Anesteziologiia i reanimatologiia
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Anesteziol Reanimatol · Sep 2009
Randomized Controlled Trial[Thromboelastographic characteristics of different infusion therapy regimens in healthy bone marrow donors].
Infusion solutions are able to change the hemostatic system. Thromboelastography (TEG) is an integral technique to evaluate the hemostatic system. TEG was used to evaluate the effect of three infusion solutions (6% hydroxyexyethyl starch (HES) 200/0.5 - Hemohes; HES 130/0.4 - Voluven; modified gelatin solution - Gelofusin) on the hemostatic system in 36 bone marrow donors (healthy individuals). ⋯ Hemostatic changes were noted by the end of an operation in all groups; however, these were less pronounced when Voluven was administered. Thus, all colloid infusion solutions have varying effects on the hemostatic system, with a tendency toward both hypo- and hypercoagulation. According to TEG, HES 130/0.4 (Voluven) has a minimal effect on the hemostatic system.
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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
Randomized Controlled Trial[Drug sedation during digestive tract endoscopy: current trends].
The paper considers whether ketofol, a mixture of ketamine and propofol, may be used for medical sedation. Prerequisites for designing this mixture are identified. The foreign experience with ketofol is analyzed. ⋯ A ketamine/propofol ratio of 1:4 is optimal for drug sedation at digestive tract endoscopy; with this ratio, ketofol has sufficient analgesic properties and a stabilizing hemodynamic effect. With the higher mass fraction of ketamine in the mixture, its controllability reduces. Overall, the mixture of ketamine and propofol has proved to be a safe and effective sedative; its use provides not only a good position comfort, possible avoidance of opioids, and no effect of ketamine on psychomotor recovery, but also a more controlled sedation than when these agents are used in the same doses alone.
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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 · Sep 2008
Randomized Controlled Trial[Analgesic and opioid-sparing effects of intravenous paracetamol in the early period after aortocoronary bypass surgery].
The study was to evaluate the analgesic and opioid-sparing effect of intravenous paracetamol injections in cardiosurgical patients in the early postoperative period. Adequate analgesia within the first 12-18 hours of the early postoperative period is very important for a good prognosis of the further course of pain syndrome and for the reduction of a risk for its progression to its chronic form. In early studies, propacetamol lowered morphine use after orthopedic and gynecological operations. ⋯ During this period, inspiratory volume values were higher in the paracetamol group; however, a statistically significant (39%) difference between the groups in the mean values was obtained only during and 2 hours after extubation. In the perfalgan group, the mean total use of promedol was 36% less than in the placebo-group, which was statistically significant (p = 0.019). The early postoperative use of paracetamol after myocardial revascularization reduces the intake of opioids and diminishes the intensity of the pain syndrome within the first hours after extubation, which promotes a higher thoracic excursion, as confirmed by a statistically significant increase in the maximum inspiratory capacity.