Anesteziologiia i reanimatologiia
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Anesteziol Reanimatol · Nov 2004
Comparative Study[The specific features of lipid metabolism and changes in the plasma activity of transaminases in patients with sepsis].
A parallel study of changes in the activity of transaminases and the parameters of lipid metabolism was conducted in patients with sepsis or septic shock, receiving renal replacement therapy. The multiple baseline increase in the activity of gamma-glutamyltranspeptidase was observed in about 50% of the patients and the elevated level of triglycerides and very low density-lipoprotein cholesterol in all the examinees. ⋯ In the absence of the baseline multiple increased activity of gamma-glutamyltranspeptidase, there was a good clinical outcome provided that there were positive changes in triglycerides and very low-density lipoprotein cholesterol during therapy and its probability was about 33%. It is concluded that the activity of gamma-glutamyltranspeptidase and the concentration of triglycerides and very low-density lipoprotein cholesterol may be used to evaluate the efficiency of treatment and as predictors of the outcome of treatment in patients with sepsis and septic shock.
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Anesteziol Reanimatol · Sep 2004
[Using non-invasive mask lung ventilation in cardiosurgical patients with acute respiratory distress syndrome].
Twenty patients aged 33 to 71 (54 +/- 6) years (male - 13, female - 7) operated on the heart and main vessels were included in the case study. I.e. those patient were investigated, whose immediate postoperative results were complicated by the syndrome of multiple organ failure (SMOF) that developed due to different-etiology shock, huge blood loss and hemotransfusion or to the syndrome of acute postperfusion lung damage. NIMLV was made at the resolution stage of SMOF and ARDS after artificial pulmonary ventilation (APL) for as long as 5-7 days. ⋯ In 18 (90%) of 20 patients, the mask pulmonary ventilation resolved the respiratory insufficiency. Two (10%) patients were reintubated because of progressing multiorgan failure and because of obturation of the left main bronchus. A questioning of patients on the comfort degree of mask ventilation denoted the Flow-by triggering to be by far better tolerated by patients versus the pressure triggering.
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Anesteziol Reanimatol · Sep 2004
Multicenter Study Clinical Trial[Prevention and treatment of postoperative nausea and vomiting (results of a multicenter study)].
Described in the paper are the results of a multicenter study that was conducted at 11 health-care facilities of the Russian Federation and that was based on an analysis of 623 medical records of adult patients operated on with general anesthesia of different variations. There were 154 (24.7%) males and 469 (75.3%) females, aged 16 to 90. ⋯ An understanding, resulting from the study, on that PONV is of the multietiology nature and on that its probability increases in proportion to a compatibility of provoking factors, like sex, surgery technique as well as duration of anesthesia and its variation is of importance. The efficiency of medicamental prevention of PONV by a blocker of HT3-receptors, i.e. by ondansetron (Zofran), is to a great extent predetermined by that if the form and, probably, dose of the drug is in line with a combination of the above factors, which needs further research.
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Anesteziol Reanimatol · Sep 2004
[Maintenance of the hypnotic component of general anesthesia with feed-back regulation].
The purpose of the study was to design and investigate the closed-loop propofol system (CLPS) with a mean arterial pressure (MAP) controller in open-heart surgery. CLPS consists of a 386 PC, a blood pressure sensor and an infusion pump. The C language computer program sets the propofol infusion rate based on an empirical algorithm including proportional component to maintain the measured MAP more closely to the target MAP (85% of patient standard MAP). ⋯ It was a closed negative correlation (r = 0.84; p < 0.01) between the propofol site effect and the MAP during the initial period of anesthesia. There were not any significant changes in the blood cortisole level during the procedures. The recovery time was 1.4 +/- 1.5 min after propofol infusion; 95.5% of patients were extubated in the operating room.
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Anesteziol Reanimatol · Sep 2004
[Use of "NovoSeven" (rFVIIa) hemostatic in patients operated with extracorporeal blood circulation].
The "NovoSeven" drug was used in 25 patients (male - 18, female - 7) operated on the heart and main vessels including with artificial extracorporeal circulation (AEC). Patients did not have any clinically significant impairment in blood circulation before surgery. Perioperatively, all of them and, immediately after surgery, 4 them had uncontrollable hemorrhages at 10-25 ml/min in spite of extensive hemostatic therapy, including freshly frozen plasma, cryoprecipitate, thromboconcentrate, trasilol and ?-amine acid. ⋯ It normalized the hemostasis by it differential action on an impairment depending on an activated or suppressed coagulation. Thus, the conclusion is that the "NovoSeven" (rFVIIa) is an effective hemostatic ensuring the correction of massive intra- and postoperative blood losses in cardiosurgery patients. The drug cuts the need in using the donor-blood components, thus, diminishing the risk of multi organ failure that can develop immediately after surgery.