Anesteziologiia i reanimatologiia
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Anesteziol Reanimatol · Nov 2006
Clinical Trial[Clinical aspects of analgesia with intravenous paracetamol in the early postoperative period].
This open one-center study included 40 patients operated on the abdomen and chest, who had moderate resting pain in the immediate postoperative hours. Paracetamol was used as a dropwise intravenous 1-g infusion for 10-15 min; the dose of the agent was 4 g. The interval of paracetamol re-infusion was not early than 4 hours. ⋯ The remaining 10% of the patients received a combination of nonsteroidal anti-inflammatory drugs, paracetomol, and opioids. Postoperative analgesia based on the intravenous infusion of paracetamol in a single dose of 1 g (4 g/day) caused a reduction in the intensity and duration of pain. The intravenous formulation of paracetamol should be regarded as one of the essential nonopioid components of multimodality therapy for pain in patients in the early postoperative period.
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Anesteziol Reanimatol · Nov 2006
[Pulmonary extravascular water in patients with acute respiratory failure].
The purpose of the investigation was to study pulmonary extravascular water levels and pulmonary vascular permeability (PVP) in the pathogenesis of acute respiratory failure (ARF)/acute respiratory distress syndrome (ARDS). Twenty-nine patients with ARF/ARDS and 10 healthy volunteers were examined. Central hemodynamics and oxygen transport were explored, by using a Swan-Ganz catheter. ⋯ Arterial hypoxemia is associated with the increase in the shunt, but, in a portion of patients, the shunt was caused with atelectasis unassociated with pulmonary edema. Increased pulmonary permeability for transferrin is detectable in ARF/ARDS irrespective the severity of pulmonary edema. The pathogenetic features of lung lesions should be taken into account while choosing a treatment for ARF/ARDS.
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Anesteziol Reanimatol · Nov 2006
[Recruiting maneuver used in the treatment of respiratory heart failure in cardiosurgical patients].
The possibility of performing the recruiting artificial ventilation technique with a high plateau and positive end-expiratory pressure was studied in 32 cardiosurgical patients, including those with cardiovascular insufficiency. The lung opening maneuver, by using the artificial ventilation adjustable by pressure and the monitoring peak pressure, PDKV, tidal volume, and dynamic compliance, by accurately determining the points of opening and closure is the method of choice in alveolar recruitment. ⋯ This maneuver using the high airway pressures adversely affects hemodynamics particularly in patients with lowered reserves of the cardiovascular system. In this connection, a careful monitoring of hemodynamic parameters is required for the timely provision of cardiotonic and vasopressor support.
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The authors studied bioelectrical millivolt-range potentials (omega potential), followed up the health status by the SAPS II and APACHE III scales and organ dysfunction by the MODS scale in patients with sepsis verified by the classification described by R. C. Bone. ⋯ In septic patients, the severest condition was noted in a decompensated state when septic shock developed, which was equal to 83 (79.3/ 83) scores by the SAPS II scale. In the patients whose condition was defined as sepsis and severe sepsis in the presence of a subcompensated state, the severity was equal to 55 (51/56.3) scores by the SAPS II scale. The mildest severity (51 (46.8/53.4) scores characterized the development of SIRS or sepsis in the presence of a compensated state.
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Anesteziol Reanimatol · Sep 2006
Comparative Study[Epidural block as a component of anesthesiological provision during abdominal operations].
Two modes of general anesthesia with artificial ventilation in combination with epidural block differing in a hypnotic component (inhalational or intravenous) were studied in 27 patients. A combination of general and epidural anesthesia afforded the best protection from surgical stress during major abdominal operations. ⋯ The safety and controllability of combined anesthesia increase when its individual components are monitored and the protocol is strictly observed. There is a need for further development of objective criteria for efficient regional block under general anesthesia.