Anesteziologiia i reanimatologiia
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Anesteziol Reanimatol · Sep 2008
Randomized Controlled Trial[Analgesic and opioid-sparing effects of intravenous paracetamol in the early period after aortocoronary bypass surgery].
The study was to evaluate the analgesic and opioid-sparing effect of intravenous paracetamol injections in cardiosurgical patients in the early postoperative period. Adequate analgesia within the first 12-18 hours of the early postoperative period is very important for a good prognosis of the further course of pain syndrome and for the reduction of a risk for its progression to its chronic form. In early studies, propacetamol lowered morphine use after orthopedic and gynecological operations. ⋯ During this period, inspiratory volume values were higher in the paracetamol group; however, a statistically significant (39%) difference between the groups in the mean values was obtained only during and 2 hours after extubation. In the perfalgan group, the mean total use of promedol was 36% less than in the placebo-group, which was statistically significant (p = 0.019). The early postoperative use of paracetamol after myocardial revascularization reduces the intake of opioids and diminishes the intensity of the pain syndrome within the first hours after extubation, which promotes a higher thoracic excursion, as confirmed by a statistically significant increase in the maximum inspiratory capacity.
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Anesteziol Reanimatol · Sep 2008
Clinical Trial[Optimization of the volemic status of cardiosurgical patients before initial anesthesia].
Twenty-six patients with coronary heart disease who had undergone aortocoronary bypass surgery were examined. In all the patients, central hemodynamic parameters were monitored by transpulmonary thermodilution. The patients were divided into 2 groups. ⋯ IOPSS objectively reflects the preload status at all stages of initial anesthesia and the leg raising test enables prediction of a cardiovascular response to a volumetric load. When infusion therapy is performed, it is advisable to take into account a relationship between altered preload (GEDVI) and cardiac performance (SI). This volumetric loading testing tactics before induction promotes GEDVI to be maintained in the normal ranges throughout the initial anesthesia and minimizes hemodynamic disorders at this stage.
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Anesteziol Reanimatol · Sep 2008
[Use of loading test to predict intraoperative heart failure in cardiosurgical patients].
The paper deals with the development of a procedure for using loading tests to predict the development of intraoperative heart failure in cardiosurgical patients. A volumetric loading test (limb elevation) was carried out to assess the mechanisms of responsible for the regulation of performance of the heart and the efficiency of its work. ⋯ Loading tests enabled the authors to identify 3 types of a hemodynamic response to a volumetric load. The incidence of postperfusion heart failure may be predicted depending on the identified type of a hemodynamic response to the volumetric load given at the very beginning of surgery.
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Anesteziol Reanimatol · Sep 2008
Clinical Trial[Method of pharmacological myocardial preconditioning with halogen-containing anesthetics in cardiosurgical patients].
The purpose of the investigation was to study whether isoflurane and sevoflurane might be used for pharmacological myocardial preconditioning (PMP) in patients with coronary heart disease during myocardial revascularization on the working (Part I) and arrested (Part II) heart and to develop a possible procedure for PMP. Part I deals with the study of the effect of PMP with halogen-containing anesthetics during myocardial revascularization on the working heart. The study included 66 patients who were divided into 4 groups; 1) sevoflurane feeding was started just after anesthesia induction and it lasted until some coronary arteries were ligated; 2) sevoflurane was fed for 15 min; 3) isoflurane was used; 4) controls. ⋯ The use of sevoflurane and isoflurane reduces a risk for myocardial ischemic lesion during myocardial revascularization both under EC and on the working heart. Short-term (15-min) use of an agent before myocardial ischemia suffices for PMP to develop its effect. The effect of PMP has its duration that is 76 min, as shown by our findings.
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Anesteziol Reanimatol · Sep 2008
[Respiratory provision of reconstructive operations for extended and multifocal tracheal stenosis].
The paper describes new approaches to anesthetic maintenance of reconstructive operations for multifocal and extended tracheal stenoses. The authors state a pathophysiological concept of and guidelines for respiratory approaches ensuring effective gas exchange and adequate hemodynamics at stages of various plastic repairs. Specifically, they describe the specific features of respiratory provision of rare surgical interventions: two-level tracheal resection and reconstruction and thyrotracheal complex transplantation in subtotal tracheal lesion. The advantages of high-frequency jet artificial ventilation using a Mansoon apparatus (Acutronic Medical Systems AG, Switzerland) are given.