Anesteziologiia i reanimatologiia
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Anesteziol Reanimatol · May 1998
Comparative Study[Use of Bullard laryngoscope in intubation of the trachea].
Bullard laryngoscope was for the first time used for intubation of the trachea in 232 neurosurgical patients. The advantages of the new laryngoscope and specific problems associated with its use are discussed. The principal advantage is no need in direct laryngoscopy, which permits using this instrument in patients with short and rigid neck, in those with ankylosis of the temporomandibular joint, with injuries to, or unstable spine. The problems are mainly related to obturation of the optic system of the laryngoscope by secretion and to selection of an adequate diameter of the intubation tube.
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Anesteziol Reanimatol · May 1998
Randomized Controlled Trial Comparative Study Clinical Trial[Study of the use of noninvasive ventilation of the lungs in acute respiratory insufficiency due exacerbation of chronic obstructive pulmonary disease].
Noninvasive positive pressure ventilation (NPPV) is a life-saving procedure in acute respiratory failure (ARF), but its technique is not yet in routine use in many respiratory centers. We carried out a prospective randomized study comparing the combination of NPPV with conventional therapy (oxygen, bronchodilators, steroids, and theophylline) with conventional therapy alone in patients with acute respiratory failure caused by exacerbation of chronic obstructive pulmonary disease (COPD). A total of 58 patients were recruited from a large group of patients admitted to our hospital between September 1995 and March 1997. ⋯ The need in intubation was lower in the NPPV group as compared to the reference group (12 vs. 28%, p = 0.18), mortality rate was higher in the non-NPPV group (31 vs. 8%, p = 0.03), and hospital stay was shorter in NPPV patients (26 +/- 7 vs. 34 +/- 10 days). The incidence of complications was lower in the NPPV group, they were less significant, and did not involve discontinuation of ventilation. Hence, NPPV is a first-line therapy in patients with ARF caused by COPD exacerbation, due to obvious advantages over conventional methods of treatment.
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Anesteziol Reanimatol · May 1998
Comparative Study[Effects of ventilation of the lungs in prone position on the pulmonary oxygenation function and hemodynamic parameters of heart surgery patients with respiratory insufficiency in the postoperative period].
Effect of ventilation in the face-down position (VFDP) on the oxygenation function of the lungs and hemodynamics is studied in 32 patients (aged 22-64 years) subjected to open-heart surgery complicated by development of acute respiratory failure (RF). In 23 patients with grave respiratory distress syndrome, VFDP was performed with forced ventilation of the lungs (FVL) and in 9 with less grave RF, with noninvasive mask ventilation of the lung (NIMVL). Body position of patients on FVL was changed every 4-12 h, of nonintubated patients, 45-60 min. ⋯ After body position of patients was changed, the above improvements did not disappear, despite a slight decrease of the effect attained. VFDP with NIMVL led to similar results: O2 alveolar-arterial gradient decreased, PaO2/FiO2 decreased by 24.2%, the mean values of this ratio approaching the norm. Positive effect somewhat decreased after catecholamines were discontinued, but the oxygenation function of the lungs remained better than initially.
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Anesteziol Reanimatol · May 1998
Comparative Study[Use of tramal for prevention of motor hyperactivity during r fiber bronchoscopy in patients in the postoperative period].
The efficacy of tramal for preventing motor hyperactivity is assessed in patients on spontaneous respiration after surgery during fiber bronchoscopy under a short-acting hypnotic ethomidate. Group 1 consisted of 22 patients to whom 100 mg of tramal was injected intravenously 30 min before fiber bronchoscopy, group 2 of 10 patients subjected to fiber bronchoscopy without preliminary tramal. Ethomidate caused manifest 20-45-sec myoclonus in the distal parts of the upper and lower limbs in 80% of cases. Pretreatment with tramal (100 mg intravenously) decreased the severity and incidence of myoclonus to 18.2%, did not affect gas exchange, and stabilized hemodynamics during fiber bronchoscopy.