Anesteziologiia i reanimatologiia
-
Anesteziol Reanimatol · Mar 2008
[Cerebral oximetry in the practice of a neurosurgical resuscitator-anesthesiologist].
The paper analyzes the use of the noninvasive cerebral oxygenation monitoring technique cerebral oximetry in patients with various brain diseases (stenotic lesions of the main arteries of the head and neck, subarachnoidal hemorrhages of traumatic and aneurysmal origin) and in those with the intracranial hypertension syndrome. A group of patients without intracranial pathology and volunteers were also examined. Analysis of the findings suggests that cerebral oximetry is a highly informative technique of cerebral oxygenation monitoring in different clinical situations and should be widely used in the practice of a neurosurgical resuscitator.
-
Anesteziol Reanimatol · Mar 2008
Randomized Controlled Trial Comparative Study[Tactics of infusion therapy in the acute period of intracranial hemorrhages].
The paper deals with the determination of infusion therapy tactics in critically ill patients with intracranial hemorrhages on the basis of invasive measurements of systemic hemodynamics. The routine hemodynamic parameters (blood and central venous pressures, heart rate) are noted to fail to assess the volemic status of the patients in full. Unlike the use of colloidal solutions, infusion therapy with physiological sodium chloride is not shown to correct systemic hemodynamics. It has been ascertained that in acute intracranial hemorrhages, infusion therapy with crystalloidal solutions leads to impaired pulmonary gas exchange and increased pulmonary extravascular fluid and the use of a combination of crystalloidal solutions and a colloidal agent in a 1:1 ratio can correct the volemic status of the patients and is not followed by lung dysfunctions.
-
Anesteziol Reanimatol · Mar 2008
Randomized Controlled Trial[Effect of the combined hypertonic colloidal solution HyperHeas on hemodynamic and oxygen transport parameters, intracranial pressure, and cerebral oxygenation].
The paper gives the results of a clinical study of the effect of the new combined hypertonic colloidal and hypertonic solution HyperHaes (Frezenius-Cabi) on the parameters of systemic hemodynamics (invasive evaluation by means of a Swan-Ganz catheter), systemic oxygen transport, intracranial pressure (ICP) (lumbar spinal fluid pressure), and cerebral oximetry (INVOS 5100) in neurosurgical patients. The paradoxical effect was found as acute blood pressure lowering and elevated ICP on the beginning of solution infusion (the vasodilator effect of a distinctly hyperosmolar agent). In all other respects, HyperHaes is an ideal agent for volumetric compensation in neurosurgical patients.
-
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.