Saratov JOURNAL of Medical and Scientific Research

Anaesthesiology and Reanimatology

Prognostic significance of delirium in the intensive care period of acute myocardial infarction

Year: 2016, volume 12 Issue: №1 Pages: 36-39
Heading: Anaesthesiology and Reanimatology Article type: Original article
Authors: Yulin A.S., Ermakov M.A., Gavrilova E.S., Astakhov A.A.
Organization: South Ural State Medical University
Summary:

The aim: to identify the frequency and clinical features of delirium in acute myocardial infarction (AMI) in the conditions of the intensive care unit. Material and Methods. The study involved 104 patients (43,3% women and 56,7% men) with AMI during the stay at the intensive care unit. The average age was 68,0 [59,0-76,7] years. Delirium was diagnosed using the criteria questionnaire Moss-ICU. For neurodevelopmental testing we used screening tests and rating scales. Results. The incidence of delirium in patients in this category was 28,8%. Most frequently delirium develops in patients aged 60-89 years: in the age group 60-74 years 25,0%, in the group of 75-89 years 44,7%. Delirium developed in the 1-2 day stay in the intensive care unit and intensive care. The average duration of delirium was 7,7 days. Hypoproductive form of delirium was detected in 64,3% of all cases, hyperproductive form in 21,4% of patients, mixed form in 14,2% of patients. The occurrence of delirium is associated with an increase of the duration of stay at the intensive care unit at 6 times compared with patients without delirium. Conclusion. The presence of delirium greatly increases the probability of death in the reanimation period of acute myocardial infarction. Moss questionnaire and training of doctors to work with rating scales should be accepted in all ICU intensive care units for early diagnosis of delirium and immediate correction of disorders of consciousness in patients in critical condition.

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Evaluation of latent period of temperature sensitivity in traditional and unilateral spinal anesthesia

Year: 2015, volume 11 Issue: №3 Pages: 263-267
Heading: Anaesthesiology and Reanimatology Article type: Original article
Authors: Lakhin R.E., Panov V.A., Schegolev A.V., Kuligin A.V.
Organization: Military Medical Academy n.a. S. M. Kirov, Saratov State Medical University
Summary:

Objective: evaluation of the differences in the level of temperature, sensory and motor blockade during the various techniques of spinal anesthesia. Materials and Methods. Prospectively the randomized study included 70 patients. In the group with conventional spinal anesthesia (n=35) 15mg of bupivacaine injected quickly. In the group with unilateral spinal anesthesia (n=35) 7.5mg of bupivacaine administered slowly, at a rate of 1 ml per minute. We studied the level of temperature and time, sensory and motor blockade. The data are statistically processed. Results. Reduced thermal sensitivity recorded in an average of 48 seconds as a unilateral spinal anesthesia group and the control group. Subarachnoid administration of 7.5 mg of hyperbaric bupivacaine resulted in the development of a complete motor blockade underlying lower extremity in only 16 patients (45.7%). Conclusion. Using lower dosages of bupivacaine for unilateral spinal anesthesia lowers the threshold concentration of the local anesthetic in the subarachnoid space, resulting in slower motor neuron blockade and it is not total in more than 50% of cases.

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Low dose spinal anesthesia for knee arthroscopy

Year: 2015, volume 11 Issue: №2 Pages: 126-128
Heading: Anaesthesiology and Reanimatology Article type: Original article
Authors: Lakhin R.E., Schegolev A.V., Panov V.A., Kuligin A.V.
Organization: Military Medical Academy n.a. S. M. Kirov, Saratov State Medical University
Summary:

Objective: to evaluate the nature of unilateral spinal anesthesia using various modes of administration of low doses of hyperbaric bupivacaine. Materials and Methods. Prospectively, the randomized study included 56 patients undergoing knee arthroscopy. In the control group bupivacaine of 5mg was administered simultaneously, in the main group — fractionally by 2.5 mg. The development of thermal and pain blocks from different sides was investigated. The data were statistically processed. Results. In the control group, the positioning of the patient usually began after the entire dose of anesthetic had been administered. In the case of temperature paresthesia in the area of the sacral segments of the full anesthesia throughout underlying limb was not always achieved. In 6 cases of block was not sufficient. In the main group patient positioning was performed after the administration of 2.5 mg of anesthetic and evaluate temperature paresthesia and in 2 cases the total dose was increased to 7.5 mg. The successful development of sensory block at fractional administration was significantly higher than in the single-step introduction. Conclusion. Temperature paresthesia occurs within the first minute and is an early predictor of developing spinal anesthesia. The area of arising paresthesia shows preferential distribution of the anesthetic. In the application of low dose local anesthetic the desired upper level of anesthesia via the patient positioning and dose adjustment may be achieved.

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Assessment of efficiency of the strengthening mode of ultrasonic visualization of needles for peripheral regional anaesthesia

Year: 2014, volume 10 Issue: №4 Pages: 612-616
Heading: Anaesthesiology and Reanimatology Article type: Original article
Authors: Kuligin A.V., Panov V.A., Lakhin R.E., Shchegolev A.V., Yatsenko D.V., Kotikova M.N.
Organization: Military Medical Academy n.a. S. M. Kirov, Saratov State Medical University
Summary:

Research goal: optimization of peripheral regional anaesthesia under ultrasound. Material and Methods. Study has been performed by SonoSite Edge (SonoSite, Bothell, США) on a lineal transducer machine for fixed terms 38-mm (13-6 MHz) of overall gain and depth. The study included 2 sonographic needles and 2 non-sonographic needles. Ultrasound images were obtained and analyzed by an experienced anaesthesiologist. Results. In this study improved ultrasound imaging needle for peripheral regional anaesthesia using technology SonoMBe compared with a conventional scanning mode has been demonstrated. Conclusions. SonoMBe technology increases the echogenicity of needles for peripheral regional anaesthesia that allows the use of this technology gain in the performance of nerve block and plexus block anesthesia

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Functional systemic approach to the resuscitation and intensive care

Year: 2014, volume 10 Issue: №3 Pages: 401-403
Heading: Anaesthesiology and Reanimatology Article type: Author's opinion
Authors: Sadchikov D.V.
Organization: Saratov State Medical University
Summary:

Functional systemic approach to the resuscitation and intensive care may be considered as a direct correlation between analysis and synthesis, induction and deduction, and, in general, between the formal and dialectical categories. The realization of this system should be started with the interaction and formation of the final beneficial result. Therefore the experience assessment on the basis of functional systematic approach will enable us to formulate more precisely the subject and methods of resuscitation from the philosophical point of view taking into consideration the interaction of the human life integrity with death phenomenon as fixed in ontogenesis and will allow to methodically justify the distinguishing of functional systems and standard processes both in sanogenesis and thanatogenesis.

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General approaches to hemostasis disturbances in necrotic pancreatitis

Year: 2013, volume 9 Issue: №4 Pages: 657-662
Heading: Anaesthesiology and Reanimatology Article type: Review
Authors: Aleksandrova E.D., Sadchikov D.V.
Organization: Saratov State Medical University
Summary:

The review presents the published data on relevance of the problem, frequency rate and mechanisms of occurrence of hemostasis disturbances in case of necrotic pancreatitis. Causes of wide diversity of hemostasis disturbances in necrotic pancreatitis have been considered.

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Anaesthesiological maintenance in total endo-prosthesis of large joints

Year: 2013, volume 9 Issue: №2 Pages: 241-246
Heading: Anaesthesiology and Reanimatology Article type: Original article
Authors: Prigorodov М.V., Pominova I.V., Noskova I.L, Tashkaev I.V., Virsta A.M.
Organization: Clinical hospital n.a. S. R. Mirotvortsev SSMU, Saratov State Medical University
Summary:

Purpose: To improve the quality of anesthetic protection in prosthetics of large joints based on a steady state energy balance. Materials and methods: Prospective, randomized study on the basis of a controlled hemodilution (CM) double mask has been performed. In the first group of patients (32-19 women) hemodilution (HS) has not been done. The second group of patients (31-17) consisted of patients with HS. Three phases of the survey have been selected — before surgery, traumatic phase of the operation, after the operation. Analyzed the parameters of central hemodynamics (Cl (I/ min/m2) and total peripheral vascular resistance TPVR (dyn * sec1 * cm5), gas exchange (DO (ml / min) and V02 (ml / min), energy metabolism (kcal / min; kcal / day). For data processing statistical package STATISTICA6,0 was used. Results: Central hemodynamic parameters in both groups did not significantly change, and did not differ between the groups. A significant reduction in D02. DO differences between groups of patients at all stages of the studies found has been determined in both groups of patients. Oxygen consumption in the first group of patients decreased significantly to traumatic phase of the operation, and the next stage rose to baseline. Oxygen consumption in the group with CM increased by traumatic phase of the operation, but then returned to baseline. In patients with CM oxygen consumption was significantly higher than in patients without CM at all time points. It is found that there is a significant drop in energy metabolism in the first group of patients in traumatic phase of the operation, followed by reduction of the energy poten-
tial. It is noted that insignificant increase of energy on stage traumatic operation in the second group of patients, with a subsequent decrease to the original level. Energy exchange at all stages of the study was significantly higher in the second group of patients. Logistic regression analysis found that controlled hemodilution is associated with increased energy metabolism at the stage prior to surgery for traumatic stage and after the intervention. Conclusion: It has been established a connection with the growth of energy controlled hemodilution with radical intervention on the hip joint. Substantial energy deficit in patients without HS on traumatic phase of the operation reveals that the high probability of occurrence of cardiovascular complications.

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Influence of anaesthesia on energy metabolism in surgery

Year: 2013, volume 9 Issue: №1 Pages: 47-49
Heading: Anaesthesiology and Reanimatology Article type: Original article
Authors: Prigorodov М.V., Tashkaev I.V., Pominova I.V., Noskova I.L, virsta A.M.
Organization: Clinical hospital n.a. S. R. Mirotvortsev SSMU, Saratov State Medical University
Summary:

The purpose of the article is to establish adequacy of protection of energy metabolism in a patient under anaes-thesiology in cholecystectomy from mini-access. Material et methods: 122 patients subjected to cholecystectomy from mini access have been surveyed. Among them 92 patients have got intravenous general anaesthesia with AVL, 30 patients have got prolonged epidural anaesthesia on spontaneous breath with insufflations of oxygen through an obverse mask with sedatations. Monitoring of energy-plastic metabolism has been carried out in all patients. Results: Groups of patients have been compared by anthropometrical data, traumatic interventions. In both groups of patients loss of energy to traumatic to an operation stage has insignificantly increased, but after the anaesthesia termination in the group of patients with intravenous anaesthesia loss of energy continued to rise, and in the group of patients with prolonged epidural blockade it has returned to the initial level. After the anaesthesia termination the energy metabolism became essential higher in the first group of patients in comparison with the second one (p

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Nongaseous exchange functions of lungs in common severe viral-bacterial pneumonia genesis

Year: 2012, volume 8 Issue: №3 Pages: 738-744
Heading: Anaesthesiology and Reanimatology Article type: Review
Authors: Zeulina Е.Е., SadchikovD. V., Blokhina E.О.
Organization: Saratov State Medical University
Summary:

The review presents modern definitions, classifications and criteria of severity of common viral-bacterial pneumonia. The study of literature about the role of metabolic functions of the lungs in the genesis of severe common viral-bacterial pneumonia has allowed the formulations of anew period in the intensive care based on the study of noradrenalin inactivating functions of the lungs.

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Dynamics of processes of free lipid peroxidation and antioxidant protection when the development of infectious-inflammatory complications in acute and early periods of spinal cord traumatic disease

Year: 2012, volume 8 Issue: №3 Pages: 734-737
Heading: Anaesthesiology and Reanimatology Article type: Original article
Authors: Ulianov V.Yu., Bazhanov S.P., Konyuchenko EA., Shchukovsky V.V.
Organization:
Summary:

Objective: to study the dynamics of individual indicators of free radical lipid peroxidation and antioxidant defense in acute and early periods of traumatic disease of the spinal cord during the development of infectious and inflammatory complications. Material and methods. An analysis of selected indicators of free radical lipid peroxidation and antioxidant protection in the development of infectious-inflammatory complications in the acute and early periods of traumatic disease of the spinal cord. In the state of the studied groups of lipid peroxydation was evaluated on the content of malon dialdehyde, antioxidant protection — at the level of ceruloplasmin and superoxidedismutase. Results. In patients with traumatic spinal cord disease in the absence of infectious and inflammatory complications revealed monophasic increase in the concentrations of the studied parameters in the 1-4th day after injury, followed by a gradual decrease in its 30th day. With the development of traumatic disease of the spinal cord is marked as a two-phase activation of the mechanisms of lipid peroxidation and antioxidant enzyme activities of systems occurring in the 1-4th and 14th day from the date of injury with a subsequent decrease in their 30th day. Conclusion. The findings suggest that differences in the metabolic response depending on the absence or presence of infectious-inflammatory process.

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