Anesteziologiia i reanimatologiia
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Anesteziol Reanimatol · Jul 1994
Review Comparative Study[Current principles of the clinical use of central-action analgesics].
The author analyzes the results of experimental and clinical studies of various central action analgesics used for total anesthesia, postoperative analgesia, and chronic pain relief in cancer patients. General shortcomings of all opioid analgesics were revealed: analgesias not always full-value because of different individual sensitivity to opioids, and side effects were often serious. The latest progress of the fundamental sciences in research of the mechanisms of pain and body responses related to pain helped improve the available and develop new more effective methods for total anesthesia and postoperative analgesia on the basis of opioid analgesics with the use of special nonopiate components compensating for the defects of opiate analgesia: clofelin, an adreno-positive agent; acelysin and contrykal, prostaglandin and kinin synthesis inhibitors. Synthetic opioids of the latest generation (buprenorphine, tramadol) were found preferable in the treatment of chronic pain in cancer vs. morphine and its analogs; an alternative scheme of drug therapy of chronic pain on the basis of these drugs is offered which is highly effective and causes the minimal side effects.
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To facilitate nasotracheal intubation a conductor made from esophageal tube is recommended. The advantage of this conductor is that the tube could be directed into the trachea without intubation forceps. No special material is required and it is available for any anesthesiologist.
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Anesteziol Reanimatol · Mar 1994
Review[The use of hypertonic sodium chloride solutions in resuscitation, intensive therapy and disaster medicine].
The review of Russian and foreign literature published in 1939 to 1993 has demonstrated possible use of small doses of isotonic salt solution for prompt correction of hemodynamic parameters in severe traumas, massive blood loss, most severe stages of shock and critical conditions. The best effect can be achieved with the use of isotonic salt solutions in combination with hyperoncotic solutions (sodium chloride and low molecular weight dextran). The principal mechanism of action is attraction of the liquid from the interstitial spaces into the vascular bed, stimulation of vascular osmoreceptors and neurogenic reflex mechanisms. High efficacy, simplicity and acceptability of the technique make it possible to recommend it for the use at prehospital stage, immediately on the spot of the accident, during transportation and at hospital stage when there are numerous patients with severe traumas and shortage of infusion-transfusion media.
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Anesteziol Reanimatol · Mar 1994
Comparative Study[A method of epidural chemical denervation in the combined treatment of a chronic pain syndrome].
The efficacy of epidural chemical denervation used for the treatment of chronic pain syndrome in cancer patients (clinical stage IV) has been studied at different phases of antinociceptive therapy and also in combination with analgesics. Early use of this technique for the treatment of chronic pain in cancer patients has been recommended and it was concluded that it is more effective in combination with analgesics.