Anesteziologiia i reanimatologiia
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Anesteziol Reanimatol · Mar 2009
[Potentialities of non-invasive hemodynamic monitoring in patients with acute destructive pancreatitis].
The potentialities of non-invasive hemodynamic monitoring were estimated in 49 patients with acute destructive pancreatitis in the postoperative period. Cardiac performance monitoring according to the results of which the patients were divided into 2 groups was analyzed. The low cardiac output values persisting within 10-12 days following the first operation were indicative of the severity of destruction processes and the high risk of complications. The simplicity, comparative low prices, initial computerization and non-invasive pattern make remonitoring an optimal source of information on hemodynamics in this cohort of patients.
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Anesteziol Reanimatol · Mar 2009
Case Reports[A clinical case of lactic acidosis development in a diabetic patient taking metformin].
Metformin is a biguanide. Due to its effects in decreasing the hepatic production of glucose and in increasing insulin sensitivity in peripheral tissues, such as adipose tissue and skeletal muscle, the agent is used in metabolic syndrome and type 2 diabetes mellitus and, in which insulin resistance is especially pronounced. Eighty-one-year old male patient was admitted to the emergency unit with sudden vertigo, tiredness, dyspnea, cyanosis, and lethargy. ⋯ On the same day, extubation was ended and O2 was given by mask at a rate of 4 L/min. After the patient's vital signs, blood sugar, and lactate levels were stabilized; his treatment regimen was arranged again and the patient was discharged on day 4 of his admission. Dyspnea, acidosis, and hypoxia seen in the patient were thought to be due to lactic acidosis which may rarely occur when metformin is used.
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Anesteziol Reanimatol · Mar 2009
[Professional selection and successful residency training in anesthesiology-resuscitation].
The professional carrier of 356 residents, the 1960-2007 graduates of the Saint Petersburg Medical Academy of Postgraduate Education, was studied to specify approaches to professional selection of anesthesiologists. Thirty (8.4%) graduates did not work as anesthesiologists at all. It should be noted that most (n = 24) of the 30 graduates had successfully completed the residency. ⋯ However, it is impossible to consider each residency graduate to be a well-trained anesthesiologist. An intermediate decision to solve this problem is to establish the new nationally accepted order: a graduate may start his/her professional career only at a university clinic or other large hospital especially licensed for this purpose, by being supervised by senior colleagues. Permission for fully independent practice should be given not earlier than after 2-3-year work at the above mentioned clinics.
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Anesteziol Reanimatol · Mar 2009
[Analysis of the clinical features and outcome of ventilator-associated Pseudomonas aeruginosa-related pneumonia in an intensive care unit].
The occurrence, the course, and outcome of ventilator-associated pneumonia (VAP) related to Pseudomonas aeruginosa were prospectively followed up in 51 patients treated at an intensive care unit. The characteristic feature of P. aeruginosa-induced VAP was its severe course and poor prognosis (mortality was 38%). ⋯ Lung tissue destruction and edema were rather frequent complications. The predictors of death in VAP caused by P. aeruginosa are admission to an intensive care unit, septic shock, and infection.