Messenger of ANESTHESIOLOGY AND RESUSCITATION / Вестник анестезиологии и реаниматологии
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ВЛИЯНИЕ МЕТОДА АНЕСТЕЗИИ НА АКТИВНОСТЬ ПЕРЕКИСНОГО ОКИСЛЕНИЯ ЛИПИДОВ ПРИ КАРОТИДНОЙ ЭНДАРТЕРЭКТОМИИ
Get PDFThe objective of the study: to assess the effect of two types of general anesthesia on lipid peroxidation and to establish a correlation between the degree of its activation and the number of post-operative neurological disorders.Subjects and methods. 130 patients (84 men and 46 women) at the age from 48 to 68 years were examined, they all were admitted to hospital for carotid endarterectomy due to atherosclerosis of internal carotid artery. The blind envelopes method was used for randomization. The patients were divided into 2 groups. The control group included 20 practically healthy persons (the median age made 50 ± 2 years).Propofol was used for anesthesia in 60 patients (Group 1), while sevoflurane was used in 70 patients (Group 2). Student test was used for statistical processing of data. The critical significance level corresponded to p < 0.05. The groups were considered representative based on 12 attributes.During the surgery, the following parameters were monitored: oxidant and anti-oxidant statuses, markers of neuronal damage; post-operative neurological complications were assessed.Results. When comparing and assessing the rates of the general pro-oxidant activity and general anti-oxidant activity in the patients from both groups, the initial rates of oxidant and anti-oxidant statuses did not confidently differ, which can be explained by the homogeneity of the patients' examinations.The activation of general pro-oxidant activity and general anti-oxidant activity was higher in Group 1 at the moment of carotid clamping. The same tendency was observed during the restoration of cerebral blood flow.The intensity of lipid peroxidation activation correlated with the frequency of post-operative neurological disorders and it was lower in Group 2.Цель работы: определение влияния двух видов общей анестезии на перекисное окисление липидов и установление корреляционной зависимости между степенью его активации и числом послеоперационных неврологических расстройств.Материалы и методы. Обследовано 130 больных (84 мужчины и 46 женщин) в возрасте от 48 до 68 лет, поступивших в клинику для каротидной эндартерэктомии по поводу атеросклероза внутренней сонной артерии. Рандомизация проведена методом слепых конвертов. Больные разделены на две группы. Контрольную группу составили 20 практически здоровых человек (средний возраст – 50 ± 2 года).Для анестезии использовали пропофол у 60 больных (1-я группа), севофлуран – у 70 (2-я группа). Статистическую обработку данных выполняли с использованием критерия Стьюдента. Критический уровень достоверности соответствовал p < 0,05. По 12 признакам группы были репрезентативны.В процессе хирургического лечения в динамике контролировали показатели оксидантного и антиоксидантного статусов, маркеры нейронального повреждения, оценивали послеоперационные неврологические осложнения.Результаты. При сравнительной оценке показателей общей прооксидантной активности (ОПА) и общей антиоксидантной активности (ОАА) у больных обеих групп исходные показатели оксидантного и антиоксидантного статуса статистически достоверно не различались, что объясняется однородностью обследованных пациентов.Активация ОПА и ОАА на этапе наложения зажима на сонную артерию была выше в 1-й группе. Такая же тендиция сохранялась на этапе восстановления мозгового кровотока.Выраженность активации перекисного окисления липидов коррелировала с частотой послеоперационных неврологических расстройств и была меньшей во 2-й группе
РАННИЕ ГЕМОДИНАМИЧЕСКИЕ ПРЕДИКТОРЫ ЛЕТАЛЬНОГО ИСХОДА АБДОМИНАЛЬНОГО СЕПСИСА
Get PDFThe objective of the study: to find early hemodynamic predictors of a lethal outcome of abdominal sepsis.Methods. 44 patients with abdominal sepsis with no signs of septic shock were enrolled into a retrospective study. The age of patients made 48.7 Ѓ} 2.26 years old; the severity of state according to APACHE II was 12.50 Ѓ} 0.55 scores, and as per SOFA ‒ 8 [6; 10]) scores. Hemodynamics was assessed through transpulmonary thermodilution.Results. During the first 24 hours, the following rates were the most sensitive and specific in respect of a lethal outcome: cardiac function index (odds ratio – 0.582; 95%CI 0.388-0.872; p = 0.008), and cardiac power index (odds ratio – 0.027; 95%CI 0.001-0.6; p = 0.022). The same results were observed in 4-5 days of treatment. At different stages of the study, the following rates demonstrated stable predictive significance: cardiac index (CI), systolic output index, global ejection fraction; and the area under ROC-curves (AUROC) for these rates was compatible with AUROC as per SOFA.Conclusion: The investigation of the after-load dependent relative cardiac efficiency proved that the normal values of CI could be predictive of an unfavorable sepsis outcome if after-load dependent relative cardiac efficiency was < 80%. It is sensible to define individual target values of cardiac hemodynamics, which significance is clinically proved in case of sepsis
ОЦЕНКА КЛИНИЧЕСКОЙ ЭФФЕКТИВНОСТИ ОГРАНИЧИТЕЛЬНОЙ ТАКТИКИ АНТИБАКТЕРИАЛЬНОЙ ТЕРАПИИ ПРИ НЕДОКАЗАННОЙ ИНФЕКЦИИ В НЕОНАТАЛЬНОМ ОТДЕЛЕНИИ ИНТЕНСИВНОЙ ТЕРАПИИ
Get PDFGoal of the article: comparative analysis of correlation of liberal and restrictive tactics of anti-bacterial therapy (ABT) in newborns with respiratory distress syndrome (RDSS) and suspected congenial pneumonia with drug resistant bacterial population in neonatal intensive care department (ICD). Methods. The study was designed as prospective, controlled, one-center, non-randomized. Enrollment criteria were the following: gestational age of 25-32 weeks, body weight of 1001-2499 g., RDSS or suspected congenial pneumonia, artificial pulmonary ventilation (APV) from the first day of birth, procalcitonin level tests. The study lasted from 01.01.2015 to 26.12.2015. 697 newborns were included into the study. Restrictive ABT was used in the treatment group (n=515), prescription of antibiotics for preventive purposes was used in the comparison group (n=182). Samples were collected from sterile cavities of the host - tracheal aspirate, content of urinary bladder and stomach. Results. 2535 gram negative and 299 gram positive isolates of pathogenic microorganisms were examined. Kl. pneumonia was the most prevalent among gram negative microorganisms (1 202 isolates, 47.4% of all strains), St. aureus was the most prevalent among gram positive bacteria (207 isolates). Conclusions. Restrictive ABT tactics provided no impact on duration of the newborns' stay in the intensive care department and general hospital stay; the tendency for mortality reduction in the intensive care department was observed, the duration of APV reduced to statistically significant extend, and this allowed constraining drug resistance of certain nosocomial strains of microorganisms.
ВНЕЗАПНАЯ СМЕРТЬ ПРИ СИНДРОМЕ БРУГАДА: УСПЕШНАЯ РЕАНИМАЦИЯ, ЭКГ-ДИАГНОСТИКА И ТРЕТИЧНАЯ ПРОФИЛАКТИКА
Get PDFThe articles describes the clinical follow-up and the data of one-year prospective follow-up of the patient suffering from the Brugada syndrome complicated by clinical death. Приведены клиническое наблюдение и данные одногодичного катамнеза пациента с синдромом Бругада, осложненным клинической смертью.
ОСОБЕННОСТИ НАСТРОЙКИ УРОВНЯ ПДКВ У ПАЦИЕНТОВ С ОРДС И ВНУТРИЧЕРЕПНОЙ ГИПЕРТЕНЗИЕЙ
Get PDFThe literature review describes current approaches to management of patients with acute cerebral lesions and intracranial hypertension, complicated by acute respiratory distress syndrome (ARDS). It presents the stages of ventilation strategy evolution in patients with ARDS. The effect of the increase in intrathoracic pressure on system hemodynamics parameters during artificial pulmonary ventilation (APV) is demonstrated. The data on changes in venous return and arterial pressure are presented. The review describes the current understanding of the correlation between pulmonary mechanics and central hemodynamics and effect of these factors on cerebral hemodynamics. The brief description of intracranial tension and cerebral compliance is given. The publication presents the results of up-to-date studies on specific parameters of PEEP optimization in the patients with concurrent acute cerebral lesions, intracranial hypertension, and development of ARDS. Numerous studies were devoted to optimization of APV in case of ARDS, but currently one can not unambiguously conclude about the safe level of PEEP if there is intracranial hypertension. The authors of the article agree with the opinion that more prospective randomized studies are needed and advanced multi-parameter cerebral monitoring is required in case of concurrent pulmonary and cerebral disorders.
ВНУТРИГОСПИТАЛЬНАЯ ТРАНСПОРТИРОВКА ПАЦИЕНТОВ С РАЗРЫВОМ АРТЕРИАЛЬНЫХ АНЕВРИЗМ ГОЛОВНОГО МОЗГА
Get PDFGoal: to evaluate cerebral hemodynamics in the patients with aneurysm rupture during their transportation within the hospital. Materials and methods. 60 patients divided into 2 groups were included into the study. Patients from group 1 were transported as it was traditionally adopted in the clinic; additional sedation and continuous administration of nimodipine were used in group 2. Results. The increase of medium blood velocity in cerebral vessels by 23.5% on the operated side was observed in group 1. Continuous administration nimodipine solution during all transport stages allows reducing the velocity increase in cerebral vessels on the operated side down to 4.5%. Conclusion. The increase of cerebral angiospasm was observed during intrahospital transportation. The need for additional sedation has been justified for the patients transported while being on the artificial pulmonary ventilation. Цель: оценить церебральную гемодинамику у пациентов с разрывом аневризм при внутрибольничной транспортировке. Материалы и методы. Проведено исследование у 60 пациентов, разделенных на две группы. Больные 1-й группы транспортированы по принятой в клинике методике, а 2-й − с применением дополнительной седации и непрерывным введением нимодипина. Результаты. Отмечено нарастание средних скоростей по церебральным сосудам на 23,5% на стороне оперативного вмешательства в 1-й группе. Применение непрерывного введения раствора нимодипина на всех этапах транспортировки позволяет снизить повышение скорости по церебральным сосудам на стороне хирургического вмешательства до 4,5%. Заключение. Выявлено повышение показателей церебрального ангиоспазма при внутригоспитальной транспортировке. Обоснована необходимость применения дополнительной седации у пациентов, транспортируемых с применением искусственной вентиляции легких.
ОКИСЛИТЕЛЬНЫЙ СТРЕСС В КАРДИОХИРУРГИИ
Get PDFIschemia, reperfusion, oxidative stress, system inflammatory response – all these events are the cause or important link in the pathogenesis of numerous serious complications of cardiac surgeries. The damaging action of each of the above has been numerously proved by experiments and clinical practice and it seems that these events can be considered to be only very negative ones. However controlled ischemia initiates development of the phenomenon so-called as ischemic pre-conditioning, when the targeted organ develops enhanced resistance to the consequent damaging ischemia. Reperfusion is an inevitable and necessary stage of rehabilitation after previous ischemia. What about oxidative stress? Damaging potential of the active forms of oxygen is a fact, however minimal concentrations of the active oxygen forms are intercellular regulators and it means they are absolutely necessary for normal cellular vital activity. Besides numerous studies have proved noticeable intensification of the oxidative stress during artificial circulation (AC), however stuides failed to demonstrate reduction in the number of complications and peri-operative mortality when performing coronary artery bypass on the beating heart compared to the surgeries performed under AC. What is the true contribution of the oxidative stress into the development of post-operative complications? There have been found no evidences of the clinical efficiency of any of existing antioxidants as per mortality reduction criteria or decrease of hospital stay duration. Unfortunately we do not have unambiguous answers to the set up questions. There is no doubt only about the fact that critical actuality dictates the urgent need for further studying of the oxidative stress role in the pathogenesis of ischemic and reprefusional lesions in cardiac surgery.
ФАКТОРЫ, ОПРЕДЕЛЯЮЩИЕ КЛИНИЧЕСКИЕ ИСХОДЫ У ПАЦИЕНТОВ С ТЯЖЕЛОЙ СОЧЕТАННОЙ ТРАВМОЙ, ОСЛОЖНЕННОЙ ДЕЛИРИЕМ
Get PDFSearch for most effective way of management of non-specific delirium is an important aspect of treatment of severe concomitant trauma. The objective of the study: to investigate the correlation and impact of sedation method on those injured with delirium during the intensive care of severe concomitant trauma. Subjects and Methods. The retrospective prospective analysis of two groups of patients with delirium was performed, 30 patients in each group, who received sedation with dexmedetomidine or propofol. Results. After stopping delirium, the intensity of multiple organ dysfunctions was lower in the group of patients who had sedation with dexmedetomidine. The complex of unfavorable events – death within 1 year and continuous cognitive deficiency was 4 times more frequent in the group of patients after sedation with propofol. Evaluation of the trauma severity was a significant predictor of unfavorable outcomes. Conclusions. The use of dexmedetomidine for management of delirium resulted in the reduction of multiple organ dysfunctions versus propofol. The severity of trauma was associated with chances to develop a continuous cognitive dysfunction and lethal outcome. Use of dexmedetomidine promoted early rehabilitation in case of cognitive dysfunction.