Anesteziologiia i reanimatologiia
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Anesteziol Reanimatol · Jul 2009
Randomized Controlled Trial[Use of microstream capnography and alveolar recruitment during off-pump coronary artery bypass grafting].
The aim of the study was to investigate changes in EtCO2 and its correlation with PaCO2, and cardiac function during off-pump coronary artery bypass grafting (OPCAB) and to evaluate whether the recruitment maneuver was effective in improving gas exchange after OPCAB. Twenty adult patients scheduled for elective OPCAB were enrolled in a prospective randomized study. Anesthesia was maintained with midazolam, propofol, and fentanyl. ⋯ The Bland-Altman analysis has shown that the difference between PaCO2 an EtCO2 was 1.9 +/- 11.4 mm Hg (M +/- 2SD). Thus, during OPCAB, EtCO2 measured by microstream capnography cor related well with PaCO2 and cardiac function. The use of RM after OPCAB increases CO2 elimination and improve arterial oxygenation.
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Anesteziol Reanimatol · Jul 2009
Comparative Study Clinical Trial[The efficacy and safety of tranexamic acid and epsilon-aminocapronic acid in cardiac surgery under extracorporeal circulation].
Sixty patients who had undergone cardiosurgical operations under extracorporeal circulation (EC) were enrolled in the study. All the patients were divided into 2 groups: (1) 40 patients were injected tranexamic acid (TA) (its loading dose was 15 mg/kg; maintenance infusion 1 mg/kg/h throughout the operation; 500 mg in the primary packing volume for an EC apparatus (EA); (2) 20 patients received epsilon-aminocapronic acid (ACA) (its loading dose was 5 g; 5 g in the primary packing volume for an EA and 10 g for infusion after EC). The effects of TA and ACA on the fibrinolytic system were evaluated from the time of XIIa-kallikrein-dependent fibrinolysis (sec) and the concentration of D-dimer (mg/ml). ⋯ The laboratory and clinical findings lead to the conclusion that TA (Tranexam, OOO "MIR-PHARM") has a 4-fold antifibrinolytic activity as compared with epsilon-ACA. The more pronounced TA-induced suppression of fibrinolysis affects the clinical course of a perioperative period in this group, which manifests itself as a reduced blood loss volume during and after surgery and a lower frequency of use of donor blood elements. By taking into account these data, TA may be recommended as one of the blood-preserving technology components during cardiosurgical operations under EC.
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Anesteziol Reanimatol · Jul 2009
Clinical Trial[General anesthesia during short operations in patients using the herbal psychogenic stimulant CAT (Catha edulis)].
The specific features of general anesthesia during short inpatient operations were performed in 85 patients who were regular CAT users owing to their national habits. According to the herbal psychogenic stimulant CAT dependence, the patients were divided into 3 groups. ⋯ In patients with moderate and severe CAT dependence, ketamine should be considered to be contraindicated due to the development of adverse psychomotor and somatic reactions requiring monitoring and drug correction in an intensive care unit. The results of the study have been introduced into practice on choosing the modes of anesthesia at the Revolution Hospital, Republic of Yemen.
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Anesteziol Reanimatol · Jul 2009
Clinical Trial[The oxidant-antioxidant system and cognitive functions in patients undergoing elective abdominal operations under various general anesthesia modes].
The impact of various general anesthesia modes on the oxidant-antioxidant system (OAS) and cognitive function in the perioperative period was studied in 88 patients (4 groups, each comprising 22 patients according to the mode of general anesthesia who had undergone elective surgery for chronic calculous cholecystitis (out of an exacerbation) and inguinal, umbilical, and postoperative hernias. Oxidative protein and lipid damages with the lower activity of antioxidant defense enzymes were found in the surgical patients exposed to various modes of general anesthesia. ⋯ Propofol-based balanced anesthesia has a minimal impact on OAS parameters as compared to neuroleptic analgesia, ataralgesia, and sevoflurane anesthesia. After elective abdominal surgery, decreased free radical oxidation under propofol-anesthesia is concurrent with lower postoperative cognitive dysfunction.
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Anesteziol Reanimatol · Jul 2009
[Choice of agents for early activation-oriented general anesthesia in patients operated on for ischemic heart disease].
The purpose of the study was to analyze the choice of agents for general anesthesia in the implementation of an early activation in patients operated on for coronary heart disease (CHD). Anesthetic maintenance protocols were analyzed in 1008 patients who were operated on under extracorporeal circulation (EC) in 1995, 1999, 2001, 2004, and 2006. After aortocoronary bypass grafting, the trachea was extubated in 45% of cases. 1999 was marked by a significant diference in the use of agents for general anesthesia in patients activated in the operating suite and in those who had prolonged artificial ventilation. ⋯ The authors paid particular attention to the pharmacodynamics of anesthetics used for the early activation of patients operated on under EC for CHD. It is concluded that early activation of patients operated on under EC for CHD is possible after general anesthesia based on diferent agents. Early activation substantially changes the concept of general anesthesia during myocardial revascularization operations.