Anesteziologiia i reanimatologiia
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Anesteziol Reanimatol · Nov 2009
[Impact of preoperative levosimendan therapy on the volemic status and vascular tone of patients with chronic heart failure during anesthesia].
The impact of preoperative levosimendan therapy on the volemic status and vascular tone was studied in patients with chronic heart failure (CHF) during anesthesia and the ways of correcting the occurring changes were defined. The study included 21 patients with CHF in the presence of dilated cardiomyopathy, who underwent mitral valve replacement and tricuspid valvoplasty. Group 1 patients (n = 11) were given levosimendan (Simdax) in a dose of 0.05-0.1 mg/kg x min 2 days prior to surgery; Group 2 (n = 10) was control. ⋯ It has been established that the preoperative administration of levosimendan causes an increase in stroke index at critical surgical stages. With the use of levosimendan, peripheral microcirculation improves and nutritional blood flow increases. The preoperative use of levosimendan causes a reduction in the tone of resistance vessels during anesthesia, which can require vasopressor support in the postperfusion period; a levosimendan-induced decrease in preload requires infusion correction of relative hypovolemia.
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Anesteziol Reanimatol · Nov 2009
[Innovation structure of postgraduate medical education in the specialty of anesthesiology as a constituent of the continuing professional development concept in the light of the Bologna Declaration provisions].
To implement the basic provisions of the Bologna Declaration for postgraduate professional education of anesthesiologists-resuscitators, to upgrade the quality of training specialists, it is important that, by preserving the existing forms of an educational process, to introduce into continuing professional development the following innovation educational technologies, by taking into account the existing forms and technologies of the Russian higher medical school: to realize the continuing professional development (CPD) concept; a credit accumulation system as a generalizing function during CPD; distance and multimedia learning; and a modular organization of a learning and educational process.
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Anesteziol Reanimatol · Nov 2009
Comparative Study[Determination of optimal spontaneous respiration anesthesia for outpatient anesthesiology].
Outpatient surgery presents a number of specific requirements for anesthesia, among which there is safety and that the main point is anesthesia, as well as postanesthesia depression should not be a limiting factor on discharge the patient from hospital. The authors compare 3 current anesthetic methods available in our country: 1) combined general anesthesia based on ketamine, dormicun, and fentanyl, 2) total venous anesthesia (TVA) based on propofol and fentanyl, and 3) anesthesia with sevorane inhalation with preserved spontaneous respiration through a laryngeal mask. ⋯ TVA and sevorane inhalation anesthesia show comparable results in emergence rate tests, and postanesthetic rehabilitation, the number of postoperative complications. However, less cost and amazing predictability enable the authors to prefer inhalation anesthesia.
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Anesteziol Reanimatol · Nov 2009
[Some problems in teaching anesthesiology and reanimatology at a higher medical educational establishment].
The paper describes the experience of the Department of Anesthesiology and Resuscitation, Chita Medical Academy, in upgrading the quality of teaching at the pre- and postgraduate stages of education and the prestigiousness of the specialty for students. The forms of collaboration of the department's collective body with the Academy's governing body and the territory's health care structures are described. ⋯ The innovation approach to solving the organizational and professional problems, which is proposed and tested by the authors, resulted in the provision of the health care facilities of the Transbaikal Territory with educated anesthetists-resuscitators (by 98.8%). The use of innovation educational technologies, including internet bases and internet libraries, and audiovisual and telecommunication technologies for distance education and counseling, makes an educational process interesting to young specialists and, overall, serves to increase the prestigiousness of the specialty.
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Anesteziol Reanimatol · Nov 2009
Comparative Study[Impact of preemptive analgesia on postoperative pain syndrome in laparoscopic surgery].
The study included 90 patients who had undergone laparoscopic cholecystectomy. The patients were divided into 3 groups: 1) paracetamol was given for preemptive and postoperative analgesia; 2) ketorolac tromethamine; and 3) promedol (a control group). ⋯ Preemptive analgesia in laparoscopic surgery using ketorolac and paracetamol could reduce the degree of postoperative pain syndrome by 40.1%, as shown by the VAS. Comparative analysis of the characteristics of the agents showed that paracetamol produced a more powerful antistress defense, as confirmed by the time course of changes in the levels of TNF-alpha and CRP.