Anesteziologiia i reanimatologiia
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Peculiarities of septic shock in obstetrics are considered in this article. Traits of pregnant woman organism concerning infectious process, etiology and risk factors, modern criteria of heavy sepsis diagnosis and septic shock are discussed. It is pointed out that septic process system manifestations considerably outstrips local manifestations of purulent process in a uterus and it is necessary to take into account modern markers and criteria when making decision on initial infection center sanitization. The modern protocol of septic shock initial intensive therapy where are defined not only modern methods of treatment, but also time of their implementation, and the basic principles of pyosepsis caused maternity mortality decrease.
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The article is a literature review on awake craniotomy. History of method, indications and contraindications, necessary conditions for successful application as well as complications and their prevention and correction are considered Outcomes in patients with neuro-oncological pathology and in patients with intractable epilepsy after awake craniotomy are also analyzed. It's also shown that awake craniotomy can make removal of tumors near eloquent cortex more radical and improve neurological outcome in such patients.
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Anesteziol Reanimatol · Jul 2012
[Intensive therapy in patients with severe traumatic brain injury complicated by delirium].
Delirium can greatly complicate progressing of TBI. Early diagnosis and intensive therapy optimization can improve the outcome. Retrospective-prospective study was performed in patients with severe TBI and delirium. 27 patients (mean age--40.8 +/- 3.3 years) were involved in experimental group and 25 patients (mean age 49.0 +/- 4.5 years)--in control group. ⋯ Reamberin ("Polisan", Russia) infusion (800 ml/day for 7 days after injury) was included in the therapy plan for the experimental group. Modified RASS score was equal in both groups on the first day (1.67 +/- 0.37 in experimental and 1.88 +/- 0.28 in control group), but later RASS score was lower in experimental group (0.7 +/- 0.30 and 1.41 +/- 0.26 (p = 0.042) on the third day; 0.45 +/- 0.20 and 1.09 +/- 0.36 (p = 0.012) on the 5th day; 0.2. +/- 0.14 and 1.00 +/- 0.39 (p = 0.008) on the 7th day). The correlation of the modified Richmond Agitation Sedation Scale (RASS) score with the ISS score and with the length of stay in ICU was noted Reamberin improves mental status in patients with severe TBI complicated by delirium, especially, with alcohol intoxication.
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The review describes postoperative disorders of the cognitive functions' (memory attention, speech, abstract thinking etc.) which is known as POCD. Frequency of POCD depending on pathology and age of patients, type of surgery and anesthesia is considered. Risk factors of POCD, especially advanced age and initial cognitive disorders are also noted. Modern diagnostic, treatment and prophylaxis facilities are discussed.
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The review describes modern diagnostic criteria for delirium in patients in ICU. Classification and prognostic significance of delirium are discussed. Prophylaxis and treatment of delirium in patients in ICU are considered in the review in details.