«Anesteziologiya i Reanimatologiya
» №
6 2013
Abstracts of the articles
AN-1306-004
EFFECT OF ANAESTHESIA ON INCIDENCE OF POSTOPERATIVE DELIRIUM AFTER MAJOR
ABDOMINAL SURGERY IN ELDERLY PATIENTS
Zabolotskikh I.B., Trembach N.V.
Kuban State Medical University, 350063, Krasnodar
Delirium can be caused by haemodynamics abnormalities during anaesthesia. The main role in delirium
appearance is given to decreasing of cerebral perfusion pressure. Especially it can happen in patients with
underlying intracranial hypertension. Anaesthetics effects on intracranial pressure are different therefore
cerebral hypoperfusion can happens in these patients even without systemic hypotension. Purpose of the
study was to define an effect of cerebral perfusion pressure decreasing during different technics of
anaesthesia on frequency of delirium in elderly patients after major abdominal surgery. The article deals with
results of study of 182 patients (medium age 69 y.o.) underwent elective major abdominal surgery. Delirium
frequency was 11%, continuing of delirium was 3 days. The frequency of delirium was higher in patients who
had got anaesthesia based on sevoflurane. Additionally these patients had higher frequency of cerebral
perfusion pressure decreasing. Conclusions; Anaesthesia based on sevoflurane is characterized by higher
frequency of postoperative delirium in elderly patients after major abdominal surgery.
Key words: postoperative delirium, cerebral perfusion pressure, anaesthesia
AN-1306-007
CORRECTION OF DYSRHYTHMIAS AND HAEMODINAMIC ABNOMALITIES IN PAITIENTS WITH RIGHT
CORONARY ARTERY DISEASE
LoukianovaI.Y.1, SokolovY.V. 2, KorotkevichI.A.3, KatasonovS.P.4
1Mechnikov North-West State Medical University, 2Ambulance Team Division of the Outpatient Clinic N8,
3Ambulance Team Division of Outpatient Clinic N24, 4Aleksandrovskii City Hospital N17, St. Petersburg,
Russia
Purpose of the study; To analyze a correlation between sino-atrial node automatic activity and atrio-
ventricular conductivity in patients with lower acute myocardial infarction (AMI) and atrio-ventricular blockade
II-III (AVB) during infusion therapy. Materials and methods; Retrospective analysis of care for patients with
AMI and AVB was carried out. Infusion therapy effectswere studied in 12 patients with right coronary artery
disease and AVB. Results; Infusion therapy in patients with lower acute myocardial infarction, atrio-
ventricular blockade and right ventricular failure corrects haemodynamicand dromotropic disturbances.
Systolic arterial pressure (SAP) increased to 100,4 mmHg (9,9)after infusion of 400 mLin comparison
withSAP after infusion of 200 mL
(р=0,003),
Diastolic arterial pressure (DAP) increased to58,7 mmHg (6,8) in
comparison with DAP after infusion of 200 mL
(р = 0,011),
central venous pressure (CVP) decreased to 12,2
cmH2O (3,7) in comparison with CVP after infusion of 200 mL
(р=0,003).
Mode of AVB degree indicator
changed to0 (0;0)
(р=0,028).
Conclusions; Infusion volume therapy should be used for correction of right
ventricular failure and disturbances of atrio-ventricular conductivity in case of right ventricular failure
absence.
Key words: myocardial infarction, atrio-ventricular blockade, heart failure, infusion therapy
AN-1306-011
RELATIONS OF CARDIOVASCULAR SYSTEM AND ENDOTHELIAL DYSFUNCTION INDICATORS IN
PATIENTS WITH HEMORRHAGIC SHOCK
Iudakova T.N.1, Girsh A. O.2, Maksimishin S.V.3 ,Malcov O.A.2
1Kabanov City Clinical Hospital N1, 644112, Omsk, Russia; 2Omsk state medical academy, 644043, Omsk,
Russia; 3 Emergency City Clinical Hospital N1, 644112, Omsk, Russia
Endothelial dysfunction is a universal mechanism of pathogenesis of many critical conditions. Goal of the
study was to assess a relationof cardiovascular system and endothelial dysfunction indicators in patients
with hemorrhagic shock. Materials and methods; 17 patients with hemorrhagic shock 3 were involved in the
study. All patients received infusion therapy, artificial lung ventilation after tracheal intubation and
symptomatic treatment in prehospital period.Common volume of blood loose was 2900±200 mL.The patients
received infusion, transfusion, inotrope, antibacterial, respiratory and symptomatic therapy in ICU after
surgical treatment. Cardio-vascular system parameters were assessed by Tischenko method of integral
reography.Number of red cells, hemoglobin, lactate, endotelin-1 and Wb-factor of venous blood were studied
before surgery, in 12 and in 24 hours after. Morphological study of the omentumbiopsy was carried
out.Results; Performed correlation analysis showed statistically significant relations of cardiovascular system
and endothelial dysfunction indicators in patients with hemorrhagic shock. Endothelial dysfunction occurs in
patients with hemorrhagic shock 3. The endothelial dysfunction correlates with parameters of cardio-vascular
system and tissue perfusion.
Key words: endothelial dysfunction, hemorrhagic shock
AN-1306-014
PREDICTION OF MORTALITY IN PATIENTS WITH ACUTE HEPATIC FAILURE
Eremeeva L.F., Berdnikov A.P., Musaeva T.S., Zabolotskikh I.B.
Department of Anaesthesiology, Resuscitation and Transfusion, Kuban State Medical University, Krasnodar,
Russia
The article deals with a study of 243 patients (from 18 to 65 years old) with acute hepatic failure.Purpose of
the study was to evaluate the predictive capability of severity scales APACHE III, SOFA, MODS, Child-Pugh
and to identify mortality predictors in patients with acute hepatic failure. Results; The best predictive ability in
patients with acute hepatic failure and multiple organ failure had APACHE III and SOFA scales. The
strongest mortality predictors were: serum creatinine> 132 mmol / L, fibrinogen <1.4 g / L, Na <129 mmol / L
Key words: acute hepatic failure, severity scales, outcome
AN-1306-017
FEATURES OF XE-BASED GENERAL ANAESTHESIA IN NEUROSURGERY
Vyatkin A.A., Petrosyan L.G., Mizikov V.M., Vasilyev S.A.
Federal State Budgetary Institution "Petrovsky National Research Center of Surgery" of the Russian
Academy of Medical Science, 119991, Moscow, Russia
Neuroprotection could be the aim to use Xenon for general anesthesia. However the experience of Xenon
anesthesia in neurosurgery is quite limited. The appraisal of Xenon based anesthesia was accomplished in
12 patients during various brain surgery. Xe in concentration 65% was used to maintenance of anesthesia,
other medication was avoided. As a result there were 8 cases of arterial hypertension and 2 cases of
superficial hypnotic state. Excitation (n=3), hyperdynamic reaction (n=8), PONV (n=8) were detected in early
postoperative period. An analysis of this study suggests a conclusion that studied method of Xenon-based
anesthesia is inexpedient for neurosurgery.
Key words: xenon, neuroanaesthesiology, inhalational anaesthetics
AN-1306-021
DEXMEDETOMIDINE USE FOR POSTOPERATIVE ADRENERGIC ANALGESIA AND SEDATION IN
ABDOMINAL SURGERY
Guryanov V.A.,1 Nosenko M.M.,2 Gadzhibekov N.Ch.,2 YalichA.Yu.,2 Alyautdin R.N.,3Tolmachev G.N.4
1Sechenov First Moscow State Medical University, 2Moscow City Hospital #31, 3Universiti Teknologi MARA,
Faculty of Medicine, 4Volgograd Medical Clinical Center of Federal Medical and Biological Agency.
Comparative study of postoperative analgesia and sedation with trimeperidineand dexmedetomidine and
their effects on haemodynamics and vegetative nervous system was performed. Assessment of analgesia
and sedation during vagotonia (first part of the study) and hypokinetic type of haemodynamics (second part
of the study) was carried out with visual analogue scale (VAS) and Richmond scale.Results of the study
showed that dexmedetomidine is more effective and safer than trimeperidine for analgesia and sedation in
patients with spontaneous breathing after abdominal surgery. Dexmedetomidine use allows keeping optimal
type of haemodynamics and vegetative nervous system parameters on first day of postoperative period.
Key words: trimeperidine, dexmedetomidine, analgesia, sedation, visual analogue scale, Richmond scale,
abdominal surgery
AN-1306-025
COMPARISON OF EPIDURAL AND OPIOID ANALGESIA EFFECTS ON FREQUENCY OF BOWEL
PERISTALSIS IN PATIENTS OF SURGICAL INTENSIVE CARE UNIT
R. V. Hakobyan
Yerevan State Medical University, 0025 Yerevan, 2 Koryun st., Armenia
The impact of epidural analgesia (EA) on bowel peristalsis in Surgical Intensive Care Unit (SICU) patients is
not well known. This study was designed to determine if EA improves bowel motility and decreases the
incidence of postoperative paralytic ileus compared to patients receiving systemic opioid analgesia
(ОА).
Through prospective cohort study we investigated 386 SICU patients who received EA [n = 70 (18.13%)], or
OA ± ketorolac trometamol [n = 316 (81.87%)]. We showed that EA does not improve time to defecation
anddoes not decrease the incidence of paralytic ileus in SICU patients
Key words: surgical intensive care unit, paralitic ileus, epidural analgesia, opioid analgesia
AN-1306-028
COMPARISON ASSESSMENT OF PROLONGED FEMORAL NERVE BLOCKADE AND EPIDURAL
ANALGESIA DURING POSTOPERATIVE CARE FOR TOTAL KNEE JOINT ARTHROPLASTY
Churadze B.T., Sevalkin S.A., Zadorozhniy M.V., Volkov P.A., Guryanov V.A.
Department of Anaesthesiology and Intensive Care, Medical Centre "Zdorovye Dlya Vas", 119415, Moscow,
Russia
The study deals with two mostly discussed techniques of postoperative analgesia for total knee joint
arthroplasty. Surgeries were performed under subarachnoid anaesthesia with intravenous sedation. 9
patients of first group in received prolonged femoral nerve blockade as a component of multimodal
analgesia. 8 patients of second group received epidural infusion of naropine. If basic technique of analgesia
was not effective patients received trimeperidine 20 mg intramuscular. Patients of second group had less
pain syndrome (in order to visual analogue scale) and did not need additional administration of opioids.
Key words: prolonged femoral nerve blockade, prolongedepidural analgesia, total knee joint arthroplasty
EXPERIENCE OF EXTRACORPOREAL MEMBRANE OXYGENATION IN CRITICAL CARE OF
RESPIRATORY FAILURE IN NEWBORN WITH CONGENITAL DIAPHRAGMATIC HERNIA IN PERINATAL
CENTER
Burov A.A.1, Nikiforov D.V. 1, PodurovskayaYu.L. 1, Dorofeeva E.I.1, Abramyan M.A.1, Makhalin M.V. 2,
Shatalov K.V.2, Nikiforov V.S.1, Degtyarev D.N.1
1Kulakov Research Center for Obstetrics, Gynecology and Perinatology, 117997, Moscow, Russia;
2Bakoulev Scientific
Center for Cardiovascular Surgery of the Russian Academy of Medical Sciences, 121552, Moscow, Russia.
The article deals with an experience of veno-arterial extracorporeal membrane oxygenation use in preterm
infants with congenital diaphragmatic hernia during postoperative period in the perinatal center.
Key words: congenital diaphragmatic hernia (CDH), extracorporeal membrane oxygenation (ECMO),
respiratory disorders in the newborn, new technologies
AN-1306-037
EFFECT OF EARLY MULTIMODAL REHABILITATION ON POSTOPERATIVE RECOVERY AFTER
ABDOMINAL HYSTERECTOMY
Antipin E.E., Uvarov D.N., Antipina N.P., Nedashkovskiy E.V., Sovershaeva S.Z.
Northern State Medical University 163000, Arkhangelsk, Russia
Purpose of the study was to evaluate the impact of the use of enhanced recovery after surgery for the
postoperative period, and the inflammatory response after hysterectomy. Introduction: Methods
Prospectively, 50 patients ASA 1-2 aged 42— 72 years were randomized into two groups: the ERAS group (n
= 25) and the control group (CG) with traditional perioperative management (n = 25). combined spinal and
epidural anesthesia technique was usedin all patients.Patient-controlled epidural analgesia in the ERAS
group and multimodal analgesia with combination of paracetamol, tramadol and ketoprofen in the control
group were used postoperatively. We measured plasma concentrations of interleukin-6 (IL-6), interleukinIL-
1. (IL-1.) and C-reactive protein (CRP) preoperatively and at 24 hours and 7 days after surgery. Data were
analyzed by Mann-Whitney U test and presented as median (25th-75th percentiles).Results: There was no
statistically significant differences in the IL-6 and IL-1. concentrations throughout the study.At 6 and 24 hours
the pain severity of according to VAS was higher in the control group at rest and on coughing during all study
stages.We found no correlation between the level of pain and plasma concentrations of IL-1. and IL-6. The
plasma concentration of CRP in the control group was higher at 24 hours and at 7 days after surgery:
(P<0.01). Level of CRP in the control group tended to increase during the observation period. Conclusions:
In our study, the serum concentration of IL-6 and IL-1. did not depend on the method of postoperative pain
management. Using the ERAS protocol reduced postoperative plasma concentration of CRP. The increased
level of CRP in the control group may be related with autoimmune reaction in wound due to delayed
mobilization of patients.
Key words: ERAS, hysterectomy, interleukins, C-reactive protein, postoperative period, inflammatory
response
AN-1306-041
ROLE OF INTRAABDOMINAL HYPERTENSION IN THE DEVELOPMENT AND OUTCOME OF OVARIAN
HYPERSTIMULATION SYNDROME
D.V. Marshalov1, I.A. Salov1, E.M. Shifman2, A.P. Petrenko1, R.R. Saljukov1,
М.О.
Bacunova1
1V.I. Razumovsky Saratov State Medical University, 410017, Saratov, Russian Federation 2Peoples’
Friendship University of Russia, 117198, Moscow, Russian Federation
Objective: To evaluate the role of intraabdominal hypertension in the development and outcome of ovarian
hyperstimulation syndrome.
Material and methods: 60 patients with varying degrees of ovarian hyperstimulation syndrome (OHSS) due
to ongoing pregnancy were involved in the study. Intraabdominal pressure (IAP) was measured in the
bladder. Performance of abdominal perfusion pressure, filtration gradient, extensibility and compliance of the
anterior abdominal wall were evaluated. A size of the ovaries, chorionic condition and ascites were
determined by ultrasonic method. Relation of pregnancy outcome and IAP was analyzed. Results: The
mean value of IAP in patients with light form of ovarian hyperstimulation syndrome was 7,05 ± 1,76 mm Hg,
13,65 ± 1,92 mm Hg in patients with moderate form, and 20,60 ± 2,52 mm Hg in patients with severe form of
OHSS. The leading factors in the development and progression of intraabdominal hypertension (IAH) are the
volume of the ovaries, ascites, and extensibility of the abdominal wall. The comparison of pregnancy
outcome and severity of IAP revealed a strong positive correlation – r = 0,726, p < 0,001.
Conclusion: Evaluation of the severity of intra-abdominal hypertension in patients with ovarian
hyperstimulation syndrome with considering the clinical data and results of laboratory and instrumental
studies allow clarifying the severity of condition and predict the potential complications and pregnancy
outcomes.
Key words: intraabdominal hypertension, ovarian hyperstimulation syndrome
AN-1306-046
ASSESSMENT OF SUGAMMADEX USE EFFICIENCY AND SAFETY FOR NEUROMUSCULAR BLOCK
REVERSION
Kirienko P.A.1,3, Babajanc A.V.4, Shmakov I.A.1,3 ; Gorobec E.S.2, Eldzharkiev A. A-N. 1,3, Gelfand B.R1,3
1Pirogov Russian National Research Medical University, 117997, moscow; 2Blokhin Cancer Research
Center of the Russian Academy of Medical Sciences, 115121, Moscow; 3 PIROGOV City Clinical Hospital N
1, 117049, Moscow; 4 City Clinical Hospital N 7, 115446, Moscow, Russia
Blockade of neuromuscular conductivity is a considered one of basic part of a patient protectionin a concept
of a balanced multicomponent anesthesia. The controlled neuromuscular paralysis in a combination of a
sedation, an analgesia and a hyporeflection not only provides comfortable conditions to surgeons for
carrying out surgeries, but also allows to manage a gas exchange, blood circulation and a metabolism in a
patient. However in clinical practice there is such complication after application of muscular relaxant (not
depolarizing) as a residual curarization. The residual curarization is interfaced to deterioration of the
respiratory answer to a hypoxemia, swallowing dysfunction that significantly increased risk of aspiration and
risk of postoperative pulmonary complications. Until recent timeacetylcholinesterase inhibitors or prolonged
ALV before spontaneous regression of the neuromuscular block were applied in clinical practice for the
purpose of restoration of adequate neuromuscular conductivity and elimination of a residual curarization.
However, there are number of the circumstances limiting application of preparations of this group including it
is related with rather high frequency of side effects and lack of efficiency at the deep neuromuscular block.
Today in an arsenal of the anesthesiologist there was the latest chemical — sugammadex. Sugammadex
realizesa new approach to restoration of the neuromuscular conductivity.
Key words: neostigmine, sugammadex, residual curarization, anticholinesterases preparations, reversed of
the neuromuscular block
AN-1306-051
URGENT FIBEROPTIC BRONCHOSCOPY FOR DIAGNOSTICS AND TREATMENT OF LUNG
ATELECTASIS
A.V. Mironov, T.P. Pinchuk, I.E. Selina, D.A. Kosolapov.
Sklifosovsky Scientific Research Institute of Emergency Medicine, 129090, Moscow, Russia
The article deals with results of fiberoptic bronchoscopyusing during treating of patients suffering atelectasis.
According to the research atelectasis is likely to advance in the first three days after serious patients have
been admitted to the intensive therapy unit or after operative treatment. Left-sided atelectasis is half as
widespread again the right-sided one. The research highlights the effectiveness of atelectasis X-ray
diagnosis. Fiberoptic bronchoscopy in almost all the cases allowed diagnosing the degree of
tracheobronchial tree obstruction and its causes. Single suction fiberoptic bronchoscopy leads to
normalization and encouraged positive dynamics in 76% of all the cases (57 patients). Repeated endoscopic
sanation in the first two days was necessary for 25 patients (25,3%) with unresolved or reoccurring
atelectasis. The effectiveness of second research was to 84%. It’s important to add that mostly patients with
serious chest injury were subjected to unresolved or reoccurring atelectasis. And mainly in these cases blood
was seen through the tracheobronchial tree lumen.
Key words: fiberoptic bronchoscopy; atelectasis
AN-1306-054
CASE OF SUCCESSFUL THROMBOLYTIC THERAPY USE IN COMPLEX CARDIO-PULMONARY
RESUSCITATION FOR MASSIVE PULMONARY THROMBOEMBOLISM IN PARTURIENT AFTER
ELECTIVE CAESARIAN OPERATION
S.I. Sitkin1, G.A. Kolgushkin2, J.K. Shishko2, A.V. Elizova2, B.I. Hizhnyak2, V.G. Yankov2, A.M. Ronenson1
1Tver State Medical Academy, 170100, Tver, Russia, 2Maternity Hospital N 1, 170030, Tver, Russia
Pulmonary thromboembolism is a main cause of parturient mortality in the world. Recently there are few
reports about a thrombolytic therapy use in parturient in medical publications. The article deals with a case of
successful application of thrombolysis in a complex cardio-pulmonary resuscitation in parturient with massive
pulmonary thromboembolism. Unexpected dyspnea and hypotension occurred in the 30 years old woman
after elective caesarian operation. SyndromeS1- Q3wasfixedonanECGmonitor. Cardiacarrestwasfixedin 10
minuteslater. Streptokinase was administrated in a 1 hour after beginning of the resuscitation.
Haemodynamic parameters recovered almost after the administration of streptokinase. Severe uterine
bleeding occurred in 20 minutes after the administration. Uterine extirpation and tight tamponade of the small
pelvis was performed for the bleeding stopping. Later a floating thrombus was diagnosed in the right femoral
vein. Tromboectomywasperformed. Convulsions had place on first and second day after the resuscitation.
Cerebral edema was diagnosed by computed tomography. Consciousness occurred on the fourth day and
the woman was weaned from the ventilator on the fifth day. The patient was discharged from the hospital on
20th day without neurological complications.
Key words: parturient, massive pulmonary thromboembolism, cardio-pulmonary resuscitation, thrombolytic
therapy, streptokinase
AN-1306-057
RECENT PRINCIPLES OF ERYTHROCYTES-CONTAINING DONOR BLOOD COMPONENTS
TRANSFUSION
Bystrykh O.A., Feodorova T.A., Strelnikova E.V.
Kulakov Research Center for Obstetrics, Gynecology and Perinatology, 117997, Moscow, Russia
AN-1306-059
HEPARIN-INDUCED THROMBOCYTOPENIA: THEORY AND PRACTICE
Guryanov V.A. 1, Tolmachev G.N. 2
1Sechenov First Moscow State Medical University; 2Volgograd Medical Clinical Centre of the Federal
Medical and Biological Agency
The article deals with detailed information about etiology, pathogenesis, clinical signs, prophylactics and
treatment of a heparin-induced thrombocytopenia.
Key words: heparin, heparin therapy complications, ,heparin-induced thrombocytopenia
AN-1306-062
ANTICOAGULANT THERAPY IN PREGNANT WOMEN WITH MECHANICAL PROSTHETIC HEART
VALVES. REVIEW OF INTERNATIONAL CLINICAL GUIDELINES.
Adilova L.R.1, Shifman E.M.2, Adamyan L.V.1, Lyashko E.S.1, Tyulkina E.E.3
1EvdokimovMoscow State University of Medicine and Dentistry, 127473, Moscow, Russia; 2Peoples’
Friendship University of Russia, 117198, Moscow, Russia; 3Filatov Moscow City Hospital N 15, 111539,
Moscow, Russia
Recently thromboembolic and hemorrhagic complications are main causes of maternal morbidity and
mortality. Normal pregnancy is associated with ahypercoagulation. This condition is complicated if the patient
has a mechanical prosthetic heart valve Therefore an anticoagulant therapy in these patients is a challenging
task. Effects of anticoagulant drugs on the fetus, pregnancy and deliverymust also be taken into
consideration. The review deals with international clinical guidelines. Diagrams of anticoagulant therapy in
pregnant women with mechanical prosthetic heart valves using direct (unfractionated and low-molecular-
weight heparins) and indirect (warfarin) anticoagulants are presented in the review.
Key words:anticoagulant therapy, pregnancy, prosthetic heart valves, cardiovascular diseases, low-
molecular-weight heparin, unfractionated heparin, warfarin
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