卷 10, 编号 3 (2016)
- 年: 2016
- 文章: 9
- URL: https://bakhtiniada.ru/1993-6508/issue/view/2573
Articles
The Federation of anesthesiologists - reanimatologists of Russia: on the way toward the effective program
摘要
The article is devoted to summing up the work of the Federation of anesthesiologists and reanimatologists of Russia and proposing the prospects of its development.
Regional Anesthesia and Acute Pain Management. 2016;10(3):146-154
146-154
Do anesthesiologists need epidural anesthesia and do surgeons need an anesthesiologist?
摘要
Presented paper reviews up-to-date often contradictive concepts about the role of epidural anesthesia in anesthesiological support of patients undergone major surgery. The author performed critical analysis of the arguments of the opponents of the wide use of epidural analgesia who propose to substitute the epidural anesthesia with minimally invasive techniques in particular infiltration analgesia with local anesthetics. The article includes convincing evidence in favour of continuous epidural anesthesia remains the method of choice for open major thoracic and abdominal surgery especially in patients from high risk groups.
Regional Anesthesia and Acute Pain Management. 2016;10(3):155-164
155-164
Prognostic modelling of blood hemodynamic response to regional and general anesthesia
摘要
Prognosis of systemic circulation response to the inducation of general anaesthesia and central neuraxial block is discussed in the review. Modern approaches to preoperative cardiovascular risk assessment, while accurately predicting overall risk level, doesn't help anaesthesiologist to choose anaesthesia methods in exact patient. The authors analyzing novel approach, based on non-invasive monitoring assessment of hemodynamic response to the stimuli, physiologically similar to those challenging patient's condition during the surgery and anaesthesia. In addition to the previously introduced prognostic model of hemodynamic response to central neuraxial block based on nitroglycerine test, esmolol test as a model of response to myocardiodepressive action of general anaesthesia induction is proposed.
Regional Anesthesia and Acute Pain Management. 2016;10(3):165-172
165-172
Influence of the method of postoperative analgesia on the dynamics of intra-abdominal pressure in postpartum women with obesity
摘要
Introduction: It is assumed that one of the factors of high incidence of postoperative complications in postpartum women with obesity is intra-abdominal hypertension (IAH). The aim of the work was to evaluate the dynamics of intra-abdominal pressure (IAP) in postpartum women with obesity, depending on the method of postoperative analgesia. The study involved 136 patients divided into 4 groups: control group - initial BMI of 18.5 to 24.9 kg / m2, II of group - patients with obesity I degree (n = 40); Group III - obesity II degree (n = 35); Group IV - III degree obesity (n = 21). All patients were divided into two subgroups - postoperative analgesia with opioids and epidural analgesia (EA). We investigated the timing of reversal of intestinal motility, passage of gas, nausea severity, dynamics IAP and compliance of the anterior abdominal wall. Postoperative dynamics IAP is associated with motor function of the intestine, which is dependent on the initial level of IAP. Paresis intestine often diagnosed at a rate of more than 95% of IAP percentile - for the control group of patients more than 20 mm Hg for patients with obesity more than 23 mm Hg., recorded before the operation. With the development of paresis bowel IAP dynamics within three postoperative days it was practically absent (Δ IAP = 2,55 ± 1,28 mm Hg). Postoperative EA, compared with the use of narcotic analgesics, significantly reduces IAP during the first postoperative day, which prevented the development of their intestinal paresis (RR 0.47; 95% CI: 0,24-0,83), reduced incidence of postoperative nausea (RR 0.47; 95% CI: 0,18-1,21), allows you to quickly reduce the level of IAP in the subsequent days of the postoperative period (59.7%, compared with the effect of opioids). The method of postoperative analgesia affects the dynamics of IAP. EA is the method of choice for postoperative analgesia in postpartum women with obesity and the initially high level of IAP.
Regional Anesthesia and Acute Pain Management. 2016;10(3):173-178
173-178
Evaluation of central (neuraxial) blocks effectiveness in patients with obesity and reducing of coronary flow reserve at abdominal delivery
摘要
The study was conducted to determine the most efficient and safe option of regional anesthesia applied abdominal delivery in obese patients (BMI - 35-39,9 kg/m2) and reduced coronary flow reserve. The study included 63 women. Depending on the anesthesia all the patients were divided into 3 groups. 1st group consisted of 21 women operated under spinal anesthesia, 2nd similar number of patients operated on epidural anesthesia, 3rd - 21 women operated on a balanced epidural anesthesia reduce the concentration of the local anesthetic combined with fentanylum and preventive analgesia. At the same time on the stages of anesthesia and surgery was studied central and peripheral hemodynamics, functional state of the sympathetic-adrenal and hypothalamic-pituitary system. It was found that the most efficient and safe way of pain relief in patients with obesity and reduced coronary flow reserve is reduced concentrations of epidural bupivacaine hydrochloride combined with fentanylum and preventive analgesia.
Regional Anesthesia and Acute Pain Management. 2016;10(3):179-183
179-183
The influence of different perioperative analgesia modes on postoperative nausea and vomiting in day-case surgery patients
摘要
The influence of perioperative analgesia modes on the prevalence of postoperative nausea and vomiting in day-case surgery patients is investigated in the article. The study involved 100 cases of unilateral phlebectomy under propofol and nitrous oxide anaesthesia, randomized by 4 groups with different perioperative analgesia modes of 25 patients each. In the first group fentanyl IV infusion was provided during surgery, in the second group it was amplified with ketoprofen 100 mg IV. In the third group sodium adenosintriphosphate IV infusion was provided for the whole surgery time, whereas the patients in the fourth group received 100 mg ketoprofen IV before it. Analgesic efficacy of all the four modes was equal, while ketoprofen administration aggravated and prolonged postoperative nausea and vomiting without influence on PONV morbidity.
Regional Anesthesia and Acute Pain Management. 2016;10(3):184-191
184-191
The influence of cytochrome p-450 gene polymorphisms on the tramadol postoperative analgesia effectiveness
摘要
The effectiveness of postoperative analgesia may be determined by genetic characteristics of patients that affect the pharmacodynamics and pharmacokinetics of drugs. In particular, as a result of the metabolism of tramadol by isoenzyme of cytochrome P-450 is formed O-desmethyltramadol having higher affinity to mu-opioid receptors. The paper explored the effectiveness of analgesia based on tramadol in 48 patients after endoscopic gynecological surgery depending on the presence/absence of polymorphisms of CYP2D6 gene.It was found that 15 patients with polymorphisms С100Т and G1846A had more intensive postoperative pain, which was accompanied by activation of the sympathetic nervous system. Determination of these polymorphisms may be useful to select the optimal postoperative analgesia.
Regional Anesthesia and Acute Pain Management. 2016;10(3):192-196
192-196
Intensive therapy systemic toxicity of local anesthetics (clinical guidelines)
摘要
Development of the systemic toxicity of local anesthetics can quickly lead to severe bradycardia and hypotension, up to cardiac arrest. The presented clinical recommendations designed to optimize medical care and are included in the list of mandatory clinical protocols according to the Helsinki Declaration on Patient Safety in Anaesthesiology. This review summarizes the main mechanisms of toxicity when using local anesthetics. The guidelines set out criteria and signs of systemic toxicity, recommendations for its prevention. The algorithm of action and recommended dosage of drugs. An intensive care protocol systemic toxicity of local anesthetics including the use of lipid emulsion.
Regional Anesthesia and Acute Pain Management. 2016;10(3):197-204
197-204
Data missing: how to solve and how to escape the problem
摘要
The article is devoted to the problem of missing data in clinical trials and clinical studies. The author considered three mechanisms of generating of missing data in collected sample. Each mechanism type is reviewed in details in terms of its effects on sample representativeness and the magnitude of result bias. The ways to reduce probability and amount of missing data are pointed in the phase of planning and on the stage of statistical data processing and inference.
Regional Anesthesia and Acute Pain Management. 2016;10(3):205-209
205-209