Anesteziologiia i reanimatologiia
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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.
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Anesteziol Reanimatol · Nov 2009
Practice Guideline[The 2008 international standards for a safe practice of anesthesia].
This is an update of the standards developed by the International Task Force on Anesthesia Safety, which were adopted by the World Federation of Societies of Anesthesiologists (WFSA) on 13 June 1992. These standards incorporate and elaborate upon the core components of the Safe Anesthesia part of the 2008 World Health Organization's World Alliance for Patient Safety "Safe Surgery Saves Lives" global initiative. These WFSA standards are intended to provide guidance and assistance to anesthesia professionals, their professional societies, hospital and facility administrators, and governments for improving and maintaining the quality and safety of anesthesia care.
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Anesteziol Reanimatol · Nov 2009
[Diagnostic value of cardiac troponin T increase in critically ill patients].
There are presently reports on elevated levels of cardiac troponins in patients without acute myocardial infarction (AMI). The objective of this investigation was to study the diagnostic value of increased blood cardiac troponin T levels in patients without its clinical picture and ECG changes characteristic of AMI. The study covered 72 patients (48 males and 24 females) aged 54 to 87 years (mean 69.8 +/- 11.2 years). ⋯ In dead patients, the level of troponin T was significantly higher than that in discharged patients, respective of the underlying disease. There was a direct correlation between the cardiac troponin T levels and the SAPS II index that reflected the severity of a patient's general condition (r = 0.44; p = 0.0001) and an inverse correlation between the cardiac troponin level and the left ventricular ejection fraction (r = -0.45; p = 0.003). Thus, despite the cardiospecificity of troponin T, its detection in the blood of critically ill patients without other manifestations of AMI is not a specific symptom of AMI, but it is suggestive of the severity of the disease, probably with the involvement of the myocardium into the pathological 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
[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.