Klinichna khirurhiia / Ministerstvo okhorony zdorov'ia Ukraïny, Naukove tovarystvo khirurhiv Ukraïny
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Developmented and introduction into clinical practice of the sciatic nerve blockade as method of guided anesthesia/analgesia for pain syndromes and surgical interventions on the lower legs. Anaesthesia was analyzed in 35 patients. In 15 patients used the blockade of the sciatic nerve bifurcation proposed method with the popliteal fossa in acute and chronic pain syndromes and comparison with spinal anesthesia in 20. ⋯ The exact setting of the catheter in place bifurcation of the sciatic nerve enables continued use of selective blockade of the nerve trunk for analgesia in critical ischemia of the lower limbs tissues without the risk of toxicity of local anesthetics. This technique sciatic nerve blockade provides better postoperative analgesia, reduction pharmacological stress, normalization of sleep the patient compared with spinal anesthesia. The proposed bifurcation of the sciatic nerve block is recommended for wider clinical use as a means of anesthesia in surgery the nerve innervation area as a highly effective means of combating acute and chronic pain syndrome.
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The investigations were conducted in 44 children, operated on for abdominal cavity tumors and tumors of ovaries. In patients of the first group a combined spinal-epidural analgesia and a continuous intravenous phentanyl infusion were applied; while in the second group--the intravenous continuous infusion of phentanyl. Conduction of a multimodal analgesia have had reduced significantly a negative outcomes of insufficient analgesia in children and secured an effective analgesia after traumatic operations.
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Randomized Controlled Trial
[Application of multimodal anesthesia/analgesia in complex of anesthesiological support of reconstructive operations, performed on the lower extremity arteries].
Anesthesiological support of 47 patients, while performing reconstructive operations on the lower extremities arteries in presence of the third level of operative risk (according to ASA), was analyzed; of them in 24 - a spinal anesthesia was applied, in 23 - a reduced spino-epidural anesthesia. Application of a spino-epidural anesthesia/analgesia with reduction of the dose of a spinal component and usage of analgesia instead of anesthesia secures lesser intraoperative oscillations of hemodynamic indices in comparison with such while performing spinal anesthesia, as well as better antinociceptive protection, is also characterized by small toxic impact on the patient, demands application of a sedative and the infusion therapy of lesser volume. While performing a potentially complex and durable reconstructive operations on the lower extremities arteries a wide application of the method depicted is recommended.
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In 1992 on symposium in Atlanta the general classification of an acute pancreatitis, adopted by world medical society for practical application, was proposed. Due to results of multiple investigations there were enhanced the data about an acute pancreatitis pathophysiology, the organs insufficiency, and improvement of the noninvasive and invasive methods of visualization and treatment, what caused necessity to revise the classification. ⋯ After first meeting the working group have directed the document project to 11 national and international associations of pancreatologists. In 2012 yr the definite conclusions, concerning consensus, were published.
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The results of a medical help delivery on prehospital stage to 200 injured persons, suffering penetrating abdominal wounding with hepatic damage, were analyzed. The main cause of death in 87.5% of the injured persons with open hepatic damage is a non-compensated blood loss, in 12.5%--traumatic shock and a prehospital stage duration. ⋯ Level of adequacy of the blood loss compensation have constituted in group of survivors--57.69%, and in the group of patients, who died--37.50%, what could not be considered satisfactory. In patients--survivors a conditional adequacy of application of hemostatics have constituted 76%, and in a group of the injured persons, who have died--0.