Anesteziologiia i reanimatologiia
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Anesteziol Reanimatol · Mar 2012
Randomized Controlled Trial[Epidural analgesia in surgical treatment of scoliosis].
The article provides data on the use of a two-level epidural analgesia as a component of general anesthesia and postoperative analgesia in surgical treatment of scoliosis on the front and back structures of the spine. The study included 150 patients aged from 12 to 25 years. All the patients were divided into 4 groups. ⋯ In the 1-st and 4-th group carried out an propofol-fentanyl TIVA or inhalational sevorane-fentanyl one. The best result were obtained in the 3-rd group, where they carried out the infusion 0.2% ropivacaine with fentanyl (1 microg/ml) and epinephrine (2 microg/ml) via 2 epidural catheters. It was noted decreased blood loss by more than 50% in groups with epidural analgesia.
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Anesteziol Reanimatol · Mar 2012
Multicenter Study[Are we controlling the sedation in ICU? A multicenter study results].
The aim of this study is to evaluate the issues of sedation and analgesia in all-purpose ICUs in Russia. To obtain that, a single-day observational survey was performed in 55 ICUs of Ural and Siberia regions. ⋯ Sedation indications do not satisfy the modern concept, sedation level evaluation scores are used only in 13%, schemes and drugs are traditional. The results of this study may serve as a reason for discussion of necessity of introducing of sedative and analgetic therapy in ICU standarts.
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Anesteziol Reanimatol · Mar 2012
[The thromboelastometric criteria of hemostasis disorders correction during liver transplantation].
The purpose of the study. Optimum correction of hemostasis remains one of the unsolved problems in anesthesia maintenance during liver transplantation. Modern methods of coagulation monitoring (thromboelastography, thromboelastometry) allows to differ the increased bleeding reason. The clear criteria for the appointment of the blood components according to these methods have not developed so far. The aim of this study was to determine the criteria of hemostasis disorders correction during liver transplantation. ⋯ Correction of coagulation factors deficiency indicated when CT-EXTEM>80 and CT-INTEM> 240, hypofibrinogenemia when A10-FIBTEM <9, thrombocytopenia when of CT-EXTEM >80 and CT-INTEM increase simultaneously more than 300.
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Anesteziol Reanimatol · Mar 2012
[Respiratory support using multi-level lung ventilation in patients in critical state with systemic inflammatory response syndrome].
To prove the effectiveness of the method and improve lung gas exchange in patients with non-homogenous lung tissue damage with multi-level (3-level, MLV) ventilation. ⋯ Artificial lung ventilation (ALV) with MLV carried out in 13 patients with severe lung tissue damage (polytrauma, pneumonia and ARDS) treated at the unit of resuscitation and intensive care (for septic patients) SCH No 1 of Omsk since May 2011. The initial values of pO2 and oxygenation index were significantly reduced, the fraction of the intrapulmonary shunting - essentially increased. During the first day after the beginning of respiratory support with the use of MLV, was registered pO2, SaO2 and oxygenation index growth, there was a positive x-ray dynamics of improved lung tissue biomechanics. As a result of the ALV with MLV in 11 patients had achieved steady improvements of arterial oxygenation. The use of respiratory support with MLV in patients with severe lung damage leads to a significant improvement of the alveolar ventilation and arterial oxygenation, and to reduce the intrapulmonary shunting level. The use of this type of ventilation system versus traditional methods of respiratory therapy leads to respiratory failure solution, in reduce of duration of ALV terms and stay in the intensive care unit.
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Anesteziol Reanimatol · Mar 2012
[Effect of intraoperative infusion-transfusion therapy on mortality of patients with massive blood loss].
The aim of the research is to determine the influence of infusion-transfusion therapy of the volume and structure on intraoperation and hospital lethality in patients with injuries and diseases, complicated in blood loss, exceeding circulating blood volume (CBV). It was conducted a retrospective analysis of the anaesthesia flow, infusion-transfusion therapy and treatment results in 112 patients with injuries and diseases complicated in intra-abdominal bleeding, volume of more than 4 liters. It was found that the risk of death increases in low-volume infusion therapy (less than 1.5 volume of blood), use of the maximum permitted doses of colloids, high speed of infusion therapy. Adverse factors of intraoperative transfusion: the lack of intraoperative compensation erythrocytes(less than 50% of the lost), ones transfuse more than 2 standard doses of the donor's erythrocytes and large volumes of fresh frozen plasma (FFP).