Anesteziologiia i reanimatologiia
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Anesteziol Reanimatol · Sep 2004
Multicenter Study Clinical Trial[Prevention and treatment of postoperative nausea and vomiting (results of a multicenter study)].
Described in the paper are the results of a multicenter study that was conducted at 11 health-care facilities of the Russian Federation and that was based on an analysis of 623 medical records of adult patients operated on with general anesthesia of different variations. There were 154 (24.7%) males and 469 (75.3%) females, aged 16 to 90. ⋯ An understanding, resulting from the study, on that PONV is of the multietiology nature and on that its probability increases in proportion to a compatibility of provoking factors, like sex, surgery technique as well as duration of anesthesia and its variation is of importance. The efficiency of medicamental prevention of PONV by a blocker of HT3-receptors, i.e. by ondansetron (Zofran), is to a great extent predetermined by that if the form and, probably, dose of the drug is in line with a combination of the above factors, which needs further research.
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Anesteziol Reanimatol · Sep 2004
[Anesthesiological problems in the surgical treatment of chronic obstructive pulmonary disease].
Maintenance of effective gas exchange made with respect to surgical comfort and lower risk of intraoperative lung damage is the main problem in the anesthetic management of surgical reduction of pulmonary volume (SRPV). Described in the paper is the experience of anesthetic management made in 10 patients in SPRV. The method of differential ALV (DALV) with continuous positive pressure in airways (CPPA) made for the ventilation support of the independent lung was found to be the only effective technique ensuring an adequate gas exchange in surgery for SPRV in patients with diffusive pulmonary emphysema (DPE). ⋯ At the same time, it provides for an optimal surgical comfort and for the most cautious manipulations on the lung. Such a combination improves the overall surgical results. The high-frequency respiratory support to the operated lung is contraindicated in such patients because of hyperinflation of the affected lung.
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Anesteziol Reanimatol · Sep 2004
[Using non-invasive mask lung ventilation in cardiosurgical patients with acute respiratory distress syndrome].
Twenty patients aged 33 to 71 (54 +/- 6) years (male - 13, female - 7) operated on the heart and main vessels were included in the case study. I.e. those patient were investigated, whose immediate postoperative results were complicated by the syndrome of multiple organ failure (SMOF) that developed due to different-etiology shock, huge blood loss and hemotransfusion or to the syndrome of acute postperfusion lung damage. NIMLV was made at the resolution stage of SMOF and ARDS after artificial pulmonary ventilation (APL) for as long as 5-7 days. ⋯ In 18 (90%) of 20 patients, the mask pulmonary ventilation resolved the respiratory insufficiency. Two (10%) patients were reintubated because of progressing multiorgan failure and because of obturation of the left main bronchus. A questioning of patients on the comfort degree of mask ventilation denoted the Flow-by triggering to be by far better tolerated by patients versus the pressure triggering.
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Anesteziol Reanimatol · Sep 2004
[Hemodynamic parameters and saturation of the cerebral cortex blood with oxygen during extracorporeal circulation in heart surgery].
Sixty-three patients were intraoperatively examined during heart surgery with extracorporeal circulation (AEC). They were operated on for an affected heart-valve apparatus (AHVA) and ischemic heart disease (IHD). ⋯ A maximal saturation of the cortex blood with oxygen at AEC was registered in patients with AHVA at an average pressure below 70 mm Hg, and in patients with IHD--at 85 mm Hg. An increased pressure in BSJV at a constant mean arterial pressure and at AEC is related with blood outflow from the venous collector of the brain.
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Anesteziol Reanimatol · Sep 2004
[Maintenance of the hypnotic component of general anesthesia with feed-back regulation].
The purpose of the study was to design and investigate the closed-loop propofol system (CLPS) with a mean arterial pressure (MAP) controller in open-heart surgery. CLPS consists of a 386 PC, a blood pressure sensor and an infusion pump. The C language computer program sets the propofol infusion rate based on an empirical algorithm including proportional component to maintain the measured MAP more closely to the target MAP (85% of patient standard MAP). ⋯ It was a closed negative correlation (r = 0.84; p < 0.01) between the propofol site effect and the MAP during the initial period of anesthesia. There were not any significant changes in the blood cortisole level during the procedures. The recovery time was 1.4 +/- 1.5 min after propofol infusion; 95.5% of patients were extubated in the operating room.