Anesteziologiia i reanimatologiia
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Anesteziol Reanimatol · Jan 2014
Clinical Trial[Postoperative analgesia with nefopam and non-steroidal anti-inflammatory drugs in patients after surgery for tumors of head and neck].
83 adult patients included in the study were divided into two groups. Patients of the group-1 (n-49) had medium level of pain after cancer head and neck surgery. Patients of the group-2 (n-34) had severe pain. Three first postoperative days their post-operative multimodal analgesia started with tenoxycam 20 mg i.m. after induction of anesthesia, then every 24 hour (58 patients). 25 patients got ketoprofen 100 mg i.m. every 8-12 hours instead of tenoxycam. All patients had nefopam 30 mg i.m. 30 min prior the end of surgery procedure, and every 8 hours afterwards. 7 patients of the group-1 had more than 4 pain scores (day 1), 4 patients--at the day 2. They received tramadol or paracetamol additionally. 7 patients (group-2) also had up to 5 pain scores on the day 1, 5 patients had 4 pain scores on the day 2, and 3 patients 4 pain scores on the day 3. All that patients received additional analgesia with tramadol or trimeperidine once a day. 8.4% of patients suffered from adverse reactions (tachycardia, PONV and sweating). ⋯ This method of multimodal postoperative analgesia is very simple and fairly efficient.
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Anesteziol Reanimatol · Jan 2014
[Application of shot-latency cortical somato-sensory evoked potentials for evaluation of swallowing disorders in early period after posterior fossa surgery].
Main tasks of early postoperative period in patients after posterior fossa surgery are the timely and safe weaning from mechanical ventilation and extubation. For clinical assessment of the hypopharynx function we use an algorithm developed in the intensive care unit (ICU) of the Burdenko Scientific Research Institute of Neurosurgery. Disadvantages of the clinical test for assessment of patient's readiness for extubation are subjectivity and impossibility to use it in conditions of even superficial sedation. Shot-latency somato-sensory evoked potentials (SSEP) can be applied in conditions of sedation and objectify the brain stem deficit. The goal of the study was to define the changes of cortical SSEP in patients with disorders of swallowing after posterior fossa surgery. To assess the swallowing disorders we used a scale of swallowing disorders in intubated patients with brain stem damage. We compared results of cortical SSEP, test of swallowing disorders in intubated patients and clinical results of extubation. 17 patients with tumors of posterior fossa were included in the study. All patients were divided into two groups depending on duration of mechanical ventilation. Patients of the group-1 were successfully extubated in 4.5 hours. Patients of the group-2 were mechanically ventilated more than 15 hours because of impossibility to pass the test of readiness for extubation. ⋯ Asymmetry of central conduction time and decreasing of N20 amplitude can be used as additional predictor of swallowing disorder.
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Anesteziol Reanimatol · Jan 2014
Case Reports[Case report of successful treatment of the patient with stab wound of the neck complicated with massive blood loss and shock].
The article deals with a case report of successful treatment of patient with massive blood loss and shock. The observation showed that use of balanced crystalloid solution and modified gelatin 4% in the program of infusion therapy effectively corrects systemic haemodynamics and effect on haemostasis, electrolyte and acid-base balance.
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To evaluate patients' hemostasis after cardiac surgery using thromboelastometric and impedance aggregometry. ⋯ Turning thromboelastometric and impedance aggregometry in the study of the coagulation profile of patients undergoing cardiac surgery in postperfusion period brings valuable information and allows a differentiated treatment of hemostasis disorders.