Anesteziologiia i reanimatologiia
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Total hip replacement has become a widespread surgical intervention, so adequate analgesia substantially improves the results of treatment. This paper reviews the literature on the choice of a perioperative analgesia mode during hip arthroplasty. There is no uniform approach to preoperative analgesia, but one can identify the basic lines of its development: the introduction of effective and safe regional procedures, the minimum use of opioid analgesics, a gradual transition of intraoperative to postoperative analgesia, the possibility of the earliest activation of a patient, the capacity of a analgesic procedure to reduce perioperative blood loss, the incidence of thromboembolic and other complications, and the cost of treatment.
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Anesteziol Reanimatol · Jul 2009
Randomized Controlled Trial[Use of microstream capnography and alveolar recruitment during off-pump coronary artery bypass grafting].
The aim of the study was to investigate changes in EtCO2 and its correlation with PaCO2, and cardiac function during off-pump coronary artery bypass grafting (OPCAB) and to evaluate whether the recruitment maneuver was effective in improving gas exchange after OPCAB. Twenty adult patients scheduled for elective OPCAB were enrolled in a prospective randomized study. Anesthesia was maintained with midazolam, propofol, and fentanyl. ⋯ The Bland-Altman analysis has shown that the difference between PaCO2 an EtCO2 was 1.9 +/- 11.4 mm Hg (M +/- 2SD). Thus, during OPCAB, EtCO2 measured by microstream capnography cor related well with PaCO2 and cardiac function. The use of RM after OPCAB increases CO2 elimination and improve arterial oxygenation.
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Anesteziol Reanimatol · Jul 2009
Randomized Controlled Trial[Drug sedation during digestive tract endoscopy: current trends].
The paper considers whether ketofol, a mixture of ketamine and propofol, may be used for medical sedation. Prerequisites for designing this mixture are identified. The foreign experience with ketofol is analyzed. ⋯ A ketamine/propofol ratio of 1:4 is optimal for drug sedation at digestive tract endoscopy; with this ratio, ketofol has sufficient analgesic properties and a stabilizing hemodynamic effect. With the higher mass fraction of ketamine in the mixture, its controllability reduces. Overall, the mixture of ketamine and propofol has proved to be a safe and effective sedative; its use provides not only a good position comfort, possible avoidance of opioids, and no effect of ketamine on psychomotor recovery, but also a more controlled sedation than when these agents are used in the same doses alone.
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Anesteziol Reanimatol · Jul 2009
Comparative Study Clinical Trial[The efficacy and safety of tranexamic acid and epsilon-aminocapronic acid in cardiac surgery under extracorporeal circulation].
Sixty patients who had undergone cardiosurgical operations under extracorporeal circulation (EC) were enrolled in the study. All the patients were divided into 2 groups: (1) 40 patients were injected tranexamic acid (TA) (its loading dose was 15 mg/kg; maintenance infusion 1 mg/kg/h throughout the operation; 500 mg in the primary packing volume for an EC apparatus (EA); (2) 20 patients received epsilon-aminocapronic acid (ACA) (its loading dose was 5 g; 5 g in the primary packing volume for an EA and 10 g for infusion after EC). The effects of TA and ACA on the fibrinolytic system were evaluated from the time of XIIa-kallikrein-dependent fibrinolysis (sec) and the concentration of D-dimer (mg/ml). ⋯ The laboratory and clinical findings lead to the conclusion that TA (Tranexam, OOO "MIR-PHARM") has a 4-fold antifibrinolytic activity as compared with epsilon-ACA. The more pronounced TA-induced suppression of fibrinolysis affects the clinical course of a perioperative period in this group, which manifests itself as a reduced blood loss volume during and after surgery and a lower frequency of use of donor blood elements. By taking into account these data, TA may be recommended as one of the blood-preserving technology components during cardiosurgical operations under EC.
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Anesteziol Reanimatol · Jul 2009
Clinical Trial[General anesthesia during short operations in patients using the herbal psychogenic stimulant CAT (Catha edulis)].
The specific features of general anesthesia during short inpatient operations were performed in 85 patients who were regular CAT users owing to their national habits. According to the herbal psychogenic stimulant CAT dependence, the patients were divided into 3 groups. ⋯ In patients with moderate and severe CAT dependence, ketamine should be considered to be contraindicated due to the development of adverse psychomotor and somatic reactions requiring monitoring and drug correction in an intensive care unit. The results of the study have been introduced into practice on choosing the modes of anesthesia at the Revolution Hospital, Republic of Yemen.