Anesteziologiia i reanimatologiia
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Anesteziol Reanimatol · Mar 2010
Review[Problem of neuromuscular block reversion: neostigmine and sugammadex].
The review covers the history of neuromuscular block reversal. It states that indications for decurarization have been changed due to the extremely high rate of residual curarization even after the use of average-acting myorelaxants. The paper provides the pharmacological characteristics of sugammadex, a new selective relaxant-binding agent for aminosteroids (rocuronium and vecuronium) with the unique mechanism of action. It also gives data on the efficacy and safety of sugammadex versus anticholinesterase agents and estimates the prospects for its clinical application.
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Anesteziol Reanimatol · Mar 2010
Clinical Trial[Effect of propofol-based combined anesthesia on the development of adaptive mechanisms to the prolonged one-lung artificial ventilation].
The paper deals with the assessment of the adequacy and safety of multicomponent anesthesia based on propofol at lung surgery requiring one-lung ventilation (OLV) in patients with chronic respiratory diseases and with the evaluation of the effect of propofol on the development of adaptive mechanisms in various ventilation modalities in thoracic surgery. The pressor, resistive, and volume characteristics of pulmonary blood flow, systemic and intracardiac hemodynamics under artificial ventilation (AV) and OLV of a duration of up to 1.5 hours by a combination of pulmonal and transpulmonal thermodilution on a PiCCO plus device with a VOLEF attachment were compared. Multicomponent balanced anesthesia based on continuous graduated propofol infusion provides adequate protection of patients during thoracic operations, including those with concomitant respiratory abnormality.
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Anesteziol Reanimatol · Mar 2010
[Acute transfusion-related lung injury in patients after cardiac surgery].
to study the incidence of acute transfusion-related lung injury (TRALI) amongst cardiosurgical intensive care unit (ICU) patients and to assess the contribution of this pathology to the total number of postoperative pulmonary complications and its influence on the course and outcome of the underlying disease. 515 patients operated on for cardiovascular diseases at the N. N. Burdenko Main Military Hospital in 2005-2007 were retrospectively examined. ⋯ The incidence of TRALI was 2.3%; mortality was 10%. At the same time, the majority of the detected cases were not timely recognized as TRALI. The latter required assisted/artificial ventilation and increased ICU stay length.
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Anesteziol Reanimatol · Mar 2010
Clinical Trial[Use of levosimendan in cardiosurgical patients with chronic heart insufficiency].
The impact of administration of the calcium sensitizer levosimendan on hemodynamic parameters, dose of intraoperative and postoperative cardiotonic maintenance, length of intensive care unit stay, and hospital mortality was studied in cardiosurgical patients with dilated cardiomyopathy, second-fourth degree mitral valve insufficiency, or NYHA Class IV circulatory insufficiency. Levosimendan was administered to 25 patients 3-5 days prior to surgery. ⋯ The use of the agent caused statistically significant reductions in pulmonary artery pressure and pulmonary wedge pressure and increases in cardiac index and left ventricular ejection fraction. The levosimedan-treated patients needed smaller doses of sjmpathomimetics, less length of intensive care unit stay and showed lower mortality rates (p < O.05 for all indices).
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Anesteziol Reanimatol · Mar 2010
Clinical Trial[Optimization of anesthetic maintenance using two-channel laryngeal masks Proseal during endovascular correction of congenital defects in infants and young children].
The paper analyzes the efficiency of the authors' procedure for anesthetic maintenance based on a combination of inhalational (sevoflurane) and intravenous (1% propofol) anesthesia on spontaneous breathing through a ProSeal laryngeal mask airway in the X-ray endovascular correction of congenital heart diseases in infants and young children. The study included 118 children aged 2 to 7 years with secondary atrial septal defect, who had undergone endovascular defect correction, by applying an Amplazer septal occluder. The key points of the anesthetic maintenance proposed by the authors are: (1) substitution of routine pharmacological premedication for psychological (the presence of parents); (2) inhalational (sevoflurane) anesthesia in the induction of anesthesia; (3) replacement of an endotracheal tube by a ProSeal laryngeal mask; (4) refusal of myorelaxants and respiratory support without artificial ventilation. The authors' anesthesia protocol during these operations provides a safe perioperative period.