Srp Ark Celok Lek
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Randomized Controlled Trial Comparative Study
[Reverse Trendelenburg's position vs. supine-horizontal position for induction of general anesthesia in obese neurosurgical patients].
The induction of general endotracheal anesthesia (GETA) is associated with variable period of apnea. Obese patients have reduced oxygen supply during period of apnea. Hypoxemia and subsequent hypercarbia, during period of apnea, are strong stimuli of cerebral blood flow and intracranial pressure increase. ⋯ 30 degree reverse Trendelenburg's position provides longer SAP when compared with horizontal-supine positions. This extra time may preclude adverse sequelae resulting from hypoxemia during induction of obese neurosurgical patients.
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Randomized Controlled Trial
[Effect of infusion of hypertonic-hyperoncotic solution on cardiovascular function in surgery of the abdominal aorta during the perioperative period].
When blood flow is decreased, as in prolonged hypovolaemia and hypotension, or in the course of transversal clamping of the aorta during aortic reconstruction, nutritive tissue perfusion can also fall below the critical level. ⋯ Cardiac output increased from 5.67 +/- 2.95 to 7.05 +/- 3.39 L min(-1) in the study group, in comparison to the controls, where it increased from 4.98 +/- 2.06 to 5.99 +/- 3.02 L min(-1) (p = 0.004). Central venous pressure increased from 8.75 +/- 3.67 to 9.30 +/- 2.77 mm Hg in the study group, in comparison to the controls, where the values decreased from 6.84 +/- 2.73 to 6.45 +/- 2.50 mm Hg (p = 0.022). Diastolic pulmonary artery pressure increased from 15.92 +/- 5.61 to 16.65 +/- 6.53 mm Hg in the study group, in comparison to the controls, where it decreased from 12.65 +/- 4.28 to 11.85 +/- 3.91 mm Hg (p = 0.021). The amount of given crystalloids 24 hours after the removal of the aortic clamp totalled 2562.5 +/- 485.82 mL in the study group, versus 3350 +/- 727.29 mL in the control group (p = 0.000). The amount of given human albumins 24 hours after the removal of the aortic clamp totalled 30 +/- 49.74 mL in the study group versus 100 +/- 4.34 mL in the control group (p = 0.001). CONCLUSION Haemodynamic stability of patients and adequate organ perfusion during surgery are achieved through the infusion of hypertonic-hyperoncotic solution, which maintains optimal values of: cardiac output, mixed venous oxygen saturation, and delivery of oxygen, while reducing alveolo-arterial oxygen difference. The balance of fluids, 24 hours after the removal of the aortic clamp, was maintained with the aid of hypertonic-hyperoncotic solution, while isotonic solution produced an excess of over 1000 mL of fluid in the control patients. Hypertonic-hyperoncotic solution increases cardiac output considerably more than does isotonic solution, and its application significantly reduces the accumulation of crystalloid solutions and human albumins.
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Randomized Controlled Trial
[Influence of proprioceptive training in the improvement of neuromuscular performance after ACL reconstruction].
ACL injury leads to a decrease in proprioceptive abilities, which can be improved with ACL surgery and postoperative rehabilitation. The goal of our study was to investigate whether the impact of coordinative training can be differentiated from the influence of surgery on proprioceptive improvement, and whether there is a correlation between improvement in coordinative abilities and other objective parameters of functional recovery. This follow-up study included 45 patients who had undergone ACL reconstruction and who were randomised into a conservative (TH-C) and an intensive (TH-I) rehabilitation group. ⋯ Already after 6 weeks, highly statistically significant progress in one leg stance abilities was noticed, while in the TH-C group the same was not noticed until 4 months after surgery (p < 0.01). Such a result speaks for the distinct influence of proprioceptive training on coordinative abilities. Also, a highly statistically significant correlation was noticed between the single leg stance, one leg hop, Lysholm, and Tegner tests (p < 0.01), which points out the importance of a good rehabilitation programme, since neuromuscular performance cannot be separated from other parameters of functional recovery.
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Randomized Controlled Trial Comparative Study Clinical Trial
[Advantage of combined spinal, epidural and general anesthesia in comparison to general anesthesia in abdominal surgery].
Type and technique of anesthesia have an important effect on per operative surgical course. The aim of the study was prospective analyses of advantages of combined spinal, epidural and general anesthesia (CSEGA) versus general anesthesia (GA) in abdominal surgery according to: 1. operative course (haemodynamic stability of patients, quality of analgesia, undesirables effects), 2. postoperative course (quality of analgesia, unfavourable effects, temporary abode of patients in intensive care). Using prospective randomized double blind controlled study, we evaluated two groups of patients whom the same type of abdominal surgical intervention was planed and the only difference was the type of technique of anesthesia. ⋯ First group of patients spent less time in intensive care (three days) than second group (six days). Final subjective effect of analgesia, according to verbal descriptive scale (VDS) of pain was satisfying with 75% of patients of the first group and 15% of patients of the second group. According to results investigation, advantages of CSEDGA versus GA in abdominal surgery manifold: better hemodynamic stability and perfusion of operative region, decrease of single doses of opioid analgesics, local and general anesthetics followed by the decrease of their side effects, better intensity and longer duration of analgesia, improved total functional capability of patients.
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Randomized Controlled Trial Clinical Trial
[Renal protection during surgical procedures on the infrarenal aorta].
Despite the progress in surgical and anaesthetic management, decreased renal function is still observed after abdominal infrarenal aortic surgery and remains an important problem in postoperative period. Although data regarding the efficacy of perioperative renal protection are conflicting, it is widely believed that renal protection before aortic cross-clamping is beneficial and therefore is commonly used. The aim of this study was to evaluate the impact of renal protection in patients undergoing elective infrarenal aortic surgery (1ARS). ⋯ Patients in groups A and B were similar regarding the age (64.32 vs. 62.00), sex (males 35, females vs. males 34, females 6) and preoperative diseases. (Tab. 2) No difference was found between groups regarding any of the parameters (BUN, serum creatinine, electrolytes, volume load, creatinine and free-water clearance, haemodynamic parameters, plasma and urine osmolality). Urinary output was higher in group B during and 2 hours after ACC. (Graph 1.) ACC time was similar in two groups (24.1 min vs 24.5 min). (Graph. 2) Only one patient in group B revealed transitory renal insufficiency, not requiring special treatment. These data indicate that renal protection did not influence renal function. Short ACC time may have impact on the obtained results. Our results suggest that renal protection should not be considered as mandatory for elective infrarenal aortic surgery. Because of the short ACC time observed in this study (in comparison to other studies), further studies of renal protection in patients with longer ACC time are needed.