Anesteziologiia i reanimatologiia
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Anesteziol Reanimatol · Mar 2009
Randomized Controlled Trial[Balanced postoperative analgesia in abdominal surgery: efficiency of the combined use of epidural block and non-opioid analgesics].
One hundred patients who had undergone elective surgery for abdominal malignancy were enrolled in the randomized, controlled study. Postoperative analgesia included only continuous epidural analgesia (PEA) or PEA with intramuscular ketorolac, or PEA with intramuscular ketorolac and intravenous paracetamol. The systemic use of ketorolac and paracetamol in addition to continuous epidural anesthesia can reduce a need for a local anesthetic and the intensity of postoperative movement pain.
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Anesteziol Reanimatol · Mar 2009
Comparative Study[Comparative assessment of electroencephalographic readings and perfusion index in patients in the perioperative period and coma].
Different monitoring modes are used to estimate the depth of anesthesia. Electroencephalography (EEG) is employed as a method of an electrophysiological study of brain function both during anesthesia and at the neuroresuscitative stage and changes in the peripheral vascular bed are evaluated by means of the perfusion index (PI). The purpose of the study was to comparatively analyze the use of EEG readings and PI at different stages of surgery and in coma of various etiologies. ⋯ The association established between the changes in EEG reading and PI in the perioperative period allows estimation of the depth and adequacy of anesthesia, by analyzing the changes in both EEG and PI. Unlike central hemodynamic parameters, PI shows an earlier response to nociception. Group 2 patients had also synchronous changes in EEG and PI characteristics in various clinical conditions.
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Anesteziol Reanimatol · Mar 2009
Case Reports[A clinical case of lactic acidosis development in a diabetic patient taking metformin].
Metformin is a biguanide. Due to its effects in decreasing the hepatic production of glucose and in increasing insulin sensitivity in peripheral tissues, such as adipose tissue and skeletal muscle, the agent is used in metabolic syndrome and type 2 diabetes mellitus and, in which insulin resistance is especially pronounced. Eighty-one-year old male patient was admitted to the emergency unit with sudden vertigo, tiredness, dyspnea, cyanosis, and lethargy. ⋯ On the same day, extubation was ended and O2 was given by mask at a rate of 4 L/min. After the patient's vital signs, blood sugar, and lactate levels were stabilized; his treatment regimen was arranged again and the patient was discharged on day 4 of his admission. Dyspnea, acidosis, and hypoxia seen in the patient were thought to be due to lactic acidosis which may rarely occur when metformin is used.
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A structured and well-organized postgraduate professional education in medical doctors is an important and necessary component in health care these days. It is the foundation for a high quality and safety of physicians' daily work. The article describes the anesthesiological educational program, which is required to finish anesthesia residency in Germany successfully.