Anesteziologiia i reanimatologiia
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Anesteziol Reanimatol · Jul 2007
Case Reports[Closed tracheal injury--surgical or anesthesiologic-and-resuscitative problem].
Closed chest injury with rupture of the trachea and main bronchi is a rare and extremely life-threatening pathology. In suspected tracheal injury, as well as in severe closed chest injury with the gas syndrome, diagnostic tracheobronchoscopy with possible intubation is indicated in order to isolate the airway lumen from the paratracheal space. Tracheal intubation through a fibrobronchoscope should be considered to be the first aid. ⋯ The operation should be performed as early as possible. It should be started from the intubation of the airways and the insertion of the end of an intubational tube caudally the rupture. When the breathing circuit is depressurized, all alternative gas exchange maintenance techniques available at an anesthetist's disposal, including high-frequency artificial ventilation and a shunt-breathing system, are indicated, which should provide a patient's safety and surgical comfort.
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Anesteziol Reanimatol · Jul 2007
[The optimization of a medicinal process and the organization of work in an operating-room].
In most hospitals, the operating-room is a most expensive therapeutic subdivision. A clear and understandable concept of organization of the management of a medical process in an operating room should be introduced into all clinics in order to satisfy increasing needs for professional and technological management. Within the framework of a promising management program to optimize a medical process and to organize work in the operating-room, the surgeons are provided with surgical equipment intended for an operating-room in accordance with their assessed needs and with their participation in budgeting, which made it possible to evaluate the efficiency of a medical process and the work of each user of an operating-room.
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Anesthetic provision of emergency surgery has a number of organizational and methodic features. The paper describes general principles in the organization of work of a team of emergency anesthetists. It also considers the problems of preoperative preparation, the choice of an anesthesiological procedure, and the tactics of intraoperative management of patients operated on, if there are emergency indications. Particular emphasis is laid on life-threatening stages of anesthesia.
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Anesteziol Reanimatol · Jul 2007
Review[Cranial nerve damage after neuroaxial methods of anesthesia in puerperas].
The paper describes cranial nerve damage, a rare complication of neuroaxial anesthesia in obstetric care. In the literature, there are summarized data on 17 cases of neurological deficit developing after subarachnoidal or epidural anesthesia in puerperas. The etiological and pathogenetic factors of the above complications may be suggested to be the high disposition of a local anesthetic, arterial hypotension due to neuroaxial anesthetics, the outflow of cerebrospinal fluid after pachymeningeal puncture (including after unintended puncture during epidural anesthesia), and ischemic injury after the blood packing performed to relieve postpuncture headache. Closer consideration of these risk factors seems to reduce the incidence of cranial nerve damage in puerperas.
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Anesteziol Reanimatol · Jul 2007
Randomized Controlled Trial[Optimization of anesthesia during surgery for bullous lung emphysema].
The paper considers a complex of methods for estimating the adequacy of anesthesia, which involves the simultaneous analysis of both the parameters of central hemodynamics, oxygen transport, blood gases, and acid-base balance and those of cardiac rhythm variability. Based on the findings, the authors propose recommendations for optimizing the routine procedure of basis-anesthesia utilizing propofol and basis-anesthesia using ftorotan at surgery for bullous emphysema.