Anesteziologiia i reanimatologiia
-
Anesteziol Reanimatol · May 2011
Randomized Controlled Trial[Evaluating the effectiveness of "open lung" maneuvre].
The purpose of this study--a comparative evaluation of the treatment of postoperative acute respiratory insufficiency in cardio surgical patients with lung opening maneuver and conventional mechanical ventilation. The study included 81 patients operated on the heart and magistral vessels in which the immediate postoperative period was complicated by the development of acute lung injury. Patients were divided into 2 groups: 1 (main) group (48 patients), on which the open lung technique was used, 2 (control) group (33 patients) who underwent a standard respiratory support. ⋯ As a result of the recruiting maneuver in the first group sustained improvement of arterial oxygenation was achieved in 35 patients. In patients with acute postoperative respiratory failure recruiting maneuver led to a significant increase in arterial oxygenation and reduce the fraction of intrapulmonary shunt. Application of "open lung" maneuver leads to the resolution of respiratory failure, which greatly reduces the timing of mechanical ventilation and length of stay of patients in intensive care units in comparison with traditional methods of respiratory therapy.
-
Anesteziol Reanimatol · May 2011
Clinical Trial[The use of tranexamic acid during large joint endoprosthetic surgeries].
The aim of the study is to measure the effectiveness and safety of tranexam acid during hip and knee joint endoprothesis surgeries. Tranexam (Mir-Pharm, Russia) was administered to 45 patients 30 minutes before the surgery in the dose of 10-15 mg/kg and 6 hours after first infusion in the same dose. In the control group (n = 45) Tranexam was not administered. ⋯ In both cases there were no tromboembolic or transfusional complications. The potential risk of transfusional complications was lower in the main group. Tranexam acid is an effective and safe blood loss prophylaxis measure during the large joint prosthetic surgeries.
-
Anesteziol Reanimatol · May 2011
[Central venous blood oxygen saturation and venous to arterial PCO2 difference after combined heart valve surgery].
The aim of our study was to investigate the relationship between central venous oxygen saturation (ScvO2) and venous-to-arterial difference in PCO2 (Pv-aCO2) and their role in the assessment of balance between oxygen delivery and consumption after combined valve surgery. The prospective observation study included 38 adult patients with acquired valvular hear diseases, requiring surgical correction of two or more valves using cardiopulmonary bypass. All patients were divided into 2 groups according to the central value of central venous oxygen saturation (ScvO2): low ScvO2 (ScvO2 < 70%) and high ScvO2 (ScvO2 > 70%). ⋯ We observed a moderate correlation between ScvO2 and Pv-aCO2 during the early postoperative period: at the end of surgery, 6 and 12 hours after it (rho = -0.53; -0.62 and -0.43 respectively, n = 38, p < 0.01). The changes in ScvO2 and Pv-aCO2 regressed after 24 hours in ICU. Thus, decreased ScvO2 and increased Pv-aCO2 after combined valve surgery are related and reflect the rise in oxygen consumption.
-
In 130 surgical patients with diseases and injuries in the area of the perineum and lower extremities the clinical effects of three modern local anesthetics: 2% solution of lidocaine, 0.5% solution of bupivacaine, 0.75% solution of ropivacaine and their combinations (2% lidocaine and 0.25% bupivacaine solution 2% lidocaine and ropivacaine 0.375% solution) were followed with regard to the influence of increasing volumes of local anesthetics and different rates of drug administration. It is established that an effective caudal anesthesia is provided with all modern local anesthetics, with increasing use of local anesthetic solution to 40 ml provides duration and the prevalence of sensory and motor blocks, the use of mixture of local anesthetics optimizes the development and maintenance of the caudal blockade.
-
Anesteziol Reanimatol · May 2011
[EEG and bispectral analysis during inhalational anesthesia in children].
Bispectral index (BIS) is a parameter of the depth of anesthesia, but the use of it in children remains discussable. The study was carried out to compare EEG and BIS considering the age of patients during anesthesia with halotane, sevoflurane and consequent combination of sevoflurane and isoflurane. 60 children 3 to 17 years of age, who underwent urological surgeries, were divided into 3 groups (20 patients in each): 1st--halothane group, 2nd--sevoflurane group and 3rd--consequent combination of sevodlurane and isoflurane group. The oxygen: nitrous oxide 1:1 mixture was used in all the mentioned groups. ⋯ The BIS index was 30-39 during maintenance and 70-76 during awakening. The parameters of EEG and BIS in all the investigated groups were proportional to the clinical stage and depth of anesthesia. Based on the clinical data and its comparison to EEG and BIS values it is determined that BIS index can be used for monitoring depth of anesthesia in children.