General Reanimatology (E-Journal) / Общая реаниматология
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Влияние тяжелой термической травмы на сократимость и метаболизм сердца
Get PDFObjective: to experimentally study cardiac functional and metabolic disturbances in the acute period of severe thermal injury. Material and methods. Experiments were carried out on 25 outbred male albino rats anesthesized with Nembutal (50 mg/kg intraperitoneally). Five-mm-thick copper plates heated up to 60°C were used to simulate thermal injury. Skin contact with the thermal agent lasted 15 seconds. Myocardial contractility and metabolism were examined using the specimen of the isolated isovolumically contracted heart. Results. Severe thermal injury was found to induce acute heart failure caused by cardiac bioenergy impairment, hypoxia, metabolic acidosis, and cardiomyocyte membrane destruction. Key words: thermal injury, cardiac contractility and metabolism.Цель исследования — изучить в эксперименте функционально-метаболические нарушения сердца в остром периоде тяжелой термической травмы. Материал и методы. Опыты проведены на 25-и белых беспородных крысах-самцах, наркотизированных нембуталом (50 мг/кг внутрибрюшинно). Для моделирования термической травмы использовали медные пластины толщиной 5 мм, нагретые до 60°С. Время контакта кожи с термическим агентом 15 секунд. Сократимость и метаболизм миокарда исследовали на препарате изолированного изоволюмически сокращающегося сердца. Результаты. Установлено, что тяжелая термическая травма вызывает острую сердечную недостаточность, обусловленную нарушением биоэнергетики сердца, гипоксией, метаболическим ацидозом, деструкцией мембран кардиомиоцитов. Ключевые слова: термическая травма, сократимость и метаболизм сердца
Оптимизация инотропной поддержки у пострадавших с политравмой и острой сердечной недостаточностью
Get PDFObjective: to evaluate the impact of ultrasound-guided nerve imaging on the efficiency and safety of supraclavicular brachial plexus block. Subjects and methods. Sixty-five patients underwent supraclavicular brachial plexus block. According to the method of nerve identification, all the patients were allocated to one of two groups: 1) Kulenkampff’s block, by identifying the nerves by a nerve stimulator (n=30); 2) supraclavicular block, by identifying the nerves by ultrasound scanning (n=35). Anesthesia was carried out with a local anesthetic solution containing 20 ml of 2% lidocaine and 10 ml of 0.5% bupivacaine (a total of 30 ml). Results. There is evidence for the high efficiency (97.1%) of ultrasound-guided nerve imaging and its safety (no multiple attempts to verify nerves and complications) as compared to the Kulenkampff supraclavicular block using neurostimulation to identify the plexus (p<0.05). Conclusion. The authors’ modified ultrasound-guided imaging in performing the brachial plexus block helps define nerve localization and observe the placement of a needle against the anatomic structures as it is advanced. Local anesthetic spread observed by ultrasound scanning confirms the precise location of the needle tip. Key words: ultrasound-guided nerve imaging, brachial plexus, efficiency of anesthesia, complication, supra-clavicular approach
Особенности проведения сочетанной анестезии с сохраненным спонтанным дыханием пожилым больным
Get PDFObjective: to optimize anesthetic tactics for perioperative management in elderly patients during lower abdominal surgery under mixed anesthesia with preserved spontaneous breathing without myoplegia. Subjects and methods. Examinations were made in 142 patients aged over 65 years. The patients were divided into 2 groups: 1) inhalation anesthesia under total myoplegia and controlled mechanical ventilation (MV); 2) inhalation anesthesia without myoplegia with preserved spontaneous breathing or assisted mechanical ventilation (AMV) in the pressure-support (PS) mode. Results and discussion. The AMV procedure allows mixed anesthesia with preserved spontaneous breathing in elderly patients during operations on the lower abdomen and great vessels in 89% of the patients without a risk for inadequate transport of oxygen under its relative uptake. MV used to maintain external respiratory function under mixed anesthesia and total myoplegia causes a decrease in cardiac index (CI) by 58.8% (p<0.05) and increases in total peripheral resistance (TPR) by 50% or more (p<0.05), and intrapulmonary shunt threefold (p<0.05). Mixed anesthesia without myoplegia and MV prevents induced changes in CI, TPR, and Qs/Qt. The differences were significant throughout the follow-up (an intraoperative stage and 9 postoperative hours). The older age group patients are more susceptible to the damaging action of MV; they were also found to have a more pronounced preventive effect of modified anesthesia. Conclusion. To rule out myoplegia and MV during mixed anesthesia prevents MV-induced changes in CI, TPR, and Qs/Qt. Key words: mixed anesthesia in elderly patients, spontaneous breathing, hemodynamics, blood oxygen transporting function
Осложнения антиретровирусной терапии и их коррекция в периоперационном периоде у ВИЧ-инфицированных беременных
No full textThe review gives information on the specific features of a perioperative period in HIV-infected patients receiving anti-retroviral therapy. The possible complications resulting from the use of antiretroviral drugs and their correction modes are described.В обзоре представлены сведения об особенностях течения периоперационного периода у ВИЧ-инфицированных пациенток, получающих антиретровирусную терапию. Описаны возможные осложнения, возникающие при приеме ан-тиретровирусных препаратов и пути их коррекции
Церебральная оксиметрия для прогнозирования неврологической дисфункции у кардиохирургических пациентов
Get PDFПредоперационная подготовка к коронарному шунтированию больных с мультифокальным атеросклерозом: механические и медикаментозные методы
Get PDFObjective: to optimize preoperative preparation of patients with multifocal atherosclerosis and reduced baseline left ventricular ejection fraction for coronary bypass surgery, by providing a rationale for the use of mechanical and medical circulatory support methods. Subjects and methods. Sixty-one patients with multifocal atherosclerosis, coronary heart disease (CHD), and reduced baseline left ventricular ejection fraction, who underwent coronary bypass surgery, were examined. Levosimendan was administered to 2 groups of patients: 1) 28 patients with preoperative intra-aortic balloon counterpulsation; 2) as inotropic support in 33 patients. There were central and intracardiac hemodynamic changes as evidenced by transpulmonary thermodilution and pulsed Doppler ultrasound echocardiog-raphy during different preoperative preparations. Conclusion. The use of levosimendan in patients with multifocal atherosclerosis, CHD, and planned coronary bypass surgery, by taking into account contraindications to intra-aor-tic balloon counterpulsation, makes it possible to improve central hemodynamical parameters and to reduce the degree of diastolic dysfunction, the incidence of organ dysfunctions, and the length of intensive care unit stay. Key words: coronary bypass surgery, left ventricular ejection fraction, multifocal atherosclerosis, levosimendan, intra-aortic balloon counterpulsation
Нарушения наноструктуры мембран эритроцитов при острой кровопотере и их коррекция перфторуглеродной эмульсией
Get PDFObjective: to study impairments in the nanostructure of red blood cell membranes in acute blood loss and methods to correct the membrane structures with perfluorocarbon emulsion. Materials and methods. Experiments were carried out on Nembutal-anesthesized outbred rats. The model of a terminal state was 60-minute hypovolemic hypotension, followed by blood reinfusion and addition of perfluorane or Ringer’s solution. Images of fragments of the red blood cell membrane surface structure were obtained using a Femtoscan atomic force microscope (AFM). Twenty-seven experiments were performed; 186 cells were scanned on the AFM, which provided 720 images of three orders. Results. The paper shows the time course of changes in the index hi for different phases of an experiment. After 5-minute hypotension, h1 increased by more than 4.3 times and after 60-minute hypotension, this value decreased to 4.7 nm. The second-order height rose linearly at the stages: control — at 5 minutes — at 60 minutes of hypotension. At 60 minutes of hypotension, the first- and second-order heights were similar. At 5 minutes of hypotension, the third-order surface slightly changed — it increased by 1.5-fold. But at 60 minutes of hypotension, the changes in the fine structures of the membrane became great — h3 increased by 6.3 times. Conclusion. Blood loss has shown to induce impairments in the microstructure of red blood cell membranes at all levels of its organization: flick in the range of 600—1000 nm, spectrin matrix at 150—350 nm, proteins, band 3, at 30—80 nm. The per-fluorocarbon emulsion «Perftoran» exerts a pronounced modulatory effect on the red blood cell membrane nanostructure at all steps of its organization, by restoring the membrane nanostructure practically to the control level. Key words: blood loss, red blood cell membrane, nanostructure, atomic force microscopy
Диагностические возможности мониторинга центральной гемодинамики в торакальной онкохирургии
Get PDFObjective: to study hemodynamic changes and the development rate of adaptive reactions in patients with hypokinetic circulation during lung resections varying in volumes. Subjects and methods. Thirty-eight patients with hypo-kinetic circulation, who had undergone sublobar resections, lobectomies, and pneumonectomies, were examined. The values of hemodynamics and gas exchange were recorded at the basic surgical stages and in the early postoperative period (on days 1, 3, 7, and 10). Results. When the patient is placed in the lateral position, the lung is switched off, or the surgical pneumothorax is less than 10—12%, cardiac index changes generally fail to give rise to the decompensation of adaptive processes in the cardiovascular system if the volume of a surgical intervention does not exceed that of sublobar resections or lobectomies. A 15% or more change in cardiac index during controlled lung collapse even with the minimum volume of surgery is indicative of the breakdown of physiological adaptation processes and may manifest itself through the symptoms of cardiorespiratory decompensation in both intra- and postoperative periods. Conclusion. The patients with baseline poor, hypokinetic circulation need not only adequate preoperative estimation of central hemodynamic values, but also continuous intraoperative monitoring of the basic parameters of central hemodynamics. The magnitude of a reduction in cardiac index is prognostically important at the stage of one-lung ventilation during surgical pneumothorax. Key words: hypokinetic circulation, thoracic cancer surgery, central hemodynamic monitoring
Регионарная блокада седалищного нерва передне-медиальным доступом
No full textAnteriomedial-access regional sciatic nerve block has been devised and applied. Thirty-five anteriomedial-access regional sciatic nerve blocks were performed in the supine position, by using ultrasound imaging and electrostimulation of the peripheral nerves. The anteriomedial approach to the sciatic nerve permits anesthesia to be made without changing the body position in patients with multiple lower limb fractures and traumatic upper limb injury. More potent premedication was used during manipulation, by achieving a Ramsay sedation scale score of 3—5. The anesthesia was effective in all cases. There were no complications. Key words: regional anesthesia, sciatic nerve, anteriomedial access, ultrasound imaging.Разработан и применен способ блокады седалищного нерва из передне-медиального доступа. Произведено 35 блокад седалищного нерва из передне-медиального доступа в положении пациента лежа на спине с использованием ультразвуковой визуализации и электростимулятора периферических нервов. Передне-медиальный доступ к седалищному нерву позволяет проводить анестезию без изменения положения тела у пациентов с множественными переломами костей нижних конечностей, травматическим повреждением верхних конечностей. Использовали более «мощную» пре-медикацию у пациентов при выполнении манипуляции с достижением 3—5 степени седации по шкале Ramsay. Во всех случаях анестезия была эффективной. Осложнений не было. Ключевые слова: регионарная анестезия, седалищный нерв, передне-медиальный доступ, ультразвуковая визуализация
Изменения микроциркуляции и гемостаза у больных после эндопротезирования тазобедренного сустава
Get PDFObjective: to estimate the values of microcirculation, hemostasis, and fibrinolysis in patients after hip joint replacement. Subjects and methods. Thirty-two patients were examined after total endoprosthetic hip joint replacement (TEHJR). Microcirculation was explored by laser Doppler flowmetry (LDF). The level of ADAMTS-13 and its inhibitor and the concentrations of tissue factor pathway inhibitor (TFPI), tissue plasminogen activator (t-PA), and tissue plasminogen activator inhibitor-1 (PAI-1) were measured in the patients’ plasma by enzyme immunoassay. Results. Analysis of LDF measurements of the operated limb showed a 1.3-fold reduction in the value of microcirculation as compared with the intact limb in the patients in the early postoperative period after TEHJR. There were 1.3- and 1.4-fold increases in neurogenic and myogenic tones, respectively. The shunting ratio was 15% higher in the operated versus intact limb. The content of ADAMTS-13 was increased by 1.4-fold in the blood of the operated limp. As compared with the control group, the blood level of TFPI in the operated and intact limbs was elevated by 1.8 and 1.6 times, respectively. As compared with the controls, the patients after hip joint replacement displayed 1.9- and 1.6-fold decreases in the blood concentration of t-PA and PAI-1, respectively. Conclusion. In the patients after hip joint replacement, the value of microcirculation was lower, neurogenic and myogenic tones were higher, as well as there were increases in the levels of ADAMTS-13 and TFPI in the blood flowing from the operated limb as compared with the intact one. The plasma content of t-PA and PAI-1 became lower in the post-TEHJR patients than that in the control group. Key words: endoprosthetic hip joint replacement, microcirculation, hemostasis