Anesteziologiia i reanimatologiia
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Anesteziol Reanimatol · May 2009
Clinical Trial[Use of albumin in infusion-transfusion therapy for acute brain injury].
The investigation is aimed at determining whether it is necessary to include 20% albumin preparations into infusion-transfusion therapy for acute intracranial hemorrhage. An insignificant improvement of central hemodynamic parameters was shown in a group wherein 20% albumin solution was used. At the same time there was a significant increase in the pulmonary extravascular water index as compared with a control group (10.1 +/- 0.5 and 9.0 +/- 0.22 ml/kg, respectively; with no differences in the severity of lung injury, LIS was 0.71 +/- 0.23 scores; while in the group receiving no albumin solution it was 0.65 +/- 0.06 scores. Thus, the routine use of 20% albumin preparation as part of infusion-transfusion therapy for acute intracranial hemorrhage is not effective and rather safe.
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Anesteziol Reanimatol · May 2009
[Thromboelastography as a method for preoperative screening for the hemostatic system in neurosurgical patients].
The paper analyzes the use of a method of thromboelastography (TEG) as a screening technique of diagnosing hemostatic disorders in risk-group neurosurgical patients: hemostatic disorders detectable from the data of routine laboratory tests; the administration of anticoagulants and desaggresants, the use of anticonvulsants causing impairments in the hemostatic system, hematological diseases, and hepatic cirrhosis. As compared with the routine laboratory tests, TEG is shown to diagnose hemostatic disorders accurately and promptly and to monitor the efficiency of their therapy.
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Anesteziol Reanimatol · May 2009
[Microemboli as a cause of postoperative deliria and cognitive disorders in surgical practice].
Analysis of contemporary clinical and experimental studies evidences that intraoperative microemboli considerably contribute to the development of postoperative deliria and cognitive disorders. A number of studies have shown that left temporal and occipital structures are especially vulnerable to intraoperative ischemia. It is important that neurological cases of ischemia of the former brain regions are frequently characterized by transient psychoses and hypomnesia. Approaches to preventing intraoperative microembolism and associated neurological complications need further research.
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The literature review concisely considers a relatively new problem of postoperative cognitive disorders occurring in surgical patients. The paper considers the present views of the etiology of postoperative cognitive disorders and their contributing and aggravating factors. Particular emphasis is laid on a factor, such as a surface anesthetic level and sudden intraoperative consciousness recovery, as well as on the prevention of this complication through the monitoring of anesthesia depth.