Anesteziologiia i reanimatologiia
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To analyze an efficiency of hypofibrinogenemia treatment. In the Scientific Center for Hematology (Moscow) significant hypofibrinogenemia occurs in 3% of patients with hemoblastosis. 1000 doses of cryoprecipitate are used for a hypofibrinogenemia treatment every year (21-23 doses for each patient). Containing of fibrinogen in a one cryoprecipitate dose is from 108 mug to 711 mug (M = 276 mug). Volume of one dose is from 8 to 90 ml (M = 24 ml). Hypofibrinogenemia occurred in all patients required a cryoprecipitate transfusion (M = 1 g L(-1), min 0.5 g L(-1), max 2 g L(-1)). We fixed an increasing of fibrinogen level in plasma by 0.7 +/- 0.2 g L(-1) after the cryoprecipitate transfusion. We analyzed a world experience of the use of fibrinogen containing blood components. ⋯ Fresh frozen plasma transfusion cannot be a choice method of treatment for hypofibrinogenemia. Fibrinogen's concentrate has the same effectiveness as a cryoprecipitate both for congenital and acquired deficit of fibrinogen. The frequency of complications due to fibrinogen's concentrate is low. Currently clinical studies of recombinant fibrinogen are conducted. Ways of implementation of fibrinogen preparations in Russia are discussed.
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Anesteziol Reanimatol · May 2014
Randomized Controlled Trial[Effects of remote ischemic preconditioning on perioperative period in elective aortic valve replacement].
To evaluate the effects of remote ischemic preconditioning (RIPC) on the perioperative period in elective aortic valve replacement (AVR) along different anaesthesia techniques. ⋯ Cardioprotective effect of RIPC and its effect on systemic inflammatory response should be assessed in the selected anesthesia groups. RIPC on the background of sevoflurane anesthesia reduces myocardial injury during AVR. RIPC does not reduce the severity of the systemic inflammatory response after AVR. RIPC reduces the risk of AF after AVR.
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Anesteziol Reanimatol · May 2014
Randomized Controlled Trial[Treatment of delirium in the early postoperative period after cardiac surgery].
To assess efficacy and safety of dexmedetomidine for treatment of delirium in cardiac surgery. ⋯ Dexmedetomidine provides an average target level of sedation, decreases duration of delirium and duration of stay in the ICU. Dexmedetomidine does not cause depression of respiration which allows keeping a verbal contact with patients and improving a diagnostics of pain syndrome. The most common side effect of the dexmedetomidine use is a dose-depending bradycardia.
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Anesteziol Reanimatol · May 2014
Randomized Controlled Trial[Epidural blockades use in low back pain treatment].
We studied 90 patients with radicular acute pain syndrome of lumbosacral localizations in the Petrovsky Russian Research Center of Surgery from 2009 to 2013. The patients were divided into two groups. We assessed an effectiveness of epidural blockades in complex therapy. ⋯ The treatment of radicular pain syndrome with intensity over 5 points according to visual analog scale should be started with epidural blockade with local anesthetics and small doses of steroids.
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Anesteziol Reanimatol · May 2014
Case Reports[Successful implementation of shortened postoperative period program after ten hours of general anaesthesia in patient with morbid obesity].
Early patient's activation is the best method of prophylaxis of many complications of the postoperative period. Patients with obesity are at high risk of developing complications in respiratory system. The following clinical report is about the successful implementation of the shortened postoperative period program in patient with morbid obesity after general desflurane maintained anesthesia and, at the same time, epidural ropivacaine-based anesthesia. ⋯ The intraoperative period was well controlled and characterized with stable hemodynamic indexes. On the fourth minute after desflurane intake was terminated and recovery of consciousness and spontaneous breathing of the patient were registered, patient was extubated. This clinical experience and also an information than can be found in the earlier publications allow us to consider a desflurane maintained anesthesia as one of the safest and comfortable methods of anesthesia for patients with a morbid obesity.