Anesteziologiia i reanimatologiia最新文献

Diabetes mellitus type 2 morbidity has increased signficantly in recent years. In spite of substantial advances in anesthesiology in past 25 years, there are no commonly used criteria in choosing anaesthetic techniques in these patients during lower limb surgery. The main risk factors in these patients are the most often complications of diabetes such as cardiovascular system diseases, polyneuropathia, nephropathia and retinopathia. Surgical stress-response is generally considered as a trigger of organ and systems dysfunctions and one of the main reasons of the postoperative complications high rate. The best anaesthetic techniques are those preventing or decreasing surgical stress response. The necessity of optimizing the approach to the choice ofperioperative anesthetic management of these patients determines the increasing interest in this issue. The objective of this review was to trace the evolution of the approach to the choice of perioperative analgesia methods in diabetic patients during lower limb surgery over the past 10-15 years.

The aim of the study was to reduce perioperative blood loss in patients with giant uterine myoma. As a result of studies have provided evidence that the use of anti fibrinolytic therapy as intravenous infusion of tranexamic acid for 30 minutes before the surgery in a dose of 20 mg/kg followed by infusion of 5 mg/kg per hour for the first postoperative day, helped to reduce perioperative blood loss by 29%. Hemoglobin level was higher by 10% (p < 0,05), blood loss was lower by 29% (p < 0,05), the length of stay in hospital was reduced by 24% (p < 0,05) in patients of the second group on the second postoperative day.

Background: Chronic heart failure (CHF) significantly worsens the prognosis of surgical treatment in noncardiac surgery, doubling mortality in compared with patients with coronary artery disease. Modern anesthesiology has at least two methods that potentially can improve the results in noncardiac surgery: anesthetic cardioprotection and the prevention of CHF decompensation with levosimendan.

The aim: to study the efficacy of anesthetic cardioprotection andpreoperative preparation with levosimendan for the prevention of CHF decompensation in patients with reduced left ventricular ejectionfraction in noncardiac surgery.

Endpoints: the primary endpoint of the trial is the need and the maximum dose of inotropic drugs in the perioperative period; secondary point: the length of stay in the ICU, composite outcome, the dynamics of SI, FI, the content ofNT-proBNP and TnT Materials and methods: A randomized study was performed in three groups of patients during reconstructive operations on infrarenal part of aorta: control (traditional methodfor prevention of decompensation of CHF were used) - 31 patients; the group with the anesthetic cardioprotectivei - 31 patients; the group with a preoperative preparing with levosimendan - 30 patients.

Results: The incidence of heart failure (estimated by need to use inotropic drugs - IS) was 83% of control group patients and 75% of the patients of the group "VIMA" (p = 0,65). The number ofpatients needing the use of dobutamine in LS-group was significantly below, 50% (p = 0,02 relative to control group and p = 0,08 compared to the group VIMA). IS in the control group was 8 [6, 9] μg xkg⁻¹ - xmin⁻¹ ; group VIMA 8 [3; 9] mg xkg ⁻¹ xmin⁻¹ , whereas in the LS group only 2 [0; 7] mg ⁻¹ xkg⁻¹ xmin⁻¹ . Differences between groups credible, given the Bonferroni correction (p = 0,0015). In our study, was not identified significant differences in 30-day mortality: in the control group it was 3,4%; in the group VIMA of 3,1%; in the group of LS - 0% (p > 0,017); however, a composite outcome (number of adverse events (heart attack+stroke+mortality) were slightly better in the LS group - 17%, against 34% in the control group (p = 0,043).

Conclusion: Preoperative preparation with levosimendan in patients with reduced fraction left ventricle ejection when performing reconstructive operations on the descending aorta reduces the incidence of episodes of decompensation of heart failure compared with the control group to 39,8% (p < 0,05). The use of this technique improves the composite outcome of operations on the infrarenal aorta. The study has not shown the influence of anesthetic cardioprotection in terms of hospitalization and composite outcome of surgical treatment.

Accidental hypothermia is defined as a trauma. Collaboration on the treatment of victims of accidental hypothermia shouldfollow a communication protocol for the seriously injured. Aim is to establish earliest possible contact with the doctor on duty at the regional University hospital to enable participation in the further communication and decision making process with relevance to technical and logistical issues. Victims of accidental hypothermia with adequate circulation and core temperature < 35⁰C can be treated with active remote heating (hot air blanket) at all hospitals providing emergency surgical care; active external warming should be started during transport to the nearest hospital. Hypothermic patients showing no signs of life, patients with inadequate circulation or hypothermia-induced circulatory arrest with core temperature < 32⁰C and serum K⁺ < 12 mmol-l⁻' should be transported directly to University hospital. Advanced life support in all these cases should be started immediately and continued without interruption during transportation until the patient is connected to a heart-lung machine for rewarming. If core temperature is < 28⁰C and/or the patient has inadequate circulation contact should be taken with the regional University hospital to discuss extracorporeal rewarming.

The aim: to study and identify the impact of the osmolarity blood plasma level on outcomes atherothrombotic ischemic stroke, and cardioembolic subtype.

Materials and methods: The study included 150 patients with severe ischemic stroke pathogenesis of diferent subtypes. We studied the effect of the of the osmolarity bloodplasma level in the first dayfrom the disease beginning to ischemic stroke prognosis.

Results: it is shown that the prognosisfor severe ischemic stroke pathogenesis of different subtypes of the first day disease is unfavorable to the level of blood plasma osmolality 297 mOsml. This cardioembolic ischemic strokes pathogenic subtypes are more severe course and worse prognosis.

Conclusion: the osmolarity of blood plasma is an independent predictor of adverse outcome for ischemic stroke pathogenesis of different subtypes.

Background: In addition to operating injury in the pathogenesis of immunological and metabolic disorders after surgical interventions anesthesia plays an important role.

The aim: to establish the relationship of the immune and metabolic disorders during various methods ofmulticomponent general anesthesia in conditions of laparoscopic cholecystectomy in patients with cholelithiasis.

Materials and methods: Under constant observation there were 68 women admitted to the hospital for surgical treatment of cholelithiasis. Patients were divided into 3 groups depending on multicomponent general anesthesia (halothane, propofol, sevoflurane). We determined the concentration of cytokines (TNFa, IL-la, IL-i/8, IL-4, IL-iRA, IL-2, IFNy), components of the complement system (C,, C3, C4, C, and C, factor H, C,-inhibitor), the activity of neutrophilsperipheral blood, the concentration of the products ofperoxidation, catalase, superoxide dismutase in blood plasma.

Results: The level of immune-inflammation and metabolic disorders in patients with cholelithiasis was higher in patients operated with the use of halothane. The use of sevoflurane has had the most positive effect on the studied indices.

Conclusion: The close correlation between the investigated immune and metabolic parameters on the background of the use of different schemes of multicomponent general anesthesia in patients with cholelithiasis have let to the conclusion that in the conditions of use of sevoflurane has the least place a "tension" immune and oxidative status.

Background: Patent ductus arteriosus (PDA) is one of the most common pathological conditions within the neonatal period Functioning of hemodynamically significant patent ductus arteriosus can cause a development ofvarious complications. This is why the earliest possible drug therapy or surgery is required in order to eliminate this fetal communication.

The aim: to study the efficacy and safety of acetaminophen administering to infants with low birth weight for medical obliteration of hemodynamically significant ductus arteriosus.

Materials and methods: The study included 16 infants with gestational age up to 29 weeks and birth weight less than 1200 g, the average birth weight was 980±230 g and gestation was 26,4±1,4 weeks. The average age of the observable patients at the moment of the beginning of the acetaminophen therapy was 56±6 h. Ductus arteriosus diameter was 3,75±1,25 mm. All the children underwent drug obliteration of the PDA through the intravenous acetaminophen administering. 15 mg / kg of the drug was given every 6 hours for three days. The full treatment course included 12 injections.

Results: The expected effect (closing of the ductus arteriosus) was achieved in 14 (87.5%) children undergoing the drug therapy. Two children with the birth weight of 1000 g and 1200 g remained with the ductus arteriosus open, but the signs of the left heart volume overload decreased significantly. To achieve a clinical benefit, it took 11 injections of the drug, on average. The children with the ongoing therapy were receiving enteral nutrition with the standard dosages corresponding to their age. No complications of the urinary tract, gastrointestinal tract or haemostatic system were registered.

Conclusion: Using acetaminophenfor medical obliteration of the ductus arteriosus is a highly effective and safe method of treatment that has to be used in routine clinical practice. Dosing of the drug is easy to control and change, hence it is possible to cancel the drug administering as soon as the required result is achieved so as to minimize any complications.

Background: Levelfor cardiac troponin I (TrI) and MB-fraction of creatine kinase (CKMB) increases in cardiomyocyte necrosis, and B-type natriuretic peptide (of BNP) increasing reflects ventricular overload.

The aim: to study the dynamics of BNP, TRI and CKMV in myocardial revascularisation with cardio-pulmonary bypass and to evaluate the clinical significance of these biomarkers elevated levels and establishing the relationship between BNP and markers of myocardial damage in the perioperative period Materials and methods. The study included 52 patients aged 62.5 (54.75; 70) years. Biomarkers concentrations was determined by immunofluorescence.

Results: The initial value of BNP were 57.9 (38.675;88.5) pg/ml, and then increased (p<0,01): at the end of the operation up to 91.75 (59.6;132.75) pg/ml, at 1st day following surgery - up to 260 (157;407) pg/ml, and at 2nd day - up to 184 (115.25;274.5) pg/ml. TrI and CKMV increased (p<0,01) up to 0.95 (0.4175;1.4525) ng/ml and up to 13.1 (5.575;15.525) U/L at the end of surgery, and up to 1,355 (0.76;3.8) ng/ml and 10.5 (5;18.325) U/L at thr Istpostoperative day. Preoperative BNP level and TrI level at the end of surgery were the predictors (p

Conclusions: The identifed strong correlations give reason to consider the postoperative release of BNP as an adaptive reaction in response to a "minor myocardial damage" as a result of surgical trauma and myocardial, ischemia during aorta cross-clamping.