Anesteziologiia i reanimatologiia
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Anesteziol Reanimatol · Mar 2005
Review[Rationale for the use of extracorporeal treatments for sepsis].
Sepsis is the leading cause of disability and mortality among critical patients; moreover, it causes high economic expenditures. Although very much is known about the pathophysiology of this condition and its mediators despite great investments directed to its control, mortality rates remain high. Recent treatment manuals emphasize the value of early goal-oriented therapy and also point to the high efficacy of activated protein C. ⋯ There are reports on its positive clinical results that are likely associated with the effective removal of septic mediators. Human and animal studies, few and rather alike as they are, have yielded promising results. It is evident that the use of these procedures is justified; however, their efficiency in sepsis requires large-scale, correctly conducted studies.
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The present literature discusses what effective concentration of xenon may be used to induce adequate anesthesia. To examine the analgesic properties of the substance, 38 patients undergone laparoscopic operations for calculous cholecystitis under informational saturation EEG (INEEG) monitoring were included into this study. All the patients were divided into 3 groups in accordance to the mode of anesthesia maintenance and INEEG monitoring. ⋯ The use of 70% xenon concentration and the standard doses offentanyl (3.1 +/- 1.6 microg/kg/h) resulted in excessively deep anesthesia (38 +/- 4% INEEG). Reduction of the dose of fentanyl on an average to 1.5 +/- 0.8 microg/kg/h permitted more adequate anesthesia; however, an excessively deep anesthesia is encountered in 40% of cases, as evidenced by INEEG. The active use of INEEG monitoring in Group 3 makes it possible to perform an adequate anesthesia (46 +/- 4% INEEG) and to determine the xenon concentration necessary for this, which is equivalent to 42 +/- 11% with the dose of fentanyl of 0.9 +/- 0.8 microg/kg/h.
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Anesteziol Reanimatol · Mar 2005
[Intraaortic balloon counterpulsation in the treatment of perioperative cardiogenic shock-complicated myocardial infarction during aortocoronary bypass surgery].
The paper presents the results of use of intraaortic balloon counterpulsation (IABC) in complex therapy for cardiogemic shock in 31 patients with perioperative myocardial infarction (PMI) developed during aortocoronary bypass surgery under extracorporeal circulation (EC) and cold cardioplegia. The diagnosis of PMI was confirmed by the ECG data (the emergence of new Q waves) and by the high level of CPC-MB (more than 6%). IABC was performed, by using a Kontron M-7000 apparatus. ⋯ Improvements in left ventricular pump function, cardiac output, and a significant reduction in the doses of sympathomimetics within the first 12 hours of IABC should be considered to be a good predictor. With the complex treatment of cardiogenic shock, by using counterpulsation after aortocoronary bypass surgery is 51.6%. The early initiation of IABC within 6 hours following the development of myocardial infarction allows mortality to be reduced.
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The paper analyzes the first experience in using the halogen-containing anesthetic sevoflurane, which is new for Russia, as an agent for initial narcosis and anesthesia maintenance in adult patients. For induction, delivery of sevoflurane was initiated in a dose of 0.7 r.% through the mask of an anesthetic-respiratory apparatus. After 3-5 breaths, the dose of sevoflurane was increased up to 2 r.%. ⋯ Sevofluorane has a pronounced hypnotic, but a weak analgesic effect in adults, which requires the co-administration of fentanyl. Sevofluorane will be mostly demanded for initial narcosis and anesthesia maintenance in children and for the induction and maintenance of anesthesia in ambulatory anesthesiology and thriving one-day hospitals. The foregoing does not rule out the use of servofluorane for the induction and maintenance of anesthesia in adults.
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Anesteziol Reanimatol · Mar 2005
[Use of continuous high-volume hemofiltration in patients with sepsis and multiple organ dysfunction].
The paper gives the authors' experience in performing continuous high-volume hemofiltration in 38 patients with sepsis and multiple organ failure. The kinetics of proinflammatory cytokines and a number of plasma enzymes as markers of substances having a relatively high molecular mass was studied. ⋯ The possibilities of correcting the parameters of homeostasis are the principles of maintenance of a hemostatic system in this group of patients during the procedure are presented. The drawbacks of this technique are also described.