Anesteziologiia i reanimatologiia
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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[Methods of anesthesia during surgical treatment for scoliosis in children].
Various anesthetic methods during surgical simultaneous double-stage correction of scoliotic deformity in the spine were analyzed in 73 children. Analgesic quality was assessed from central hemodynamics and some biochemical parameters of stress, the volume of blood loss, and the number of complications. ⋯ In 33 children, this general anesthesia mode was added by epidural analgesia with 1% morphine solution in 10-12 ml of a solvent. Epidural morphine analgesia used in the complex of general anesthesia upgraded the quality of nociceptive defense, substantially decreased the consumption of systemic narcotic analgesics, an anesthetic, and relaxants, lowered blood loss by 10%, and reduced the number of postoperative complications by 20%.
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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.
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Anesteziol Reanimatol · Jan 2010
[Fetal inflammatory response in the development of multiple organ dysfunction in newborn].
The fetal inflammatory response syndrome (FIRS) is one of the causes of multiple organ dysfunction (MOD) in critically ill newborn infants. The paper shows a role of interleukin-8 (IL-8) in the development of FIRS and MOD in neonates a correlation between the concentration of IL-8 and the number of organs involved in the pathological process and demonstrates the leading role of endothelial dysfunction in the pathogenesis of the pathological processes concerned.
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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.