Anesteziologiia i reanimatologiia
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Anesteziol Reanimatol · May 2012
Randomized Controlled Trial[Iliofascial versus epidural block during hip endoprosthesis].
The study was carried out to compare analgesia, the side-effects incidence and the need for analgetics when you use the continuous iliofascial block (CIFB) versus epidural analgesia (EA) after the total hip joint endoprosthesis (THJEP). 60 patients undergoing planned THJEP under spinal anaesthesia were included in a randomized controlled study. The day before the surgery all patients were divided into 2 groups (30 people each). In the 1st group postoperative analgesia carried out on the basis of the EA, and in the 2nd group - CIFB. All patients received balanced analgesia with nonopioid analgesics, and in case of pain syndrome - tramadol injections. In the 1-st group the value of the visual-analogue scale - VAS (0-100mm) 6 h after the operation was significantly lower at rest and in motion. The maximum average value of VAS in motion was 2.3 +/- 2, 1 mm in EA group and 3.2 +/- 2.6 mm in CIFB group. Frequency of tramadol use in 1-st and 2-nd groups was 6.9% and 41.4%, and of nausea - 34,5% and 6.9%, respectively. Patient analgesia satisfaction was higher in the 2nd group. ⋯ Extended IFB provides a good level of analgesia in patients after THJEP. Prolonged EA exceeds CIFB in analgesia, but is accompanied by a greater frequency of postoperative nausea occurrence.
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Anesteziol Reanimatol · May 2012
Clinical Trial[Hemostasis during MARS therapy and hemodiafitration in patiens with acute renal-hepatic failure].
to study the dynamics of the haemostatic system, depending on coagulopathy type and efferent therapy method (HDF, MARS) in patiens with acute renal-hepatic failure. As a complex of intensive therapy, all the patients were trated extracorporeal techniques: HDF therapy in group I (n = 121) and MARS in group 1 (n = 62). Patients were aged from 18 to 67 years. ⋯ MARS - is an effective therapy and has effects on haemostasis system: observed recovery of platelet-vascular disorders of coagulation and haemostasis. HDF is effective in patients with coagulation type of laboratory disseminated intravascular coagulation (DIC), and was dangerous in fibrinolytic DIC type because of haemostasis status decompensation risk.
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Anesteziol Reanimatol · May 2012
Review[Pathophysiology of recruit ventilation and its effect on the respiration biomechanics (review of the literature)].
In patients with acute respiratory distress syndrome (ARDS) lungs consist of aeration zones and zones of alveolar collapse, which lead to intrapulmonary shunting and hypoxemia. ALV may increase alveolar collaps and potentially lead to lung damage arising out of displacing surfaces tension between aerated and collapsed lung parts and re-closing and opening of the alveoli. ⋯ Data on the use of recruitment in ARDS patients, show varied results with increased efficiency in patients with early ARDS, good complaisance of the chest and extrapulmonary Genesis of lung damage. In this review, we discuss the pathophysiological basis of recruitment use, recent evidence and contradictions of the application of this method.
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Anesteziol Reanimatol · May 2012
Randomized Controlled Trial[Correction of early cognitive disorders in school-age children operated under total intravenous anaesthesia].
The aim of the study was to assess the possibility and effectiveness of hopaten acid use for early postoperative cognitive dysfunction correction in children of school age. ⋯ In case of propofol-fentanyl TIVA anesthesia in children of school age is indicated preventive prescription of multimodal cerebroprotectors without age limitations (for example hopaten acid (40 mg/kg per day) for POCD treatment.
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This case report describes the malignant hyperthermia (MH) accident in 12-year old boy undergoing maxillary-facial surgery: Crisis began 30 min after normal sevoflurane induction. Patient was successfully treated hence the MH exhibited abortive course. One should considerthis case as urgent reason for dantrolen registration in Russia, because it is not officially available yet. And it also demonstrates the necessity for more vigilant relation to the MH especially in pediatric anaesthesiology.