Anesteziologiia i reanimatologiia
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Anesteziol Reanimatol · Jan 2004
Clinical Trial[Continuous positive airway pressure and high-frequency independent lung ventilation in patients with chronic obstructive lung diseases].
The original hypoxemia, hypercapnia, high pulmonary hypertension, high resistance of microcirculation vessels, right volumetric ventricular overload, persistent sub-edema of pulmonary intersticium as well as disparity of ventilation and perfusion between both lungs are the main problems in patients with chronic obstructive disease of the lungs (CODL). Such patients are, as a rule, intolerant to the independent lung collaboration or artificial single-stage ventilation (ASV). Patients with respiratory insufficiency, stages 2 and 3, and with a pronounced impaired type of ventilation have originally a deranged blood gas composition, like hypoxemia or hypercapnia. ⋯ The use of constant high-frequency ventilation in the independent lung in patients with obstructive pulmonary lesions does not improve the gas exchange or hemodynamics. Simultaneously, a growing total pulmonary resistance and an increasing pressure in the pulmonary artery are observed. Consequently, the discussed method must not be used for the ventilation support of the independent lung in patients with the obstructive type of the impaired external breathing function.
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Anesteziol Reanimatol · Jan 2004
Comparative Study[Changes in hemodynamics during regional anesthesia and medicinal sedation in children traumatology].
Thirty-nine patients, aged 8 to 15, who were operated for damaged bones in the upper lower limbs were examined. The parameters of central hemodynamics, heart rate and arterial pressure were studied (monitor HP "Viridia m3", USA). Strike volume was determined automatically (rheography monitor NCCOM-3"Boomed Co.", USA). ⋯ The changes of hemodynamics detected in the children of group 1 revealed an insufficient analgetic and antistress efficiency of halothane. The data obtained for group 2 are indicative of insignificant hemodynamic changes observed at all examination stages and related with the impact exerted by drugs, used for sedation and regional anesthesia, on the vascular tonus of the original undetected hypovolemia. A lack of complications, a fast awakening and recovery of an adequate consciousness after combined regional anesthesia as well as comfort and a lack of need in extra analgetics that are normally used in the immediate postoperative period make it possible to refer to the discussed anesthesia variation as to the preferential one in cases of surgeries for damaged bones in children.
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Anesteziol Reanimatol · Jan 2004
[Postoperative analgesia with nonsteroid anti-inflammatory drugs in children].
The purpose of the case-study was to evaluate the efficiency of non-steroid antiinflammatory drugs (NAD) for postoperative analgesia in children after small-scope surgical interventions. Diclofenac, 1 mg/kg per day administered as rectal suppositories or intramuscular injections after initial narcosis, was used for postoperative analgesia in children of the main group; postoperative analgesia made by analgin and promedol in the control group was compared with the former. Forty-seven children and 10 children with identical diseases like groin hernia, varicocele and dropsy of testicular membranes, were respectively in the main and control groups. ⋯ The efficiency of postoperative analgesia was evaluated by means of cardiointervalography according to Bayevsky method as well as by a state of central hemodynamics and by clinical examinations, including the visual-analogue 10-point scale and the 0-4 point verbal pain assessment scale. The postoperatively obtained data revealed a pronounced misbalance between the main and control groups, which is indicative of that the application of NAD for preventive and postoperative analgesia in children improves essentially the postoperative course and contributes to a fast rehabilitation of patients. A comparative analysis of the efficiency of postoperative analgesia by the discussed drugs showed that diclofenac possesses a sufficient analgetic activity and is free of any side-effects inherent in narcotic analgetics.
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Anesteziol Reanimatol · Jan 2004
[Regional anesthesia of the sciatic nerve with anterior approach in children: new landmarks].
The purpose of the case study was to evaluate new landmarks for the needle insertion in sciatic nerve block made through the anterior approach. We identified, by X-Ray, new simplified bone landmarks and suggested that the skin should be marked in order to find the puncture site. ⋯ The former ensures the regional anesthesia of the lower limbs in all trauma cases; besides, it cuts the block implementation time. The rate of complications and the duration of postoperative analgesia are not dependent on a selected approach.
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Anesteziol Reanimatol · Jan 2004
[Preventive analgesia and early postoperative period in ambulatory orthopedic surgeries in children].
The purpose of the case study was to compare the adequacy of anesthetic management and the specificity of the early postoperative course with preventive analgesia (group 1) and without it (group 2). Preventive analgesia comprised diclofenac, 50-75 mg/kg in intramuscular injections made 1 h before surgery, and microdoses of ketamine, 1.0 mg/kg in intramuscular injections 0.3 mg/kg in intravenous injections as a component of premedication. ⋯ An earlier awakening was observed in group 1, which we attributed to a more valuable antinociceptive protection and to lower doses of ketamine (group 1--3.2 mg/kg; group 2--4.3 mg/kg). According to the results the preventive analgesia method reduces significantly the postoperative pain and anxiety, which makes the administration of additional analgetics advisable and cuts the child's stay in one-day hospital.