications, and it requires constant monitoring of clinical and laboratory parameters of their condition, the joint hematologist, obstetri- cian and anesthesiologist observationand delivery in hospitals of III and IV levels.