Anesteziologiia i reanimatologiia最新文献

Background: Rejection from prolonged mechanical ventilation with conversion to support ventilation modes during the surgery and subsequent immediate extubation at the end of the surgery could be the method ofprophylaxis ofpostoperative respiratory complications.

The aim: To improve the results of surgical treatment of patients with infrarenal aorta injury due to the development and implementation to the anesthetic management complex the modes of support ventilation.

Materials and methods: 2-staged clinical trial on patients undergoing surgery on infrarenal aorta was conducted. At the 1st stage patients were assessed for opportunity of immediate or early extubation and support ventilation initiation. At the 2nd stage support modes during the intraoperative ventilation were introducted into clinical praxis.

Results: Based on received data we concluded that not everyone patient needed intra- and postoperative mechanical ventilation in spite ofprolonged duration of the surgery and large surgical trauma. Inclusion in the protocol of anesthesia support ventilation strategy decreases requirement ofparalytic agents and their side effects.

Conclusion: Applying the support ventilation modes during the anesthesia gives a chance of immediate and early extubation after the surgery and decreases the number of critical events and respiratory complications.

The aim: to determine patterns during combined anesthesia andfrequency ofcritical incidents, depending on the initial level of wakefulness and patient age.

Materials and methods: 158 patients of planning operated under combined anesthesia for colon tumors were divided into two groups of elderly patients (n= 79) and old (n= 79). Each group was divided into 3 subgroups, depending on level of wakefulness, the estimatedfor level of direct current potential: low, optimum and high levels ofwakefulness. Relations of age and level ofwakefulness with afrequency of critical incidents. In the number of registered incidents included hemodynamic incidents: hypotension, hypertension, bradycardia, arrhythmia and tachycardia; respiratory incidents: hypoxemia, hypercapnia, the needfor prolonged postoperative mechanical ventilation; metabolic incidents: hypothermia, slow recovery of neuromuscular conduction, slow postoperative awakening has been studied.

Results: The most frequent incidents in our study were hemodynamic incidents, which prevailed in the structure of hypotension and hypertension. Among of the respiratory incidents dominated by hypoxia and hypercapnia. In the group of elderly patients the most incidents occurred in the subgroup with low level of wakefulness, while in the oldest patients statistically group significant differences between the groups were not found Conclusion. Frequency of critical incidents does not only depend from the age but also from a preoperative level of wakefulness; frequency was lower in elderly patients with an optimum level of wakefulness, and the low level of wakefulness - was high regardless of age.

Currently, surgery on the trachea underwent significant progress including in the latest methods of complex resections and reconstructions of the respiratory tract. In this regard, anesthesiologist needs the knowledge and skills of using various special respiratory techniques. Modern respiratory methods in tracheal surgery are "shunt-breath", high frequency jet ventilation, methods of extracorporeal oxygenation and respiratory relatively new technology - apneic oxygenation. This review deals with the pathophysiologicalfeatures of each of these techniques. Searching for information was made on the database: Scientific electronic library, Central Scientific Medical Library, PubMed, Scopus and Web of Science.

The aim: To identify the role of the intestine in the development of metabolic disorders with operations in the thoracoabdominal aorta developing after clamping of the aorta above the celiac trunk Materials and methods. The study was conducted in pigs (n = 6) with similar body weight (m = 35-39 kg). After the intoduction of animal anesthesia, surgery was performed by access to the visceral veins (upper and lower mesenteric kidney, liver spleen andfemur), from which the Blood samples to determine the concentration of lactate, glucose, as well as indicators of acid-base status. Then placing the clamp on the aorta above the level of discharge of the celiac trunk. Blood sampling and laboratory diagnosis carried out twice: before clamping the aorta and blood flow before the start after 60 minutes of ischemia. Histological study intestinal tissue also conducted.

Results: It is shown that the aorta cross-clamping develops pronounced metabolic disorders, manifested in the form of increased levels of lactate and glucose concentrations in all investigated parts of the splanchnic region. The most pronounced increase in lactate after clamping the aorta was observed in the blood samples flowing from the intestine. The results of histological studies show that intestinal hypoperfusion leads to severe pathological changes, that is a predisposing factor leading to the translocation of bacterial agents into the systemic circulation, to the process of expression of systemic inflammatory response and a powerful oxidative stress.

Conclusion: Our experimental data show that when aortic clamping above the celiac trunk (ischemia mesenteric region) the greatest quantitative contribution to metabolic disorders the body of the animal created in a pathophysiological situation contributes to intestinal hypoperfusion. In this regard, one of the main tactics of the anaesthetist in the perioperative period should be the protection of the intestine against ischemia and its consequences.

Background: Optimizing analgesia in total hip arthroplasty contributed to the idea of combined use of spinal and paravertebral anesthesia.

The aim: the clinical evaluation of combined spinal-paravertebral anesthesia in patients undergoing total hip ar- throplasty.

Materials and methods: 67 patients were divided into groups: at the first a combined spinal-paravertebral anesthesia (KSPA) was used, the second - a combined spinal-epidural anesthesia (CSEA). The location of the lumbar plexus was determined by ultrasound scan. Spinal component was provided 0.5% ropivacaine solution. In the perioperative period propofol infusionfor sedation was used. After operation infusion of 0.2% ropivacaine solution at a rate of5-6 ml/hour was started through the catheter for 48 hours. The postoperative period was assessed pain intensity on a 10-point visual analog scale (VAS), the needfor analgesics, incidence of complications and patient satisfaction with the quality of anesthesia.

Results: The lumbar plexus at the L2-3 level was in 29,9%- immediately after the release ofthe intervertebral holes, in 67.2%- in the psoas major muscle at L4-5 level of 80.1% in the psoas major muscle. In both groups postoperative pain intensity within 48 hours does not exceed 3, VAS scores. The frequency of complications in the postoperative period was against the background of paravertebral blockade of 18.2%, against the backdrop of epidural analgesia - 26 5%. 90.1% ofpatients in the first group and 82.4% ofpatients in the second group were fully satisfied with the chosen method of anesthesia (p> 0.05).

Conclusions: Combined spinal-paravertebral block for total hip arthroplasty is an effective and safe method of pain relief.

Background: Currently, the trend continues to increase the number ofpatients with cicatricial tracheal stenosis (CTS). Therefore, prevention and treatment ofthis disease remains topical. The main cause ofcicatricial tracheal stenosis is damaging the trachea during mechanical ventilation. The scheme ofprevention of this disease in Russia hasn't brought the desired results.

The aim: to clarify the modern etiology of cicatricial tracheal stenosis, to identify the trend in incidence rates, to determine whether there is an optimal safe alternative to tracheostomy including the use of minimally invasive techniques, to improve diagnostic and therapeutic algorithm at various stages of assistance, and also to study the results of innovative operations and new ways of maintaining gas exchange.

Materials and methods: 1128 patients with cicatricial tracheal stenosis was treated from 1963 to 2015 in Petrovsky National Research Centre of Surgery and IMSechenov First Moscow State Medical University. Over time methods of di- agnosis, methods of anesthesia and operations have been varied. In this regard all patients were divided into two groups depending on the period of time from 1963 to 2000 (297 patients) andfrom 2001 to 2015 (831 patients). In recent decades there is a steady increase in the number of treated patients. So, if in the first group during the year operational treatment about the CTS 8,0 patients were underwent, in the second - to 55.4. Cicatricial tracheal stenosis appeared after lung mechanical ventilation at 1025 (for 90.9%) patients. They have undergone both radical one-stage treatment and multi-stage and sequential intraluminal procedures. In general there is a clear trend towards more aggressive surgical tactics. So, if in thefirst group, the tracheal resection with anastomosis was performedin 59 patients only, the second-330. Thefrequency ofpostoperative complications and mortality in the second group ofpatients was 12.9 and 0.7 %, respectively.

Results: Only a reasonable combination of all treatment methods, the principle of "every patient his own version of operation" allows to minimize the risk oftreatment and to get a good lasting result. Proof of such provision may be the fact that the frequency of complications and postoperative mortality at our patients have had a tendency to decrease and currently stands at 12.9 and 0.7 %, respectively for many years. It is 2.3 and 9.6 times less, respectively, than in the periodfrom 1963 to 2000. It appears that further reduction of these indicators will be at a slower pace, afurther solution of the CTS problem will be based on the prevention of disease.

Conclusion: Prevention of cicatricial tracheal stenosis in the departments of reanimation and intensive care is currently inadequate. It requires fundamentally new approaches, but reform still has not brought the desired results. Diagnosi

The aim: To compare efficiency of various techniques of anesthesia after Cesarean section on degree ofpain expression in randomized clinical trial.

Materials and methods: 120 puerperas aged from 21 till 33 years who were undergone to Caesarean section were studied. Patients were divided into four equal groups by number of observations. In groups 1st and 2nd patients were performed local anesthesia with continuous and bolus anesthetic. In group 3rd were performed bilateral blockade of the cross-space belly. In the 4th groups was used multimodal analgesia system. Each patient during the postoperative period was estimated the severity ofpain on a visual analog scale at rest and movement at 3, 6, 12, 24 and 48 hours.

Results: Intensity ofpain after surgery in patients of all groups decreased and reached lows of 48 hours after a Cesarean section. At the same time the 2nd group ofpatients (6,1 ? 1,4) had pain significantly less than that ofpuerperas from the 3rd and the 4th groups (13,2 J 2,4 and 18,0 ? 2,7). Meanwhile, indices offemale patients pain severity from the 1st and 2nd groups of the study were not statistically different. When studying distribution ofpatients on degree ofpostoperative pain it is established that atpuerperas of the 1st and 2nd group pains prevailed weak (47% and 67%) and moderately expressed (50% and 33%). In the 3rd group expression of a pain syndrome in all cases was moderate. In the fourth group the pain syndrome was considerably more expressed (the moderated - 53%; the strong - 4 7%).

Conclusion: Pain syndrome after Cesarean section using the localanalgesia with continuous or bolus is reduced by 28-35%, which was significantly more than the blockade of the cross-space stomach and systemic analgesia.