Anesteziologiia i reanimatologiia
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Anesteziol Reanimatol · Sep 1999
Comparative Study[Combined spinal-epidural and epidural anesthesia in operations on the vessels of the lower extremities].
Eighty-eight anesthesias in patients operated on the lower limb vessels are analyzed. In group 1 (77 pts) combined spinal-epidural anesthesia (CSEA) was used, in group 2 (16 pts) epidural anesthesia (EA). Segmentary blocking was induced by 2% lidocaine and 0.5% bupivacaine. ⋯ Accidental perforation of the dura mater occurred in two patients, and prolonged spinal anesthesia was carried out. No headaches ensued. Hence, CSEA should be preferred to common prolonged EA in operations on the lower limb vessels.
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A total of 250 subarachnoidal anesthesias (SA) have been performed in patients operated on the lower limbs, perineum, external genitals, pelvic organs, and anterior abdominal wall at department for plastic and reconstructive surgery. The efficacy and safety of SA in everyday practice has been evaluated. A total of simultaneous 228 SA with three hyperbaric solutions were carried out: 5% ultracaine, 0.75% bupivacaine, 0.5% marcaine, and one isobaric solution 0.5% bupivacaine. ⋯ Hyperbaric and isobaric solutions caused analgesia of different duration, latent period, and dissemination of the anesthetic under different clinical situations. Prolonged SA is justified in patients with limited hemodynamic reserves, and CSEA should be preferred when the expected duration of the intervention is longer than the estimated duration of SA effects. SA is an effective and safe method for surgical anesthesia on condition of proper choice of the local anesthetic, use of high-quality kits, and strict adherence to the protocol of subarachnoidal puncture and injection.
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Despite numerous methods of drug and non-drug analgesia, acute pain relief remains a pressing problem, particularly for the postoperative period. Individual protocols of analgesia are still to be developed. Standard doses of analgesics, administered in some intensive care wards, may be inadequate in some patients. ⋯ The main advantage of PCS in comparison with traditional administration of analgesics are effective analgesia meeting the individual requirements of a patient, rapid desired effect, a shorter period without analgesia, stable concentration of the analgesic in the plasma, time saving for the staff, and a lower incidence of side effects. PCA has been used in 227 patients in intensive care wards of Research Center of Surgery. The majority of patients appreciate this method high, which results in adequate analgesia in 82-95% cases.
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Anesteziol Reanimatol · Sep 1999
[The perioperative diagnosis of cerebral ischemia during reconstructive operations on the carotid arteries (initial experience in using transcranial oximetry)].
Intraoperative monitoring of cerebral ischemia during surgery on the brachiocephalic arteries is carried out by several methods: transcranial dopplerography, electroencephalography, recording of the somatosensory evoked potentials, puncture measurement of intravascular pressure, etc. However, not all these methods are sufficiently informative, reliable, and safe. One of the methods meeting these requirements is noninvasive cerebral oximetry. ⋯ The method of cerebral oximetry is based on optic spectroscopy using infrared light in the 650-1100 nm waveband. Monitoring was carried out in 34 patients with involvement of the brachiocephalic arteries. The results persuasively prove high informative value and safety of the method.