Anesteziologiia i reanimatologiia
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Anesteziol Reanimatol · Jul 2004
Randomized Controlled Trial Clinical Trial[A risk of myocardial ischemia and the nature of infusion-transfusion therapy in scheduled surgical treatment of infrarenal aneurisms of the aorta].
The authors analyzed effects produced by different variations of the infusion-transfusion therapy on the risk of cardiovascular complications that can develop in the scheduled surgical treatment of the aorta abdominal part. The patients were randomized in 2 groups. Intraoperative hemodilution was made in group-1 patients (n = 50) before aorta clipping. ⋯ The below results were obtained on the basis of conducted research: preventive infusion load aggravates, before aorta clipping, the risk of cardiac complications. Maintenance of Hb below the level of 90 g/l is accompanied by an impaired transport of oxygen to tissues; it speeds up the heart beat and provokes an increased cardiac need in oxygen, which enhances the risk of myocardium ischemia. Preparation of autoblood and hardware-based reinfusion of autoerythrocytes provide for an adequate compensation of blood losses and diminish the risk of cardiac complications in the scheduled surgical treatment of infrarenal aneurisms of the aorta.
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The onset and development of cardiac insufficiency is associated with diverse pathophysiological mechanisms with attention being focused recently on studying the significance of "proinflammatory" cytokines, primarily, of TNFalpha. Fifty-nines patients (age--18-24, body weight--54-76) with sepsis (19 persons, group 1), severe sepsis (20 persons, group 2) and with septic shock (20 persons, group 3) were examined. ⋯ The central hemodynamic indices were investigated by integral tetrapolar rheography according to Tishchenko. The results denote a big significance of diastolic malfunction of the left cardiac ventricle or "rigid" myocardium in shaping of myocardial malfunction as observed in sepsis and septic shock.
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Anesteziol Reanimatol · Jul 2004
[Total intravenous anesthesia with ketamine and the condition of the higher psychic function in the early and remote postoperative periods].
Influence of total intravenous anesthesia with ketamine on the higher psychic function was studied, immediately after surgery and in the remote postoperative period, in 143 patients with different typological properties of the nervous system after a scheduled surgery--supravaginal uterectomy in fibromyoma of the uterine body. The authors defined 6 groups of patients with different typological properties of the nervous system. Persistent impairment of the higher nervous functions were established, immediately after surgery and in the remote postoperative period, in patients with a weak nervous system, biased nervous balance towards excitation, and with lability of nervous processes. ⋯ The use of such anesthetic scheme was found to be inadvisable in the above groups of patients. The described impairments were not registered when total intravenous anesthesia was used in patients with a balanced nervous system irrespective of its type, a biased nervous balance towards inhibition and with inertness of nervous processes. The above anesthetic management is acceptable for such patients.