Anesteziologiia i reanimatologiia
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Anesteziol Reanimatol · Jul 2010
Clinical Trial[Brain edema treatment procedure using continuous controlled infusion of mannitol in neurosurgical patients].
The paper evaluates the efficiency and safety of the developed osmotherapy protocol using controlled continuous infusion of 15% mannitol solution. Two hundred and nine patients with intracranial hypertension (ICH) syndrome of various etiologies had 15% mannitol infusion, the rate of which was determined by clinical criteria. The infusion rate was 50 ml/hr with midline brain structure dislocation of 8 mm or more and major depression of consciousness (a Glasgow coma scale (GCS) score of less than 8) and 25 ml/hr with brain dislocation of 7-mm or less and a GCS score of 8 or higher. ⋯ The duration of mannitol infusion averaged 6.6 days. No urinary tract complications were observed. The proposed procedure of osmotherapy is effective and safe if the scope of monitoring is adequate.
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Anesteziol Reanimatol · May 2010
Case Reports[Paradoxical dynamics in the values of bispectral index for bilateral registration in a patient during parastem tumor removal (a clinical case)].
The paper describes an unusual clinical case. During a neurosurgical operation (removal of parastem tumor (neuroma) on the right side), bilateral registration of the bispectal index (BSI) in order to monitor a hypnotic component of anesthesia showed that the tumor removal stage was marked by a paradoxical reaction of the BSI as an increase in its values up to 70-80% (corresponds to the patient's emergence) on the right, ipsilaterally, with the preserved low BSI values on the left--30-40%. Possible explanations of the observed are considered.
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Chronic non-cancer pain management is an urgent global problem. To set up pain clinics is a promising and economically sound approach. There are pain clinics operating in Russia; however, there are no unified approaches to solving their organizational, therapeutic, and educational-and-methodological problems. An antipain care model is proposed for patients with chronic non-cancer pain, which makes it possible to optimize the treatment of the patients, to train pain specialists, and to enhance the economic efficiency of management.
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Thirty-five autopsy cases of influenza A/HIN1 in Moscow were analyzed. Primary pathological changes were found in the trachea and lung. ⋯ In addition, there were signs of infectious-toxic shock associated with viremia, as suggested by pronounced changes in the brain, kidneys, liver, spleen, adrenals, and lymph nodes. Bacterial bronchopneumonia was detected in only 20% of cases.