Anesteziologiia i reanimatologiia
-
Anesteziol Reanimatol · Jul 2013
Clinical Trial[Patient positioning on the operating table in neurosurgery: sitting or lying].
Efficacy and safety of microvascular decompression of trigeminal nerve depending on the position on the operating table were assessed in 200 neurosurgical patients in retrospective observational study It was shown that efficacy doesn't depend on positioning. Lying position eliminates probability of such complications as postural hypotension, hypotension during surgery, tension pneumocephalus and peripheral nerves injury. ⋯ It is also decreases risk of corneal reflex reduction by 3 times, hyperpathia by 2 times and paresthesias by 5 times, but increases probability of postoperative hyperesthesia by 4 times. Microvascular decompression of trigeminal nerve in lying position is safer than similar operation in sitting position.
-
Anesteziol Reanimatol · Jul 2013
[Intracranial pressure plateau waves in patients with severe traumatic brain injury].
The goal of the study was to assess frequency of plato waves, their influence on outcomes and define factors leading to plato waves. Ninety eight patients with severe traumatic brain injury (TBI) were included. Blood pressure (BP), intracranial pressure (ICP), cerebral perfusion pressure (CPP) and pressure reactivity index (Prx) were registered. ⋯ CPP did not differ in groups, because CPP was strictly controlled. Patients of the group I had preserved autoregulation and less severe trauma (predominance of closed trauma and Marshall I, II type of brain damage). Plato waves did not predict bad outcomes.
-
Anesteziol Reanimatol · Jul 2013
[Mass-spectrometric control of compound A during minimal flow anesthesia and its influence on liver and kidneys functions].
The article contains results of mass-spectrometric control of sevoflurane and compound A concentrations during inhalation anesthesia with minimal flow (< or = 0.5 l/min) and its influence on liver and kidney function. 40 patients (ASA I-II) were included in the study. Transsphenoidal pituitary adenomectomy was performed in all cases. Patients didn't have any signs of liver or kidneys disfunctions preoperatively. ⋯ They included: AST, ALT, total bilirubin, total protein, urea, creatinine. Quantitative analysis of the compound A and blood test before and after anesthesia showed only a tendency to increase biochemical markers levels within normal range, except small, but significant, AST elevation and total protein reduction in postoperative period. We concluded that maximal registered level of compound A (275 ppm/h) during minimal flow anesthesia didn't associate with significant liver and kidneys injury in healthy patients.
-
Anesteziol Reanimatol · Jul 2013
[Dynamics of intracranial pressure in patients with massive ischemic stroke after decompressive craniotomy].
The goal of the study was assessment of the value of ICP monitoring in patients with massive ischemic stroke after decompressive craniotomy. 12 patients with massive ischemic stroke were performed ICP monitoring after decompressive craniotomy. We identified 3 types of ICP dynamics: a) normal ICP, which no need to treat; b) ICP elevation to 20 mm Hg and more in postoperative period, which can be treated by nonsurgical therapy; c) refractory to therapy ICP elevation to 20 mm Hg and more with development of intracranial hypertension. We consider that ICP monitoring in patients with massive ischemic stroke after decompressive craniotomy can be useful for optimization of the therapy and correction of intracranial hypertension.
-
Anesteziol Reanimatol · Jul 2013
[Endoscopic diagnosis, treatment and prevention of intubation related injuries of the larynx and trachea in neurosurgical patients].
The goal of the study was to assess of efficacy of endoscopic diagnosis, prevention and treatment of intubation related larynx and tracheal injuries in patients with acute neurosurgical pathology and prolonged mechanical ventilation. 199 patients with different neurosurgical pathology were enrolled in the study group. Mean age was 50 +/- 14. Control group consisted of 399 patient. ⋯ Such injuries weren't mentioned in 83 patients in study group and in 146 patients of the control group. Tracheal stenosis was developed in the study group in 0,8% of patients, which is by 7,9 times lower than in the control group (6.3%). We consider that this result was achieved due to our approach to treatment and prevention of tracheal stenosis.