Anesteziologiia i reanimatologiia
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Anesteziol Reanimatol · Mar 2008
[The first experience in monitoring the cerebral vascular autoregulation in the acute period of severe brain injury].
The paper presents the first experience in monitoring the pressure reactivity index (Prx) of cerebral vascular autoregulation in a group of patients with severe brain injury. This autoregulation index along with the monitored parameters of intracranial pressure (ICP) and cerebral perfusion pressure (CPP) allows the outcome to be predicted in brain injury: the outcome is poor at a Prx of > 0.2. The continuous estimation of the autoregulation index makes it possible to determine the optimum CPP value for each patient and to timely diagnose decompensation of cerebral vascular autoregulation, which is of importance in selecting treatment policy.
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The paper analyzes the clinical effectiveness of various blood-sparing techniques (hypervolemic hemodilution, isovolemic hemodilution, and instrumental infusion of washed autoerythrocytes) in neurosurgical interventions (n = 93) in 89 patients. Hypervolemic hemodilution that remains, however, to be the method of choice for young and low-weight children has proved to be the least clinically effective as a method for blood saving. ⋯ A combination of hemodilution and instrumental reinfusion of autoerythrocytes provides a summation of blood-sparing effects for the mechanisms of blood saving vary with these techniques. The use of any blood-sparing technique accelerates and worsens hemostatic disorders.
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Anesteziol Reanimatol · Mar 2008
[Effect of sevoflurane on spontaneous brain bioelectrical activity in neurosurgical patients].
The present study was undertaken to evaluate the effects of sevoflurane on spontaneous brain bioelectrical activity in neurosurgical patients. Forty patients treated at the Research Institute of Neurosurgery underwent a neurophysiological examination. ⋯ Sevoflurane causes a relative acceleration of epileptiform activity synchronization, as evidenced by EEG, which is not a contraindication to the use of this drug in patients with cerebral organic lesion of various genesis with a history of epileptic syndrome and fails to induce clinically significant EEG epileptiform manifestations in patients without epilepsy. In patients with cerebrovascular abnormalities (arteriovenous malformation, cavernous angiomas) who have a history of paroxysmal conditions, inhalational sevoflurane anesthesia can be performed in combination with anticonvulsants (benzodiazepines) during an operation.
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Anesteziol Reanimatol · Mar 2008
[Using solutions of hydroxyethyl starch (6% HES 200/0.5 (refortan) and 6% HES 130/0.4 (voluven)) in neuroanesthesiology].
The paper provides the results of a complex experimental and clinical study of the effects of infusion solutions of hydroxyethyl starch (HES 200/0.5--Refortan and HES 130/0.4--Voluven) on hemostatic and systemic hemodynamic parameters in patients operated on for neurosurgical pathology of the brain. The HES solutions are shown to have a more pronounced volemic effect and a slightly higher hypocoagulation effect on the hemostatic system (as compared with physiological solution); the latter does not, however, achieve its clinical value with the used doses of the solutions.
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Anesteziol Reanimatol · Mar 2008
[Multimodal neuromonitoring in the early diagnosis of brain ischemia during carotid arterial reconstruction].
The paper analyzes the efficiency of multimodal neuromonitoring (transcranial ultrasound Doppler study, cerebral oximetry, and electroencephalography) for the early intraoperative diagnosis of cerebral ischemia in patients during carotid reparative interventions. On the basis of the findings, the authors have developed a diagnostic algorithm of cerebral ischemia in this group of patients at surgery. ⋯ The diagnosis of cerebral ischemia during operation on the carotids is a direct indication for the usage of a temporary intraluminal shunt. During carotid reconstructive interventions made under general anesthesia, the application of multimodal neuromonitoring is a valid approach and it should make the most use.