Anesteziologiia i reanimatologiia
-
Anesteziol Reanimatol · Sep 2016
[CLINICAL ASPECTS OF THE BLOOD LACTATE DYNAMICS DURING OPERATIONS ON THE HEART AND THE AORTA IN CONDITIONS OF CARDIOPULMONARY BYPASS.]
The frequency and the causes for the development of hyperlactatemia during operations on the heart and aorta in conditions of cardiopulmonary bypass (CB) is not adequately described in the literature. ⋯ Preperfusion period in all groups of cardiac surgery patients was characterized by a normal level of blood lactate in the absolute majority ofpatients, the frequency of hyperlactatemia did not exceed 1%. Hemodynamic stability was achieved without the use of catecholamines by optimizing volemia and heart rate. While CB showed a trend of increasing lactate on average in comparison with the previous period in patients operated on the heart. Duration CB less than 3 hours was not a factor in the development of hyperlactatemia, provided that oxygen delivery in all patients during perfusion exceeded 300 ml/min/m2, hematocrit ofperfusate at the end of CB was at 25-27% in most patients. To maintain it at a large hemodilution the ultrafiltration hemoconcentration was used. The frequency of hyperlactatemia was 3%. A significant increase in lactate concentration at the end of the CB to 3.39k1,3 mmol/l (range of 2.1-7.2 mmol/l) on the background of metabolic acidosis found only in patients with circulatory arrest due to receipt of blood products of anaerobic glycolysis after the resumption of the CB. They have frequency of hyperlactatemia risen to 29%. The lac- tate average value at admission ofpatients in the ICU with application of 50-60% ofpatients in dopamine/dobutrex at a dose of 5 mcg/kg/min and reaching the targets of transfusion therapy was slightly higher in the baseline period and corresponded to the upper level of normal values. Only during operations on the aortic arch under conditions of circulatory arrest, the concentration of lactate at the end of the operation was 3,4+1,1 mmol/l with a tendency to decrease in comparison with the period of the CB. From 88 to 93% patients during operations on the heart and ascending aorta without circulatory arrest and 64% ofpatients after operations on the aortic arch with circulatory arrest were admitted to the ICU with a normal lactate level in arterial blood Conclusion. The duration ofperfusion less than 3 hours in the conditions of these indicators preservation is not a risk factor for the development of hyperlactatemia. In postbypass period during operations on the heart and aorta without circulatory arrest about 90% ofpatients transferred to the intensive care unit (ICU) with normal values of lactate. During operations on the aortic arch with circulatory arrest about 60% ofpatients have normal levels of lactate at admission from the operating room to the ICU.
-
Anesteziol Reanimatol · Sep 2016
Comparative Study[PHARMACOLOGICAL POSTCONDITIONING BY SEVOFLURANE DURING CARDIAC SURGERY.]
Optimization of myocardial protection during cardiac surgery with a long period of anoxia infarction using sevoflurane postconditioning of myocardium. ⋯ Combined with sevoflurane cardioprotection FPC has a much better resistance to myocardial ischemia-reperfusion injury in patients with myocardial infarction time over 100 minutes than monoprotection with cardioplegic solution "Console ". This method can be recommended as an additional method ofprotection against myocardial ischemia-reperfusion injury.
-
The article is devoted to the existence of the problem of intraoperative provide patients with concomitant diabetes mellitus: a disease is not diagnosed in time, it increases the probability of death in the performance of surgery by 50%, where as the timely prevention and preparation reduces the chance of developing specific complications to the level of patients with the general population. The paper discusses the recommendations developed by the British Association ofEndocrinologists 2011 and Russia in 2015, as well as the Association ofAnaesthetists of Great Britain and Ireland (2015), provides practical recommendations for the preoperative preparation, anesthetic and resuscitation provide patients with concomitant diabetes mellitus.
-
Despite the fact that there is a wealth of experience of using ultrasound in medicine, its application in anesthesiology and critical care began relatively recently Ultrasound navigation can improve the quality of the invasive procedures. There were developed special protocols for critically ill patients, which helps to obtain the diagnosis at the bedside. Therefore all the world's leading societies and associations recommend to include the training of ultrasound technology in the education program for anesthesiologists and intensive care specialists. ⋯ Resident physician should have skills for ultrasound assistance during catheterization central veins and for ultrasound monitoring in critical ill patients to the extent of FAST protocol (level ofpractical skill "to be able'). Other topics should being studied at the level "to know". It is reasonable to hone practical skills on these competences as part ofpostgraduate continuing education program to the extent that is needed for specialist at his workplace.
-
Anesteziol Reanimatol · Mar 2016
[ENTROPY MONITORING DURING LOW-FLOW INHALATION ANESTHESIA--A TRIBUTE TO FASHION OR NECESSITY?].
To compare anesthesia quality and sevoflurane consumption during standard and extended intraoperative monitoring. ⋯ The study revealed that the use of entropy monitoring in high-risk surgery alleviates providing the controlled anesthesia with the optimal inhalation anesthetic concentration and minimal hemodynamic reactions of the patient.