Anesteziologiia i reanimatologiia
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Ischemic tolerance (preconditioning) is taken to mean a short ischemic episode subfatal to cells that activates the protective endogenous mechanisms that ensure tolerance of further longer and more severe episodes of ischemia by the organ (tissue). The present review attempts to analyze information on ischemic preconditioning in the light of the possible use for brain protection. Experimental models, temporal aspects, crossed tolerance, genomic reaction, and mechanisms are considered. There is evidence for human ischemic preconditioning.
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Anesteziol Reanimatol · Mar 2008
[Intraoperative and early postoperative complications of puncture-dilation tracheostomy in neurosurgical patients].
The paper provides a detailed analysis of the most common and clinically significant complications due to percutaneous dilation tracheostomy performed in 479 patients with neurosurgical diseases in 2002-2007. It also considers such complication of the technique, which is specific to neurosurgical patients, as elevated intracranial pressure (ICP), and describes a procedure of tracheostomy in patients with elevated ICP. Percutaneous dilation tracheostomy made by a skilled surgeon is shown to be effective and safe.
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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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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.