Anesteziologiia i reanimatologiia
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Anesteziol Reanimatol · Jan 2010
Clinical Trial[Pre-emptive analgesia in the complex of multicomponent general anesthesia in pediatric neurosurgery].
The study enrolled 30 patients aged 2 to 18 years, who had been operated on at the Prof A. L. ⋯ The patients had undergone total intravenous anesthesia with the opioid analgesic fentanyl (3.5 microg/kg x hr), the central alpha 2-adrenoblocker clofelin (1.2 microg/kg x hr), recofol (3 mg/kg x hr) under myorelaxation (arduan, esmeron) and artificial ventilation. Assessment of a neuroendocrine response and postoperative analgesia levels by the physiological and self-appraisal scales showed the high efficacy of pre-emptive analgesia using paracetamol in the complex of multicomponent anesthesia using the central alpha 2-adrenoblocker clofelin.
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The purpose of the study was to define the depth of a sedative effect during continuous intravenous drug co-administration by BIS monitoring in children in intensive care units. Sixty-eight patients aged 12 to 15 years who had severe purulent abdominal processes and somatic diseases on artificial ventilation were examined. The patients were divided into 4 main groups by the types of a combination of taken drugs: sodium oxybutyrate with promedole, sodium oxybutyrate with fentanyl, sodium thiopental with promedole, and sodium thiopental with fentanyl. ⋯ At Stage II during drug co-administration, there was a significant reduction in BIS values in all the groups, which was indicative of a sedative effect. The depth of sedation therapy was estimated during infusion of each type of a combination of the drugs tested in the study. Thus, to eliminate undesirable outcomes of sedation therapy in children during continuous intravenous drug co-administration, it is necessary to monitor the depth of sedation; where possible, BIS may be used to monitor central nervous system performance.
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A volume replacement therapy compensates a reduced intravascular volume to stabilize and maintain hemodynamics and vital signs. For this therapy, a physiologically-based solution comprising both, osmotic and colloid osmotic components, should be administered. The basic requirement for a sufficient fluid replacement and volume resuscitation therapy in children are the profound and special knowledge of the physiological and pathophysiological interactions in water balance and electrolyte metabolism in childhood, the pharmacology of the applied solutions and the adequate monitoring of this fluid and volume replacement therapy. Wrong dosages and side effects are reasons for a negative postoperative outcome in children.
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Anesteziol Reanimatol · Jan 2010
[Hypernatremia as a predictor of poor outcomes in children with severe brain injury].
The aim of the study was to elucidate a relationship between the development of hypernatremia and the frequency of poor outcomes in children with severe brain injury (SBI). The retrospective study enrolled 77 children (54 boys and 23 girls) aged 1 month to 18 years, who had SBI in the period of January 2008 to September 2009, and were divided into 3 groups after treatment termination. The admission injury severity criterion was Glasgow coma scale (8 scores or less) rating. ⋯ Poor outcomes (Glasgow outcome scores of 1-3) at 30 days were noted in only Groups B and C: comparison of outcomes in Groups B and C showed the higher incidence of poor outcomes in 10 (84%) Group C patients (with hypernatremia and polyuria) and 4 (28%) children in Group B. Comparison of Groups B and C children indicated that the hazard ratio was 0.3. Therefore, the risk of poor outcomes is much higher in the development of central diabetes insipidous in the presence of hypernatremia.
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Anesteziol Reanimatol · Jan 2010
Clinical Trial[Oral premedication with midasolam and ketamine in children with neurosurgical diseases].
The study was undertaken to evaluate the efficiency and safety of oral premedication in children with intracranial neurosurgical pathology before elective interventions in two modalities: a combination of midasolam 0.5 mg/kg body weight and ketamine 3 mg/kg (Group 1; n = 80) and midasolam 0.75 mg/kg only (Group 2; n = 20). The study was conducted in 100 children aged 2 to 10 years. Medical and sweet syrups were used to dilute the agents. ⋯ The mean duration of effect achievement was 20 minutes. There were no serious complications when both regimens were used. Both oral premedication modes are considered to be effective and must be used for premedication in children with neurosurgical diseases.