Anesteziologiia i reanimatologiia
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Anesteziol Reanimatol · Mar 2008
[Effect of sevoflurane on spontaneous brain bioelectrical activity in neurosurgical patients].
The present study was undertaken to evaluate the effects of sevoflurane on spontaneous brain bioelectrical activity in neurosurgical patients. Forty patients treated at the Research Institute of Neurosurgery underwent a neurophysiological examination. ⋯ Sevoflurane causes a relative acceleration of epileptiform activity synchronization, as evidenced by EEG, which is not a contraindication to the use of this drug in patients with cerebral organic lesion of various genesis with a history of epileptic syndrome and fails to induce clinically significant EEG epileptiform manifestations in patients without epilepsy. In patients with cerebrovascular abnormalities (arteriovenous malformation, cavernous angiomas) who have a history of paroxysmal conditions, inhalational sevoflurane anesthesia can be performed in combination with anticonvulsants (benzodiazepines) during an operation.
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Ischemic tolerance (preconditioning) is taken to mean a short ischemic episode subfatal to cells that activates the protective endogenous mechanisms that ensure tolerance of further longer and more severe episodes of ischemia by the organ (tissue). The present review attempts to analyze information on ischemic preconditioning in the light of the possible use for brain protection. Experimental models, temporal aspects, crossed tolerance, genomic reaction, and mechanisms are considered. There is evidence for human ischemic preconditioning.
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Anesteziol Reanimatol · Mar 2008
[Intraoperative and early postoperative complications of puncture-dilation tracheostomy in neurosurgical patients].
The paper provides a detailed analysis of the most common and clinically significant complications due to percutaneous dilation tracheostomy performed in 479 patients with neurosurgical diseases in 2002-2007. It also considers such complication of the technique, which is specific to neurosurgical patients, as elevated intracranial pressure (ICP), and describes a procedure of tracheostomy in patients with elevated ICP. Percutaneous dilation tracheostomy made by a skilled surgeon is shown to be effective and safe.
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The paper analyzes the clinical effectiveness of various blood-sparing techniques (hypervolemic hemodilution, isovolemic hemodilution, and instrumental infusion of washed autoerythrocytes) in neurosurgical interventions (n = 93) in 89 patients. Hypervolemic hemodilution that remains, however, to be the method of choice for young and low-weight children has proved to be the least clinically effective as a method for blood saving. ⋯ A combination of hemodilution and instrumental reinfusion of autoerythrocytes provides a summation of blood-sparing effects for the mechanisms of blood saving vary with these techniques. The use of any blood-sparing technique accelerates and worsens hemostatic disorders.
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Anesteziol Reanimatol · Mar 2008
[Multimodal neuromonitoring in the early diagnosis of brain ischemia during carotid arterial reconstruction].
The paper analyzes the efficiency of multimodal neuromonitoring (transcranial ultrasound Doppler study, cerebral oximetry, and electroencephalography) for the early intraoperative diagnosis of cerebral ischemia in patients during carotid reparative interventions. On the basis of the findings, the authors have developed a diagnostic algorithm of cerebral ischemia in this group of patients at surgery. ⋯ The diagnosis of cerebral ischemia during operation on the carotids is a direct indication for the usage of a temporary intraluminal shunt. During carotid reconstructive interventions made under general anesthesia, the application of multimodal neuromonitoring is a valid approach and it should make the most use.