Anesteziologiia i reanimatologiia
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Anesteziol Reanimatol · Sep 2010
[Diagnosis and antimicrobial therapy of pneumonia caused by continuous mechanical ventilation after cardiosurgery].
The paper gives an update on the incidence and etiological structure of mechanical ventilation (MV)-associated pneumonias. The specific features of their pathogenesis are considered; clinical and laboratory diagnostic methods are reviewed. It is shown that it is necessary to make a microbiological monitoring. An algorithm is proposed to choose the tactics of antimicrobial treatment for MV-associated pneumonia; recommendations for the rational choice of antibiotics are given.
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Anesteziol Reanimatol · Sep 2010
Review[Purine analgesia: experimental results and clinical perspectives].
The high rate of dissatisfaction with analgesia in patients undergoing surgery and by those with chronic pain prompts a search for new pain relief methods. Purine analgesia may considerably ease suffering in these patient groups. This review considers the results of the studies dealing with the analgesic activity of non-selective purine receptor agonists, such as adenosine and adenosine triphosphate, on experimental models and the feasibilities of their clinical application. ⋯ Much attention is given to the studies using purine analgesia as a component of general anesthesia. It is no less than important that good results of treatment were obtained after administration of purine agonists to patients with neuropathic pain syndromes. Thus, purine analgesia should be regarded as a promising line of the development of anesthesiology.
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The paper deals with a role of spectral entropy-based neuromonitoring at cardiac surgery. Eighty cardiosurgical patients were examined. The depth of entropy-based anesthesia was monitored in all the patients. ⋯ Anesthesia was carried out in the study group (n=40), by taking into account entropic parameters, and in the control group (n=40) on clinical grounds. Information on entropic parameters in this group was accessible only to an investigator and inaccessible to an anesthesiologist who had made anesthesia. The results of the study indicated that entropy-based neuromonitoring permits more controllable and predictable anesthesia to be achieved, makes an individual adjustment of the doses of sedatives easier for each patient, at the induction of anesthesia particularly, enables hypo- and hyperhypnotic episodes to be timely revealed, thus reducing the frequency of hypo- and hyperdynamic reactions by 2.4 times.
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Anesteziol Reanimatol · Sep 2010
Comparative Study[Comparative evaluation of the hemodynamic effect of 6% hydroxyethyl starch 130/0.42 solution versus 4% modified liquid gelatin solution in cardiosurgical patients].
The study included 20 patients who underwent a 6% HES 130/0.42 (venofundin, B-Braun) infusion test. A 4% MLG (gelofusine, B-Braun) infusion test was carried out in 16 patients. The baseline hemodynamic parameters did not differ before infusion of the compared solutions. ⋯ HES 130/0.4 resulted in increases in CBV by 18%, GEDV by 16.6%, RAP by 80%, and PAWP by 43%. 6% HES 130/0.42 and 4% MLG in doses of 500 ml had a similar hemodynamic effect in the infusion test during 30 min. Volume load with the test colloid solutions allows the functional reserves of the cardiovascular system to be estimated in cardiosurgical patients. Inotropic drugs are indicated for patients with lower cardiac output and infusion therapy is performed in those with considerably increased CI.
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Anesteziol Reanimatol · Sep 2010
[Management of patients with chronic renal failure during surgical correction of cardiovascular disease].
End-stage of chronic renal failure (CRF) is frequently associated with cardiac and vascular comorbidities requiring cardiosurgical interventions. Over 9 years, from 2000 to 2009, the A. N. ⋯ After open operations, renal replacement therapy (first hemodiafiltration, then hemodialysis) as daily sessions was initiated on day 2 and, when the patients were transferred to intensive care units, it was performed by the programmed hemodialysis protocol. There were no fatal outcomes at the follow-up. The key aspects of treatment success achievement and improved quality of life in patients on programmed hemodialysis are the detection of cardiovascular diseases requiring surgery, the timely referral of the patients to a cardiosurgical hospital, the meticulous pre- and perioperative management (correction of anemia, hypoproteinemia, water-electrolyte balance, use of ultrafiltration and the adequate rate of perfusion at the stage of extracorporeal circulation, and daily renal replacement therapy in the postoperative period), and continuity in the work of all specialists.