Anesteziologiia i reanimatologiia
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Anesteziol Reanimatol · Sep 2000
Comparative Study[Functional state of the right and left heart at different stages of anesthesia in patients with ischemic heart disease during myocardial revascularization surgery].
57 ischemic heart disease (IHD) patients entered the study of right and left heart function at different stages of anesthesia and operation to reveal possible reasons of myocardial dysfunction and to propose effective prevention of this dysfunction. All the patients were operated on under multicomponent balanced anesthesia (relanium, fentanyl, arduan, nitric oxide with oxygen 1:1). Left ventricular function was assessed at Doppler echocardiography, right ventricular function--at catheterization of the lung artery with a Swan-Ganz catheter with low time constant. ⋯ Diastolic and systolic right ventricular dysfunctions were observed at all stages and three stages of the operation, respectively. Diastolic and systolic left ventricular dysfunction was observed at four and one stages, respectively. Basic causes of the above systolic and diastolic disorders in the preperfusion period may be tachycardia, arterial hypertension, reduction of the preloading and increased postloading (for the right ventricle) in artificial lung ventilation.
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Anesteziol Reanimatol · Sep 2000
Comparative Study[Results of the treatment of cardiac surgery patients with postoperative acute respiratory distress syndrome by prone-position pulmonary ventilation].
Prone position ventilation (PPV) became an effective method of management of ARDS since 1974. Its positive effects on arterial oxygenation have been amply described, but its impact on the results of treatment and hospital mortality remains a disputable point. We observed 2 groups of patients, 36 pts. each, with ARDS after cardiovascular surgery. ⋯ Clinical outcomes were better in the PPV group than in the controls: a lower frequency of threatening arrhythmia, better results of MOSF treatment, and lower mortality (69 and 33.4%, respectively). Prone position is an effective measure improving arterial oxygenation in patients with ARDS after cardiovascular surgery. The main results of PPV are decrease in complications induced by hypoxia and higher survival rate.
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Anesteziol Reanimatol · Sep 2000
Comparative Study[Clinical experience with low- and minimal-flow isoflurane in extensive resections of the liver and liver transplantation].
A comparative study was performed of general balanced anesthesia on the basis of neuroleptic analgesia (NLA) and inhalation low- and minimal-flow anesthesia with isoflurane in anesthesiological management of extensive operations on the liver. A total of 75 anesthesias were conducted. ⋯ Low-flow isoflurane significantly lowers pharmacological load with opiates, myorelaxants which is essential in patients with hepatic diseases. This leads to more rapid recovery of adequate spontaneous respiration and activation of the patient in low risk of postoperative iatrogenic complications.
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Effective therapy of chronic frequently recurring pain is a complex important problem from practical medical, social, and economic viewpoints. Organization of specialized "pain clinics" and pain control centers is discussed. These institutions will take care of patients with chronic pain syndromes. ⋯ The authors offer recommendations on the use of traditional and nontraditional methods of pain relief. New highly effective integrative diagnostic methods (computer pulsometry) and therapies (resonance electropuncture analgesia and therapy) are used in various pain syndromes, including chronic frequently relapsing, which are usually resistant to common methods. Integrative methods of clinical reflex therapy create conditions for replacing traumatic surgical and radiological methods used in the treatment of critically ill patients by methods of integrative medicine.
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Anesteziol Reanimatol · Sep 2000
Comparative Study[Autonomic reactivity and intraoperative arterial hypertension in patients with ischemic heart disease].
As patients with ischemic heart disease (IHD) may develop intraoperative hypertensive and hyperdynamic reactions provoking myocardial ischemia, the authors estimated reactivity of the autonomic nervous system before giving anesthesia. This was made for prediction of intraoperative hypertensive reactions and choice of an optimal anesthesia variant. Combination of spectral analysis of variability of the heart rhythm and active orthostatic test was employed for this purpose in 50 IHD patients undergoing myocardial revascularization.