Anesteziologiia i reanimatologiia
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Anesteziol Reanimatol · Sep 2002
[Rocuronium (esmerone) in anesthesia during surgery under extracorporeal circulation].
The study was undertaken to examine the myoplegic, hemodynamic, and histamine-releasing effects of the new aminosteroidal myorelaxant Rocuronium (esmerone, Organon firm) used to maintain anesthesia in cardiac surgical patients by orienting to early tracheal extubation. Twenty two patients aged 50 +/- 3 years operated on under extracorporeal circulation were examined. At the initial stage of maintenance, the agent in a dose of 0.6 mg/kg failed to affect cardiac pump function and to elevate plasma histamine levels. ⋯ Early tracheal extubation was conducted in 68% of the patients 69 +/- 7.6 min after the end of the operation. Residual myoplegia was absent. The predictable recovery of NMC following the use of Rocuronium creates conditions for early activation of patients operated on under extracorporeal circulation.
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Anesteziol Reanimatol · Sep 2002
Comparative Study[Postoperative period in early activated patients after myocardial revascularization].
The specific features of an early postoperative period were studied in 115 patients undergone myocardial revascularization who were divided into 3 groups according to the time of postoperative activation. Group 1 comprised 35 patients in whom tracheal extubation was made in the operating room 30-60 min after the end of the operation. Group 2 included 32 patients extubated 2-8 hours after admission to the resuscitation and intensive care unit (RICU); Group 3 consisted of 48 patients undergone tracheal intubation for more than 8 hours. ⋯ In Group 1, the frequency of reintubations for arterial hypoxemias was 2.8% and that of pneumonias and pulmonary microatelectasis was 2.5 times less as that in Group 3 (9%, p < 0.05). Chills occurred in 6, 4, and 15% of cases in Groups 1, 2, and 3, respectively (p < 0.05). A programme on early activation after aortocoronary bypass surgery could reduce the patients' stay at the RICU on an average by 24 hours without increasing the risk for postoperative complications.
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Anesteziol Reanimatol · Sep 2002
Comparative Study[Optimization of anesthesiological maintenance of x-ray surgical interventions in children].
Two procedures for intravenous anesthesia during X-ray surgical interventions were evaluated in 38 children aged 3 to 13 years. Initial anesthesia (with intramuscular midazole and ketamine), followed by the fractional use of the latter agents in Group 1 and propofol in Group 2, in order to maintain anesthesia. Blood pressure (BP) (noninvasively), heart rate (HR), SpO2, and respiratory rate (RR) were monitored. ⋯ In Group these changes retained throughout the basic stage of intervention. In Group 2 on propofol infusion, BPmean and HR returned to normal values and remained at this level till the end of the intervention, SpO2 and RR did not differ from the baseline values in both groups. Thus, a combination of intravenous ketamine and intramuscular propofol provides steady-state values of BP and HR at the basic state of X-ray surgical intervention in children, which increases the reliability of studies and surgical safety in patients.
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Anesteziol Reanimatol · Sep 2002
[Implementation of modern principles of blood saving methods at cardiac surgery under extracorporeal circulation].
The introduction of principles of bloodless surgery into different areas of practical medicine is favoured by not only risks from donor blood transfusion, but also by the results of the researches dealing with the body's adaptation to acute anemia, with the determination of its allowable limits, and with much experience with bloodless operations used in Jehovah's Witnesses. The present study was undertaken to make a scientific-and-practical assessment of actual own blood funds and their introduction in order to decrease or refuse to use donor blood at cardiac surgery under extracorporeal circulation (EC). ⋯ The introduction of the above own blood saving methods may decrease the use of donor erythrocytes and freshly frozen plasma by 2.6 and 1.8 times, respectively, may completely refuse transfusing thromboplasma, assure adequate hemostasis, reduce the incidence of adverse reactions associated with donor blood transfusion in cardiac surgical patients. A complex use of the developed saving donor blood methods and pharmaceuticals aimed at improving hemostasis allowed donor blood transfusion to be completely refused in more than 70% of patients at aortocoronary bypass surgery under EC.
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Anesteziol Reanimatol · Sep 2002
Comparative Study[Carboxyperitoneum and clinical efficacy of nondepolarizing relaxants with different types of metabolism].
A total of 108 patients operated on the abdominal cavity were examined with laparoscopic equipment or via laparotomic assess. The recovery time of neuromuscular conduction was defined for a myorelaxant with organ-depended metabolism (pipecuronium) and, predominantly, nonorgan-depended metabolism (athracurium and cisathracurium) in relation to the type of surgical technique (laparoscopy and laparotomy). It is concluded that carboxyperitoneum prolongs the recovery of neuromuscular conduction for pipecuronium without affecting this parameter in athracurium and cisathracurium. It is more expedient to use these myorelaxants during laparoscopic operations than pipecuronium, a myorelaxant having organ-dependent metabolism.