Anesteziologiia i reanimatologiia
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Respiratory narcotic devices and monitoring devices have been rapidly improved since World War II; new effective and safe drugs and high-quality materials appeared. This resulted in a notable decrease of mortality caused by anesthesia: from 1 per 50 patients before the war to 1 per 200,000 patients during the last years of the twentieth century. Paradoxical as it is, anesthesia today is one of the most safe medical specializations. ⋯ One and the same method can meet the most strict requirements to outpatient and venture surgery. Hence, the initially rather long list of anesthesiological methods becomes shorter as it should meet modern requirements to the efficiency and safety of anesthesia and becomes quite short if we take into consideration patient's comfort and physician's convenience. The choice from 3-4 methods is completely determined by physician's habits or preferences or traditions of the hospital.
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Use of propofol in anesthesiology increases with every year. On the other hand, some data indicate a risk of postoperative complications caused by bacterial contamination of propofol solution in the course of its utilization. ⋯ A modified formula of propofol (diprivan-EDTA) has been developed, which is characterized by antibacterial (bacteriostatic) effect towards 20 most prevalent microorganisms. Preliminary results of clinical evaluation of diprivan-EDTA safety indicate its positive effect on the incidence of severe postoperative complications and mortality of patients in intensive care wards.
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The article reviews modern concepts regarding stress response and its effects on various organs and systems of critical patients. Postoperative pain is regarded with emphasis on its pathophysiology and the prospects of using epidural anesthesia-analgesia for alleviating its injurious effects. ⋯ The importance of adequate analgesia for alleviation of the injurious effects of nociceptive impulses in critical patients is emphasized. Analgesia should be regarded as one of the methods of intensive care of critical patients along with respiratory support, fluid replacement, and parenteral nutrition.
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Anesteziol Reanimatol · May 2002
Comparative Study[Comparative evaluation of methods for preoperative treatment and variants of anesthesia in patient with toxic goiter].
Surgery on the thyroid has been extensively developing in recent decades. All organs and systems are involved in thyrotoxicosis, but cardiovascular involvement predominates. ⋯ Preoperative treatment modified the central hemodynamic parameters and levels of thyroid and adrenocortical hormones in the blood, which should be borne in mind during preparations of patients to surgery. Central hemodynamic parameters and hormonal profiles during the intervention depended on the variants of preoperative treatment and anesthesia.