Anesteziologiia i reanimatologiia
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Anesteziol Reanimatol · Mar 2013
[Anaesthesia and monitoring in cardiac and aortic surgery at Russian Scientific Surgical Center].
Basic principles of anaesthesia management in cardiac and aortic surgery, elaborated in the Department of cardioan aesthesia of Petrovsky National Research Centre of Surgery are presented and discussed. Clinical, instrumental and laboratory data helped us to mark out main aspects of anaesthesia safety and efficacy improvement in cardiac surgery patients. These include: complex preoperative preparation for heart failure degree reduction, drugs selection for balanced anaesthesia, enhanced homeostasis monitoring, the effective protection of myocardium, brain and spinal cord, internal organs, pharmacological and mechanical cardiovascular support, haemostasis optimization etc.
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Anesteziol Reanimatol · Mar 2013
[Intubating laryngeal mask efficacy in obese and overweight patients].
We evaluated the Intubating Laryngeal MAsk (ILMA Fastrach) efficacy for airway management, ventilation and blind intubation in obese and overweight patients. Methods. 50 adult patients (22 men and 28 women) with predicted difficult trachea intubation (PDTI), undergoing general anaesthesia with ILMA were included in this study. ILMA was selected according to gender: ILMA No 5 for men and No 4 for women. PREMEDICATION: diazepam and H,-blockers. Anaesthesia induction: midazolam 0. I - 0.15 mg/kg, propofol 1.6-2.5 mg/kg, fentanyl 0.1-0.15 microg/kg, rocuronii bromide or atracurii besilate 0.6 mg/kg. ⋯ ILMA Fastrach was used successfiully in obese patients with PDTI for both ventilation and TI. Technique is simple in training, but a preliminary experience is essential for ILMA use in difficult cases.
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The aim of this study was to evaluate tissue oxymetry dynamics in patients with different initial tissue oxygenation levels and to analyze the relation of these data with the perioperative period flow peculiarities. ⋯ None patients had episodes of StO2, decrease below the critical level during the operation, that allows to talk about central haemodynamics stability during the study. 1st group - patients with initial StO2, below 70% (n=19). In this group StO2, remain low throughout the operation. 2nd group- patients with initial StO2, over 70%, but before CPB decreased below 70% (n=49). 3rd group - patients with high StO2, throughout anaesthesia. VOT data confirmed tissue oxygenation disturbances in Ist and 2nd groups. In st group oxygen reserve (OR) was lower than in other groups and at the end of the surgery - lower than initial one. In 2nd group OR decreased significantly before CPB and during CPB didn't differ from 1st group. In 3rd group OR during anaesthesia was higher, than in 1st and 2nd group, but decreased by the end of the surgery. Lactate level after CPB doesn't exceed the upper limit, however, it's level was higher in the 1st and 2nd group than in the 3rd group. Central vein saturation in 3rd group was higher than in the Ist and 2nd group at all stages, except for operation start. Lower StO2, levels in 1st and 2nd group were accompanied with extension of ALV ICU length-of-stay and hospitalization. RESUME: Tissue oxymetry may be useful for regional oxygenation assessment during anesthesia. There is a decrease in tissue oxygenation and oxygen reserve of peripheral tissues during on-pump cardiosurgery The low tissue oxygenation level during preperfusion period may be a predictor for early postoperative complications.
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Anesteziol Reanimatol · Mar 2013
[Sevoflurane optimal dosage estimation for myocardium pharmacological postconditioning: an experimental study].
We estimated the optimal dosage of inhalation anesthetic sevoflurane, for the maximum cardioprotective effect with minimal angioparalytic action. 25 pigs were included in this study, they were divided into 5 groups, depending on the sevoflurane dosage used for pharmacological postconditioning (PPC): control group - PPC has't been conducted, a group of PPC 0.5 - sevoflurane PPC in a dose of 0.5 V%, a group of PPC 1.0 - sevoflurane PPC in a dose of 1.0 V%, a group of PPC 1.5 - sevoflurane PPC in a dose of 1.5 V%, a group of PPC 2.0 - sevoflurane PPC in a dose of 2.0 V%, a group of PPC 2.5 - sevoflurane PPC in a dose of 2.5 V%. Ischemia was simulated by left coronary artery crossclamping. ⋯ Myocardial ischemia period was 60 min in all groups. It was found and experimentally proved that the optimal sevoflurane dosage for PPC is 2 V%