Anesteziologiia i reanimatologiia
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Anesteziol Reanimatol · Sep 2005
[Neuropathic pain in oncology: mechanisms of its occurrence and current approaches to its treatment].
The paper provides evidence for the topicality of therapy for neuropathic pain syndrome (NPS) in cancer patients, describes the mechanisms of its occurrence, the specific features of its clinical manifestations, and presents a complex of currently available etiopathogenetic agents for the therapy of NPS. It also gives the authors' own data on the clinical application of the new anticonvulsant gabapentin (neurontin) in 34 patients with chronic NPS. ⋯ The side effects of the drug are not hazardous and they are moderately pronounced. These results are in agreement with the presented data of multicenter randomized placebo-controlled studies of the efficacy and tolerance of gabapentin in the treatment of cancer-induced NPS of various genesis.
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Anesteziol Reanimatol · Sep 2005
Comparative Study[Choice of lung ventilation at suspension laryngoscopy in patients with laryngeal neoplasms].
Three methods of artificial ventilation (AV) (volumetric, high-frequency injection, and high-frequency percutaneous transtracheal jet ventilations) were studied in 340 patients when laryngeal tumors were removed, by using a Stortz laryngoscope under multicomponent general anesthesia and local airways anesthesia. Examining the parameters of respiration and circulation in the use of three AV methods has indicated the advantages of the high-frequency percutaneous ventilation that ensures the prevention of aspiration complications and steady-state values of gas exchange and blood circulation, including in those with laryngeal stenosis and at a high risk for hemorrhage.
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Anesteziol Reanimatol · Sep 2005
Case Reports[Perspectives of prevention of postoperative neuropathic pain syndrome in cancer patients].
The paper deals with the anesthesiological problems in the prevention and therapy of neuropathic pain syndrome (NPS), including phantom pain syndrome (PPS) at different stages of surgical treatment in a cancer patient. A prospective study has been conducted; a protocol has been elaborated for the management of patients with preoperative chronic pain syndrome and those at a high risk for NPS after cancer operations associated with damage to nerve structures. A clinical case of successful therapy for severe NPS in a female patient after 4 surgical interventions, including exarticulation of the upper limb, is described. The undertaken prevention of NPS and its treatment policy that is based on the current views of the mechanisms responsible for this type of pain and included, in addition to opioid analgesics, different types of antineuropathic agents, including the recent generation anticonvulsant gabapentin (neurontin), are analyzed and investigated in detail.
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Anesteziol Reanimatol · Sep 2005
[Use of continuous epidural infusion of ropivacaine as a component of an anesthesiological appliance and postoperative analgesia in elderly patients in cancer surgery].
The study was undertaken to evaluate the effectiveness and safety of ropivacaine used via long-term epidural infusion and to define the optimum doses of the agent in the intra- and postoperative period. The parameters of hemodynamics, the adequacy of anesthesia, and the consumption of the agent were explored in 53 patients (ASA III-IV) aged 68 +/- 1.4 years operated on for abdominal cancer. Following 15 and 25 min of the injection of a bolus dose of ropivacaine, the occurrence of sensory block II was observed in 60 and 95% of the patients, respectively. ⋯ Postoperative intestinal paresis was abolished in 85.8% of patients after an average of 52 +/- 2.7 hours. Long-term epidural infusion of ropivacaine may be regarded as an effective component of anesthesia at abdominal surgery in elderly patients with severe comorbidity. The method allows one to completely refuse the use of narcotic analgesics in most cases both during a surgical intervention and in the postoperative period, which creates good conditions for an early activation of patients and for a reduction of postoperative complications.