Anesteziologiia i reanimatologiia
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Anesteziol Reanimatol · May 2009
Clinical Trial[Use of albumin in infusion-transfusion therapy for acute brain injury].
The investigation is aimed at determining whether it is necessary to include 20% albumin preparations into infusion-transfusion therapy for acute intracranial hemorrhage. An insignificant improvement of central hemodynamic parameters was shown in a group wherein 20% albumin solution was used. At the same time there was a significant increase in the pulmonary extravascular water index as compared with a control group (10.1 +/- 0.5 and 9.0 +/- 0.22 ml/kg, respectively; with no differences in the severity of lung injury, LIS was 0.71 +/- 0.23 scores; while in the group receiving no albumin solution it was 0.65 +/- 0.06 scores. Thus, the routine use of 20% albumin preparation as part of infusion-transfusion therapy for acute intracranial hemorrhage is not effective and rather safe.
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Despite the extended potentials of modern medicine, noncompensated blood loss remains one of the leading causes of death in the able-bodied population all over the world. At present, there is no uniform policy of transfusion maintenance and intensive care in victims with severe decompensated blood loss. The purpose of the study was to assess the results of compensation for acute blood loss in victims with concomitant injury and wounds at various sites, which were attended by the loss of a circulating blood volume (CBV) with the use of new technologies. ⋯ CBV was compensated for by the currently available infusion media; globular blood volume deficit was restored via intraoperative instrumental reinfusion of autoblood and donor blood. The proposed procedure for infusion-transfusion therapy made it possible to stabilize the patient's condition and to perform emergency surgical treatment in victims with fatal blood loss. Total mortality in the chosen intensive care modality was 62.1%.
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Anesteziol Reanimatol · May 2009
Case Reports[A case of transient complete suppression of cerebral electrical activity during anesthesia based on propofol].
In an anesthesiologist's practice, except the occurrence of clinical death on the operating table a long-term complete suppression of the electrical activity of the brain may arise only from the medical staff's crude error when administering intravenous anesthetics from the unlikely breakage of the anesthesia apparatus vaporizer. However, the authors assert that such a phenomenon may develop during general anesthesia using propofol given in its usual doses. Clinical examples are given. Whether the depth of general anesthesia should be controlled by the principle of feedback, by making neurophysiological monitoring is discussed.
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Anesteziol Reanimatol · May 2009
[Thromboelastography as a method for preoperative screening for the hemostatic system in neurosurgical patients].
The paper analyzes the use of a method of thromboelastography (TEG) as a screening technique of diagnosing hemostatic disorders in risk-group neurosurgical patients: hemostatic disorders detectable from the data of routine laboratory tests; the administration of anticoagulants and desaggresants, the use of anticonvulsants causing impairments in the hemostatic system, hematological diseases, and hepatic cirrhosis. As compared with the routine laboratory tests, TEG is shown to diagnose hemostatic disorders accurately and promptly and to monitor the efficiency of their therapy.
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Anesteziol Reanimatol · May 2009
[Microemboli as a cause of postoperative deliria and cognitive disorders in surgical practice].
Analysis of contemporary clinical and experimental studies evidences that intraoperative microemboli considerably contribute to the development of postoperative deliria and cognitive disorders. A number of studies have shown that left temporal and occipital structures are especially vulnerable to intraoperative ischemia. It is important that neurological cases of ischemia of the former brain regions are frequently characterized by transient psychoses and hypomnesia. Approaches to preventing intraoperative microembolism and associated neurological complications need further research.