Khirurgii͡a
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According to literature data Atracurium besylate is a nondepolarizing muscle relaxant akin to the "ideal", insofar as it is governed by the "dose-relaxation time" principle. To secure normal clinical effect, doses in the range 0.4-0.5 mg/kg body mass are recommended, with the maximal manifestation of neuromuscular block occurring within 4.6-7.7 min, and lasting for 35.1 to 39.2 minutes. Maintenance dose: 0.05-0.1 mg/kg body mass. ⋯ A significant muscle relaxation with virtually twice as long duration (35-101 min) is noted, attributable to the presence of metabolic acidosis ("0.605), interfering with the normal course of the Hoffmann reaction for Atracurium disintegration. In the genesis of the phenomena observed any central mechanisms, e.g. hyperventilation, overdosage of the anesthetic, hypothermia and the like, are ruled out. In patients with acidosis it is advised to handle the muscle relaxant with greater caution.
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Assessment of the joint effect of propofol (Diprivan) and etomidat on hemodynamics and side effects is carried out in a series of 60 patients with ASA I--IV, divided up into two groups of thirty cases each. A single dose of 2.2 mg/kg(-1) propofol brings about safe anesthesia induction. In the event of anesthesia induction being preceded by fentanyl and lormetasepame injections, the propofol dose is reduced to 1.8 mg/kg(-1). ⋯ Analysis of the side effects shows isolated cases of flush, fasciculations and the like, prevailing in etomidat cases. Complaints of pain at venipuncture site after propofol are very few. In conclusion, propofol and etomidat account for favourable conditions of anesthesia induction, as well as for short-lasting anesthesia.
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Sepsis and septic shock continue to be the most common causes of death and multiple organ failure among patients in intensive care units. The standard therapeutic regimens include surgical removal of the source of sepsis, antimicrobial therapy, optimizing oxygenation, volume resuscitation, and treatment with catecholamines. ⋯ New therapeutic approaches have become available, including the administration of high doses immunoglobulins, monoclonal antibodies against endotoxin, pentoxilfyline and nitrous oxide inhibitors. Based on the encouraging findings, controlled clinical studies are undertaken to assay with precision their clinical efficacy.
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Propofol is an anesthetic characterized by specific pharmacologic qualities, conditioning compliance of the clinical picture with the drug infusional rate, high-degree safety and facilitated anesthesia conduction--qualities by which it bears resemblance to inhalation anesthesia. This is an assessment of the qualities of TIVA with Propofol in poor-risk patients according to ASA, operated on an emergency basis. Proceeding from the obtained results, the inference is reached that continuous Propofol infusion provides for adequate anesthesia control and safety of the patients with heightened anesthesiologic and operative risk.
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Proceeding from retrospective analysis of 1802 casualties presenting open and closed combined trauma (CT), treated in the Emergency Medicine Institute "Pirogov" over the period 1985 through 1994, attention is focused on the changes in incidence and patterns of associated injuries. Problems relating to organization of the treatment of such patients at the various stages are discussed. The basic requirements of diagnosing and establishing the indications for operation are outlined from the standpoint of general surgery. Finally, the main developmental trends of the therapeutic approach to CT, and the possible ways to find a solution of the most important problems along this line are summed up.