Anesteziologiia i reanimatologiia
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Anesteziol Reanimatol · Sep 1998
Review Comparative Study[Antinociceptive components of general anesthesia and postoperative analgesia].
The philosophy of full-value antinociceptive protection of patients during and after surgical interventions is discussed. The author presents her viewpoint on the problem with due consideration for recent published reports. She advocates a prophylactic approach to attaining the antinociceptive protection (the so-called "preemptive analgesia"). ⋯ For preventing secondary (central) hyperalgesia and decreasing the intensity of postoperative painful syndrome, NMDA-receptor antagonist ketamine in microdoses is recommended before and during surgery. Afferent nociceptive flow can be decreased by local and regional anesthesia. Practical application of the preemptive analgesia principle improves the efficacy and safety of analgesia at different stages of surgical treatment, decreases total and local (at the level of operated tissues) consequences of surgical trauma, and decreases the probability of complications.
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Anesteziol Reanimatol · Sep 1998
Review Comparative Study[Analgesic agents: comparative evaluation, mechanisms of action, prospects].
A classification of analgesics based on the localization and mechanisms of their action is proposed. Opioid analgesics are compared: opioid receptor agonists, agonists-antagonists, and partial agonists. Central-action nonopioid analgesics are listed: alpha 2-adrenomimetics, Na- and K-channel blockers, reverse monoamine neuronal capture inhibitors, stimulating amino acid antagonists, etc. Peripheral-action analgesics (cycloxygenase inhibitors) are described.
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Anesteziol Reanimatol · Sep 1998
Comparative Study[Prospects of the use of caudal epidural anesthesia].
Caudal epidural anesthesia for interventions on the lower limbs and pelvic organs was used in 525 patients. A specific feature of the method is use of hypoosmolic local anesthetic solution (osmolality 260 mosmol/kg) containing lidocaine, 0.9% sodium chloride, and distilled water. Pathologic studies showed that in adult patients, at least 40 ml anesthetic should be injected into the caudal canal for adequate blocking. ⋯ The duration of analgesic effect was 3 +/- 0.5 h and even longer, if local anesthesia was potentiated with sedative drugs. No complications were observed, failures occurred in 5.2% cases. The method is simple and reliable and is recommended for practice.
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Anesteziol Reanimatol · Sep 1998
Comparative Study[Epidural anesthesia using local anesthetics and clopheline in geriatric urology].
Study of pharmacokinetics of lidocaine, trimecaine, and clofelin demonstrated rapid resorption of these drugs in the postoperative period. Comparison of two methods of epidural anesthesia in high-risk patients (ASA 3) subjected to urologic surgery showed the objective advantages of adrenergic regional anesthesia, ensuring the stability of vital functions during surgery and allowing operations in awaken patients with adequate spontaneous respiration.
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Anesteziol Reanimatol · Sep 1998
Comparative Study[Prolonged epidural analgesia induced by clopheline in combination with lidocaine in obstetric analgesia].
The study was carried out in 178 women without grave obstetrical or extragenital diseases. In group 1 labor pain was relieved by prolonged epidural anesthesia with 2% lidocaine solution (2-2.5 mg/kg), in group 2 prolonged epidural anesthesia with 1% lidocaine solution (1 mg/kg) and 0.01% clofelin (1 microgram/kg) was administered. ⋯ However, a combination of epidural clofelin (1 microgram/kg) with lidocaine permits an appreciable decrease in the doses of both drugs without decreasing the efficacy of anesthesia. This method has a favorable effect on the course of labor: the mouth of the womb opens sooner at a lower uterine activity and there are no negative effects on the fetus and newborn.