Anesteziologiia i reanimatologiia
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Anesteziol Reanimatol · Sep 2003
Review[Postoperative analgesia in abdominal surgery: a new look at an old problem].
Analgesia in abdominal surgery is a sufficiently complicated problem. The extensive surgeries in the abdominal cavity are concomitant with massive tissue damages and are associated the systematic tissue inflammatory response to an intensity of the pain syndrome and of other postoperative complications. The modern understanding of surgical-trauma pathophysiology is indicative of the necessity to modulate the systemic inflammatory response whose severity is preconditioned not only by postoperative pain intensity but also by surgical results. With respect to the above stated, multi-model analgesia can be regarded as an optimal technique since it presupposes the long-term administration of local anesthetics (preferably 0.2% ropivakain) concurrently with non-steroid anti-inflammatory drugs used preoperatively (the most effective one is lornoxicam).
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Anesteziol Reanimatol · Sep 2003
[Continuous epidural infusion of ropivacaine hydrochloride (naropin) during postoperative analgesia in cardiosurgical patients].
An efficiency and safety of continuous infusion of naropin in the epidural analgesia of 38 patients after coronary artery bypass grafting were demonstrated. A variation of combined anesthesia, which was elaborated at the Russian Research Center of Surgery of the Russian Academy of Medical Sciences and which comprises (as a basic component of anesthetic management) a high thoracal epidural block (T2-T4) by continuous infusion of a 2% solution of naropin at a velocity of 5 +/- 2 ml/h. Anesthesia was supported by isoflurane (0.5 +/- 0.9%). ⋯ CVP decrease versus stage 1 was ensured in 38.% of patients by stage 4 and the number of patients with a decreased CVP (less than 60 mm H) went up, versus stage 1, by 3 times. APsyst of less than 90-80 mm Hg was registered in 15 (39.8%) of patients at different examination stages, which necessitated the use of noradrenalin at mean dose of 174 +/- 21 ng/kg.min. The infusion of naropin at dose of 1-6 ml/h did not entail any impairment in the central nervous system (hallucinations, convulsions, and headache).
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Anesteziol Reanimatol · Sep 2003
Clinical Trial[Clinical aspects of using patient-controlled analgesia with nonsteroidal anti-inflammatory agents in postoperative period].
We used lornoxicam (n = 16) and ketorolac (n = 20) to study the possibilities of applying the non-steroid anti-inflammatory drugs within the postoperative patient-controllable analgesia (PCA). With respect to a used analgetic, the frequency rate of good PCA anesthetic results was found, on day 1, to be 60-77%. The good anesthetic results were registered in 25% of patients when the routine scheme was in use. Non-steroid anti-inflammatory agents (lornoxicam, ketorolac) can be prescribed within the early postoperative PCA as basic analgetics, which essentially reduces the need in promedol without worsening the analgesia efficiency.
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Anesteziol Reanimatol · Sep 2003
[Selection of components and methods for postoperative analgesia after extensive abdominal surgeries].
The modern technique of postoperative analgesia after extensive and traumatic surgical interventions presupposes the administration, apart from opiates, a variety of preparations inhibiting the biological activity of substances (prostaglandins, kinins, TNF, leukotrienes, etc.), i.e. mediators of the systemic-inflammatory response, which are of the key importance in modeling the postoperative pain. The paper deals with the specificity of postoperative analgesia at different stages of surgical treatment of patients with destructive pancreatitis (DP). The surgical tactics in DP envisages a primary revision of the abdominal cavity, necrectomy and omentobursostomy with subsequent multi ple stage-based sanations of the abdominal cavity. ⋯ The entire postoperative period in DP patients is divided into 4 stages with each stage having a certain specific level of intoxication, systemic-inflammatory response and of pain syndrome. An analgesia scheme, based on epidural anesthesia combined with the inhibitors of kinin-genesis (inhitril, contrical) of prostaglandin-genesis (ketorol of xefocam) and of a synthetic analogue of leu-enkephalines (daralgin). A specific combination of analgetics was typical of each treatment stage.
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Anesteziol Reanimatol · Sep 2003
[Safety of subarachnoid anesthesia during cesarean section in pregnant women with preeclampsia].
The paper contains data on a retrospective observation study of 54 cases of subarachnoid anesthetic management (SAM) for Cesarean section in pregnant women with preeclampsia. The results contradict the generally accepted viewpoint on that the SAM in patients with preeclampsia is not safe due to the negative methods impact on the hemodynamic state. No complications whatsoever were detected in mothers and fetuses of the experimental group, which was apparently due to a suggested set of preventive measures. The study confirmed the SAM safety in patients with preeclampsia.