Khirurgii͡a
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A historical review of the development of endotracheal intubation is made. Clinical and some X-ray features, allowing to prognosticate the difficult intubation are searched for. Classifications are suggested of the possible reasons for difficulties. ⋯ It is a stress moment both for the patient and for the anesthesiologist. The signs through which the anesthesiologist may determine the position of the tube and rule out eventual esophageal intubation are systematized. Percentages are given on the relative incidence of difficult intubations and fiber optic intubations [correction of fibrointubations] in the different aspects of operative surgery.
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Operative interventions in the upper half of the abdomen have been performed in 32 surgical patients under thoracic epidural analgesia (TEA) with bupivacain at T4-L2 level, with the use of catheter technique. Before operation the patients were hydrated with 12.5 per cent of the circulating blood volume, calculated by nomogram. By noninvasive approach were monitored: pulse rate (PR), mean arterial pressure (MAP), minute cardiac volume (MCV), peripheral vascular resistance (PVR) and cardiac index (CI) for the following times; T0--basal preoperative value, T1--on the 5. min; T2--on the 10. min; T3--on the 15. min.; T4--on the 20 min.; T5--on the 50. min after application of bupivacain analgesia. ⋯ The results may be summarized, as follows: 1. Noninvasive monitoring of PR, MAP, MCV, CI and PVR in TEA is necessary for early detection and control of their pathologic changes; 2. The hemodynamic changes in TEA with bupivacain at T4-L2 level after premedication with vagolytic and hydration with Ringer-lactate (in amount 12.5 per cent of the circulating blood volume) are not significant and do not require additional treatment; 3, TEA at T4--L2 level allows performance of operative interventions in the upper half of the abdomen with adequate analgesia and relaxation, being particularly indicated for patients at risk.
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Case Reports
[Subphrenic abscess and suppurative pericarditis as complications in children with perforated appendicitis].
The combination of subphrenic abscess with purulent pericarditis is a rare postoperative complication of perforated appendicitis in children, with severe clinical course, difficult to diagnose and high case fatality rate. A 7-year-old child with this complication, successfully diagnosed and treated is reported. The importance of complex therapy--surgical and intensive and collaboration between pediatric surgeons, anesthesiologists, cardiac surgeons and cardiologists for the favourable outcome is emphasized.