Search

Introduction. In the evolving landscape of anesthetic practices for short-duration urologic procedures, the quest for an anesthetic agent that balances efficacy with minimal side effects remains a significant clinical challenge.The objective was to compare the efficacy and safety of 2% hyperbaric prilocaine and 0.5% hyperbaric bupivacaine in spinal anesthesia.Materials and methods. A comparative analysis was performed in terms of onset and duration of sensory and motor block, incidence of side effects (hypotension and bradycardia), and overall patient outcomes in urologic endoscopy. The research sample was divided into two groups, each consisting of 20 patients. In one case, spinal anesthesia was performed using 2% hyperbaric prilocaine (40 mg) + fentanyl 25 mcg, in the other – 0.5% hyperbaric bupivacaine (10 mg) + fentanyl 25 mcg.Results. Prilocaine offers a faster onset of sensory and motor block and a shorter duration of sensory block compared to bupivacaine. Prilocaine also showed a quicker recovery of full motor function and had a significantly lower incidence of side effects such as hypotension and bradycardia.Conclusion. These results suggest that 2% hyperbaric prilocaine could be an alternative to 0.5% hyperbaric bupivacaine in spinal anesthesia for urologic endoscopy, especially in procedures requiring quick recovery. The promising results of prilocaine in such short-duration surgeries can also prompt a reevaluation of anesthesia protocols across various surgical interventions and lead to enhanced patient outcomes, emphasizing safety, comfort, and efficacy of surgical care.

Introduction. Spinal anesthesia (SA) is widely used for cesarean sections, yet its safety in preeclamptic patients remains uncertain. This study explores the use of subarachnoid block (SAB) in preeclamptic parturients during cesarean sections. Patients and Methods. This study was a single-center hospital-based controlled clinical trial. 30 normotensive and 30 preeclamptic women undergoing cesarean section were included in the study. Heart rate, systolic blood pressure (SBP), diastolic blood pressure (DBP), mean arterial blood pressure (MAP) and SpO2 were evaluated at one, three, five, seven, nine, 11, 13, 15, 20, 25, 30, 40, 45, 50, 55 and 60 minutes intervals after giving the block. The independent samples t-test was used for statistical analysis. Results. In the normotensive (group N) vs. preeclamptic (group PE) comparison, significant differences in weight, SBP, DBP, and MAP were noted, with higher values in group PE (p

Introduction. General anesthesia (GA) and spinal anesthesia (SA) are the main techniques applied during total knee arthroplasty (TKA). SA belongs to neuraxial anesthesia (NA) category. Numerous studies have explored benefits of NA in diminishing the complications, among which are pulmonary embolism (PE), urinary tract infection (UTI), and deep vein thrombosis (DVT). Aim. To compare rate of complications of SA and GA in TKA. Materials and methods. This is a retrospective cohort studie conducted on 190 patients who attended Alwasity teaching hospital in Baghdad and underwent TKA. The age ranged from 41 to 75 years and 69% of patients were females. The patients were enrolled into SA group (80 patients) and GA group (110 patients). We reviewed patients’ records and interviewed patients and medically examined them to obtain data on age, sex, body mass index (BMI), comorbidities including diabetes mellitus(DM), hypertension (HT) and other comorbidities. Results: Higher age and BMI were found in SA group. Complications’ incidence in SA group vs. GA group was PE 0.03 vs. 0.09, DVT 0.04 vs. 0.10, Pneumonia 0.04 vs. 0.08, UTI 0.06 vs. 0.23, and ARF 0.03 vs. 0.33, they didn’t differ significantly. Conclusion: SA is a good option for anesthesia in TKA because it wasn’t associated with higher complications rate compared to GA.

Introduction Fat embolism syndrome (FES) is a formidable complication that occurs with extremity long-bone fractures. Overall, the mortality of FES is estimated to be 10–36 % depending on the severity of the injury. Early detection of complications, selection of optimal methods for fracture fixation and for anesthesia that would prevent FES are essential. The objective was to assess the incidence of clinical manifestations of FES in patients with lower extremity long-bone fractures, determine the optimal methods of prevention, methods of anesthesia and surgical intervention in the management of the patients. Material and methods The study included 355 patients with lower extremity long-bone fractures treated between 2020 and 2021 at the Trauma Department, State Budgetary Healthcare Clinical N.I. Pirogov Hospital No. 1. Patients were grouped according to different parameters including frequency of occurrence of FES depending on the length of the preoperative period: patients with a long and short preoperative period; treatment strategy: patients treated surgically or conservatively; preoperative use of prophylaxis: patients receiving and not receiving "Essentiale"; anesthetic aidused: general or spinal anesthesia. Results Of the 355 patients examined, FES was detected in 8 patients with fractures of the lower extremities, one patient died. FES developed mainly in the first 72 hours of injury. FES occurred in less than 12 hours (n = 1), in 12‑24 hours (n = 2), in 24‑48 hours (n = 2), in 48-72 hours (n = 3). Discussion FES developed in patients with a delayed operative period and in patients treated conservatively. The prophylaxis policy suggests timely diagnosis using Schonfeld's scoring system for FES and taking "Essentiale" early post trauma. Patients who underwent surgery with spinal anesthesia showed a decreased incidence of FES as compared with patients operated on using general anesthesia. Conclusion There is a high incidence of FES. Hepatoprotectors can be used on the first days after injury to prevent FES. Osteosynthesis under spinal anesthesia is the preferred method of treatment.

The review article discusses in detail the problem of complications in maternity patients associated with spinal anesthesia and cesarean section surgery. The evidence base demonstrating the risk of complications in pregnant women with the development of acute neurological conditions is presented. The problems of the toxic effect of a local anesthetic (bupivacaine) and the consequences of a coronavirus infection on the body of pregnant women are considered separately.

Data on factors contributing to the development of postoperative cardiac complications (myocardial infarction, heart failure, cardiac arrhythmias) in non-cardiosurgical operations are presented. Hypotension and blood loss are usually distinguished among such factors, but less attention is paid to the role of neuroendocrine reactions, in particular, hyperactivation of the sympathoadrenal system; the protective effect of anesthesia, in particular, regional anesthesia: epidural anesthesia and spinal anesthesia. Therefore, the review focuses on the description of the protective effects of regional anesthesia and their mechanisms, in particular, the prevention of the development of postoperative neurogenic dystrophy of internal organs, including the cardiovascular system.

Introduction. The prevalence of hemorrhoidal disease is 200 people per 1000 adult population, of which 75% are professionally active people. The choice of anesthetic support affects not only the effectiveness of the operation, but also the course of the early postoperative period. At the same time, regardless of the use of various variants of neuroaxial blockades, most authors indicate the development of complications such as acute urinary retention and severe postoperative pain syndrome in the postoperative period.Aim. To substantiate and evaluate the effectiveness of the proposed system of anesthesiological support for proctological operations.Material and methods. The study was conducted in 100 patients who were divided into two groups of 50 people. The operations were performed under conditions of combined anesthesia (spinal anesthesia + medical sedation). Spinal anesthesia was achieved with 0.5% isobaric bupivacaine solution, the average dose was 8.5 ± 0.12 mg. For drug sedation, a continuous infusion of propofol was used at a target concentration of 5–4–3 mg/kg per hour. The criterion for including patients in the main group was the appointment in the early postoperative period of the alpha 1 adrenoblocker tamsulosin hydrochloride at a dose of 0.4 mg/day.Results and discussion. The system of anesthetic support, including a combination of spinal anesthesia using an isobaric solution of bupivacaine at a dose of 7.5 to 10.0 mg and intravenous sedation with propofol at a target concentration of 5–4–3 mg/kg per hour, program of postoperative anesthesia based on a combination of multidirectional drug action and the appointment of alpha 1 adrenoblocker tamsulosin hydrochloride at a dose of 0.4 mg/day allows for high-quality and safe surgical treatment.Conclusion. The administration oftamsulosin hydrochloride at a dose of 0.4 mg prevented the development of acute urinary retention of patients.

Background: 90% of C-sections are supported by spinal anesthesia, which is complicated by arterial hypotension in 60%-80% of cases. The perfusion index seems to be a significant prognostic tool for arterial hypotension.Objective: Тo confirm the value of perfusion index in predicting arterial hypotension associated with the spinal anesthesia.Materials and methods: The study included 105 female patients who underwent С-section under spinal anesthesia. A decrease in mean arterial pressure by ≤ 20% was considered as arterial hypotension. Baseline perfusion index was assessed with a pulse oximeter. Results: 68 patients (64.8%) developed arterial hypotension in the intraoperative period. In 37 (35.2%) parturient women there were no significant changes in blood pressure. A cut-off threshold of 3.1 with 75% sensitivity and 75% specificity was obtained with the ROC analysis. Arterial hypotension developed in 29.4% (n = 15) of parturient women with a perfusion index < 3.1 and in 72.2% (n = 39) of parturient women with a perfusion index > 3.1.Conclusions: We can use the perfusion index threshold of 3.1 to identify parturient women with an increased risk of arterial hypotension associated with the spinal anesthesia for C-section. The arterial hypotension rate is significantly higher in women with an initial perfusion index > 3.1 compared with those with an initial perfusion index < 3.1.

The objective was to compare the efficacy and safety of morphine in neuraxial blocks during knee arthroplasty.Materials and methods. A retrospective analysis of 60 medical histories of patients who underwent total knee arthroplasty for the period from 2017 to 2019 was performed. All patients were operated under general anesthesia with mechanical ventilation in combination with epidural or spinal analgesia with opiates. Patients of the 1st group (n=20) after catheterization of the epidural space at the level of L1–2 were injected with a morphine solution 1% – 0.3 ml epidurally. Patients of the 2nd group (n=20) were injected with a morphine solution 1% – 0.01 ml intrathecally at the level of L3–4. Patients of the 3rd group (n=20) underwent standard combined anesthesia: general anesthesia with mechanical ventilation and epidural analgesia at the level of L1–2 with a solution of 0.2% ropivacaine in the form of an infusion of 6 ml/hour. All patients received infusion of 0.2% solution of ropivacaine epidurally 6 ml/hour at the level of L1–2 in the postoperative period.The incidence of nausea, vomiting, pruritus, headache and the level of postoperative pain syndrome were assessed on a numerical rating scale 6 hours after the end of the surgery.Results. The level of pain syndrome in patients who received intrathecal and epidural analgesia with morphine was equally low, while in patients who received epidural analgesia with ropivacaine, the level of pain syndrome was statistically significantly higher, which required the additional prescription of non-steroidal anti-inflammatory drugs and/or narcotic analgesics parenterally. The frequency of nausea, vomiting, pruritus and headaches was maximum in the 2nd group, significantly lower in the 1st, while in the 3rd, pruritus did not occur.Conclusion. The use of morphine in neuraxial block in knee arthroplasty has a positive effect on the quality of anesthesia and postoperative pain relief.

Anorectal abnormalities are among the most common congenital malformations in children requiring emergency surgical interventions.The objective is to analyze existing domestic and foreign publications on the features of anesthesia in anorectal abnormalities in children.Subjects and Methods. The search for publications was carried out in the abstract bases of Russian Scientific Citation Index, PubMed and Scopus according to the key words: anorectal abnormalities, anesthesia, regional anesthesia, children. 105 publications were found, 49 studies were selected for analysis.Results. For the purpose of anesthesia, both general and regional anesthesia are used to correct anorectal anomalies. Among regional techniques, spinal and caudal anesthesia is most often used. The most effective anesthesia option for anorectal surgery is saddle anesthesia since it is accompanied by a significant decrease in the tone of the anal sphincter. Combined use of general anesthesia and caudal analgesia contributes to the reduction of intraoperative blood loss and early restoration of bowel functions.Conclusion. Further research is needed to establish rapid post-operative recovery protocols for anorectal malformations in children.

Modern anesthesia is a very complex process, in which an important role is played not only by a highly qualified specialist, making quick and deliberate decisions in emergency and planned situations, but also a set of ways to solve the problems faced by him. This review provides information on pharmacological drugs – anesthetics, used to perform spinal and epidural anesthesia, which are described in chronological order. The origin of anesthetics is considered; as well as their inventors and promoters, positive and negative effects; indications and contraindications; choices of local anesthetics for various surgical interventions; methods of their application; dose and volume; and physiological effects of neuraxial blocks. In recent years, there have been global changes in the pharmacological arsenal of anesthesiologists. New pain management drugs with significant benefits have emerged. Modern anesthetics provide a longer analgesic effect than their precursors, lack significant toxic effect, do not cause significant hemodynamic changes during surgery, and have a short latency period, which allows them to be recommended for spinal, epidural and spinal-epidural anesthesia.

Abstract Placenta accreta (PAS-disorders) is one of the most serious complications of pregnancy, associated with the risk of massive uterine bleeding, massive hemotransfusion and maternal mortality. Peripartum hysterectomy is a common treatment strategy for patients with placenta accreta. Currently, there is a clear trend of changing surgical tactics in favor of organ-saving operations, but there are no studies devoted to anesthesiological support of such operations.The aim of the study is to substantiate an effective and safe method of anaesthesia in organ-saving operations for placenta accreta spectrum disorders.Materia l and methods The study involved 80 patients with a diagnosis of placenta accreta spectrum disorders, confirmed intraoperatively, who underwent organ-saving operations. The patients were randomized depending on the method of anesthesia into 3 groups: general anesthesia, spinal anesthesia with planned conversion to general after fetal extraction and epidural anesthesia with planned conversion to general also after fetal extraction. The comparison of intraoperative hemodynamics, efficiency of tissue perfusion, efficiency of antinociceptive protection at the stages of surgery was performed. A comparative analysis of the volume of blood loss and blood transfusion, time of patients activation in the postoperative period, severity of pain on the first day after surgery, duration of hospital stay before discharge and comparison of the assessment of the newborn according to Apgar score at first and fifth minute after extraction.Conclusion The study shows that the optimal method of anesthesia in organ-saving operations for placenta accreta spectrum disorders is epidural anesthesia with its planned conversion to general anesthesia with an artificial lung ventilation after fetal extraction. Such an approach to anesthesia allows to maintain stable hemodynamic profile with minimal vasopressor support, sufficient heart performance, providing effective tissue perfusion and a high level of antinociceptive protection at the intraoperative stage and reduce the volume of intraoperative blood loss and hemotransfusion. In the current study there were no differences in neonatal outcomes and duration of hospitalization depending on the method of anesthesia. The advantage of epidural anesthesia with its conversion to general anesthesia was earlier activation after surgery and lower intensity of postoperative pain syndrome.

Аnesthetic management of cesarean section in pregnant women with severe kyphoscoliosis is quite debatable. It is believed that kyphoscoliosis is a contraindication to neuraxial anesthesia methods. The article presents a successful experience of spinal anesthesia in pregnant women with severe kyphoscoliosis. Authors believe that spinal anesthesia can be successfully performed in pregnant women with severe kyphoscoliosis – paramedian access at the L5–S1 level, due to the anatomical features of these vertebrae.

Background and Objectives: The most used of regional anesthesia technic is spinal anesthesia. Spinal anesthesia is an easier technic to get the depth and speed of nerve blockade. Some medicine can be used as an adjuvant of local anesthesia to increase the effect of analgesia bupivacaine. This research is aimed to compare the effectiveness of administration of 0.1 mg intrathecal morphine and 0.1 mg intrathecal epinephrine to prolong 0.5% 12.5 mg hyperbaric analgesia bupivacaine toward caesarean section postoperative period. Method: This research is an experimental clinical trial randomized double-blind phase II. Subject of this study is the elective surgery patients (ASA I and II) with spinal anesthesia who are 18–40 years old and having weight around 50–70 kgs. There are 48 patients that is divided into 2 groups; 24 patients of group M (morphine 0.1 mg) and 24 patients of group E (epinephrine 0.1 mg). Result: The result of this study revealed the duration of analgesia is longer in group M (morphine 0.1 mg) than group T (tramadol 25 mg) (309.08±5.55 vs 221.66±6.43). Conclusion: adjuvant of 0.1 mg morphine and 0.5% 12.5 mg intrathecal hyperbaric bupivacaine can make the work period of analgesia longer while post caesaria section surgery rather than 0.5% 12.5 mg bupivacaine and 0.1 intrathecal epinephrine.

The practical part of the state final certification implies an assessment of skills.The objective of our study was the approbation of the Station of Subarachnoid Space Puncture as a part of the objective structured clinical examination.Subjects and methods. 26 students of the second year of the clinical residency were included in the study; they all were taking the practical part of the final exam in Anesthesiology and Reanimatology. A phantom-simulator was used for the manipulation, which allowed authentic simulating of a lumbar puncture. Two trainers evaluated the manual skills, independently of each other.Results. 25 (96%) residents passed the station successfully. The total time required to pass the station made 3.1 (2.58, 3.45) min. In 1 (4%) case, the student failed to gain the required number of points for the successful passage of this station. The most common mistakes during the manipulation were associated with improper control of the patient's state after the drug administration into subarachnoid space, there were 14 (54%) such cases; and in 10 (38%) cases, several attempts were required to obtain cerebrospinal fluid. The monitoring of the check-list filling incompletion demonstrated that different trainers at the station could use it. The difference in the filled check-lists was less than 5%.Conclusions. The developed check-list allows performing an objective assessment of the practical skills of graduates from the clinical residency.

The wide implementation of different regional anesthesia techniques is also actual in pediatric anesthesiology. Using modern methods of regional anesthesia (RA) and modern local anesthetics is a new level in development of pediatric anesthesiology. This article is about advantages of regional pediatric anesthesia in intra- and post-surgery pain management and analgesia. We analyse the techniques of spinal and epidural anesthesia, as well as their varieties such as unipolar spinal block and caudal anesthesia, compare their advantages and disadvantages. Some more techniques such as paravertebral block, TAP-block are considered as an alternative to epidural anesthesia. Methods and possibilities of ilioinguinal, iliohypogastric and TAP-blocks are also mentioned here. The use of the above-mentioned methods allows to reduce the use of narcotic analgesics and hypnotics and, as a consequence, reduces their systemic effects on the child’s body. These methods are safer for use, since they allow you to plan a safe anesthetic for each child and minimize complications.

The review describes modern approaches to pain relief in the patients after total knee and hip replacement. It covers the principles of multi-modal analgesia, benefits and drawbacks of such ways of pain relief as intravenous analgesia with opioids, spinal and epidural analgesia; it compares different variants of peripheral blocks, and puts some light on a relatively new method of local periarticular infiltration anesthesia.The authors agree that further research is needed to optimize post-operative pain relief after total knee and hip replacement.

The post-operative cognitive dysfunction is an adverse disorder of higher functions of the nervous system, which develops in the post-operative period and it is associated with surgery and anesthesia. The goal: to investigate the impact of sedation through spinal anesthesia on the frequency of the post-operative cognitive dysfunction after uterus amputation. Subjects and methods. 65 middle age women were examined, they all had the uterus amputated with spinal anesthesia with 15-20 mg of 0.5% hyperbaric solution of bupivicaine. Dexmedetomidine (0.5-1.2 mcg/kg per 1 hour) was used in the patients from Group 1 (28 women), and propofol (2-10 mg/kg per 1 hour) was used in Group 2 (37 women). Mini Mental State Examination (MMSE) and Montreal Cognitive Assessment (MoCA) were used for assessment of cognitive functions before and after the surgery. Results. The statistically significant difference in the level of cognitive functions was observed between the Groups on the 1st and 5th day after the surgery. The level of cognitive functions was statistically significantly higher in the group where dexmedetomidine was used versus the group where propofol was used, which provided the evidence of the minimum negative effect of spinal anesthesia with dexmedetomidine on the cognitive potential in the patients undergoing gynecological surgery. Conclusion: Spinal anesthesia with dexmedetomidine during uterus amputation reduces the risk of the post-operative cognitive dysfunction.

The articles presents the review of data about pathogenesis of stress erosive ulcer lesions of mucous coat in gastro-duodenal area. Imbalance between protection factors of mucous coat and aggression factors towards the latter (ischemia of mucous coat, microcirculation disorders in it, activation of free radical oxidation, acidopeptic factor etc) is recognized as a main pathogenic moment. The presented data are discussed from the point of view of sympathetic nervous system (SNS) for nervous trophism and its disorders – neurogenic dystrophia of internal organs caused by stress hyperactivation of SNS and consequent atrophy of its mediator of norepinephrine in the tissue of internal organs. These norepinephrine balance disorders are crucial regarding development of erosive ulcer lesions of mucous coat. Spinal anesthesia, epidural anesthesia and combined spinal-epidural anesthesia prevent development of numerous post-surgery complications when used during surgery.

Under spinal anesthesia, different types of nerve fibers forming spinal nerve roots are unequally blocked. Objective: to estimate differences in the development of temperature, sensory, and motor blockades when performing different procedures of spinal anesthesia. This prospective study covered 70 patients undergoing different operations. In accordance with the procedure of spinal anesthesia, the patients were divided into classical (n = 35) and unilateral spinal anesthesia (n = 35) groups. The performed study has indicated that blockade of temperature fibers occurs, and first, next is that of sensory neurons, and at last motor ones. The latent period of temperature blockade is about 1 min and that is an early predictor of evolving sensory block. At all stages and under traditional and unilateral spinal anesthesias, the width of temperature blockade was 1–2 segments higher than that of sensory blockade. The lower bupivacaine dosage used with the unilateral procedure gave rise to even greater block differentiation. Sensory anesthesia developed more slowly, but motor blockage did fully in not all cases.

The trail was conducted with the purpose to compare two heating devices in the groups of patients who had surgery due to varicose veins of the lower extremities with spinal anesthesia with intravenous sedation in the intra- and post-operative periods. It was found out that warming with the help of blankets with active self-heating technology is more efficient for prevention and treatment of intra-operative hypothermia compared to resistive mattresses. The article includes discussion of mechanisms of intra-operative hypothermia development, its negative effects and measures for its prevention and treatment. Recommendations on the use of this equipment are given.

The operation of total endoprosthesis replacement of large joints is associated with several anesthetic problems. Solving these problems ensures the safety of these highly traumatic operations and requires the solution of the following anesthetic tasks in the perioperative period: high degree of antinociceptive protection of patients with effective relaxation of the surgical intervention area; prevention of fatty hyperglobulinemia; decrease in the volume of perioperative hemorrhage and prophylaxis of thrombogenic complications. We developed our own program of anesthetic maintenance at major joints replacement. The components of the program are: the type of anesthesia - spinal anesthesia preservation of spontaneous respiration; our method of fat globulinemia prevention, based on maintaining the functional stability of the hepatocyte; our own method of replacement of peri-operative blood loss, based on the additional principle of "normalization of the oncotic blood pressure". Before the operation, patients receive a solution of tranexamic acid at a dose of 10 mg/kg of body mass to inhibit proteolysis (blood preservation technology). This method provides a "dry" operating field, reducing intraoperative hemorrhage. In the early postoperative period (5 hours after the surgery), under the control of whole blood clotting time, patients receive low molecular weight heparin Clexane at a therapeutic dosage of 1 mg/kg of body weight. This provides effective prevention of thrombogenic complications. The application of the developed technique shows its high clinical effectiveness. Over the past 5 years, 5,800 operations for large joint prosthetics have been performed, including 3,200 total hip replacement operations, 2,600 total knee replacement operations. There were no complications with a fatal outcome, in 5 cases fatty hyperglobulinemia was noted, which was stopped by the own method of treatment. There are no thrombogenic complications.

In recent years, the frequency of application of regional anesthesia methods, and especially in economically developed countries, has progressively increased. This paper presents the experience of high spinal anesthesia during operations on the upper part of the abdominal cavity in 112 patients. We have developed and proposed a method of simultaneous high spinal anesthesia, with the development of high neuromuscular block to the level of the first and second thoracic vertebrae. By its simplicity and technique, as well as by maintenance high spinal anesthesia is close to epidural analgesia, but unlike that it provides adequate, long-lasting and high level of pain relief of the abdominal organs. Compared to "traditional" methods of pain relief high spinal anesthesia reduces the risk of thromboembolic complications, decreases the amount of blood loss, reduces risk of developing complications from respiratory and cardiovascular systems, reduces the duration of postoperative paresis of the intestine. The use of high spinal anesthesia during operations on the upper part of the abdominal cavity is the method of choice. This type of anesthesia has advantages over other types of pain relief, and is better tolerated by patients. The proposed technique of regional anesthesia - high spinal anesthesia - has broad prospects for use in clinical practice.

Copyright of Medicina Neotloznyh Sostoanij is the property of Zaslavsky O.Yu and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Introduction: Spinal anesthesia, and any method of anesthesia, is not free of complications and side effects. Despite the fact that the use of thin pencil points, piercing a hard tire can be a headache, sometimes with a large therapeutic problem that is rarely present. Methods: The study was performed in 130 patients aged 28-84 years (mean 56.2 ± 16.2) undergoing orthopedic, urological and surgical operations. Data were obtained from the questionnaire, anesthesia card and nursing documentation and included: sex, age, medication, type and duration of the procedure, presence of degeneration of the spine, obesity, number of intervertebral fractures and complications related to anesthesia. The t-test, the two-fraction test, the Pearson chi-square independence test. Results: Early complications occurred in 43.07% of patients, with no demonstrated their relationship to the type and duration of surgery. A significant association between the age of patients and the incidence of hypotension (p

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.

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.

Copyright of Medicina Neotloznyh Sostoanij is the property of Zaslavsky O.Yu and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Objective: to study the impact the impact of surgical delivery on the time course of changes in the concentration of tumor necrosis factor-а (TNF-а), interleukin (IL)-1/8, y-interferon, IL-4, IL-6, IL-10, and neopterin in the venous blood of women with severe gestosis and to develop a method for correcting a perioperative systemic inflammatory reaction (SIR).Subjects and methods: 89 females in whom surgical delivery had been performed under spinal anesthesia were examined. A control group comprised 30 females with uncomplicated pregnancy; Group 1 included 29 females with severe gestosis; Group 2 consisted of 30 females with severe gestosis to whom the developed method of perioperative SIR correction with dexametha-sone and pentoxyphylline was applied. Solid-phase enzyme immunoassay was used to determine the peripheral blood level of the cytokines and neopterin. The study was conducted in the following steps: 1) before surgery; 2) during surgery (after aponeurosis suturing), 3), 4), and 5) on days 1, 3, and 5 postoperatively, respectively.Results. In females with uncomplicated pregnancy, surgical delivery was accompanied by increases in the concentrations of IL-1/8 and neopterin. This reaction was limited by the increased synthesis of IL-10. Beginning with the third postoperative day, there was a reduction in the level of proinflammatory cytokines. Significantly elevated venous blood concentrations of y-interferon, IL-1/8, TNF-а, IL-6, and decreased levels of anti-inflammatory cytokines, such as IL-10 and IL-4, were detectable in pregnant females with severe gestosis. Against the above background, surgical delivery caused an increase in the synthesis of proinflammatory cytokines and neopterin with the high level being within 5 postoperative days. The developed method for correction of perioperative SIR in females with severe gestosis lowered the concentrations of y-interferon, IL-1/8, TNF-а, IL-6, and neopterin and promoted the recovery of cytokine balance.Conclusion: In females with uncomplicated pregnancy, the reaction of the cytokine system during abdominal delivery is characterized by an increase in the proinflammatory potential at surgery and its reduction, beginning with the third postoperative day. This adaptive reaction of the cytokine system is aimed at enhancing the body’s anti-infectious resistance and stimulating the neuroendocrine catabolic system. Pregnancy in severe gestosis is characterized by the development of cytokine imbalance with a preponderance of proinflammatory cytokines. Surgical delivery induces activation of the mechanisms of SIR; at this background, a long phase of autoag-gression postoperatively forms, with the maximum rate being seen on the third day. The developed therapy lowers the levels of proinflammatory cytokines and neopterin, and improves T-helper cell differentiation balance, which suggests the lower activity of mononuclear phagocytes and specific cell immunity.

What option of anesthesia should be preferred if there is a need for cesarean section in pregnant women with severe preeclampsia remains unanswered so far.Objective: to evaluate the safety of spinal anesthesia (SA) in pregnant women with preeclampsia.Materials and methods. Fifty four cases of spinal anesthesia during cesarean section were analyzed in pregnant females with preeclampsia. Preoperative preparation involved an occult aortocaval compression test; lower extremity strapping up to the upper third of the hip; study of central hemodynamic parameters (cardiac index, end-diastolic volume, total peripheral vascular resistance). Preoperative central hemodynamics was examined by two-dimensional echocardiography using a Shimasonic SD1 310 apparatus. Standard monitoring of blood pressure (BP), heart rate, arterial blood oxygen saturation (SpO2) was made during anesthesia, by employing a Cardiocap II CG-CS monitor (Datex). BP was measured every two minutes until the fetus was extracted and then every 5 minutes before the puerpera was transferred to a rehabilitative ward.Results. The findings disagree with the traditional view of the negative hemodynamic effects of SA in pregnant females with preeclampsia. No cases of developed arterial hypotension were revealed in the study group.Conclusion. Spinal anesthesia strategy has been proposed, which is effective in preventing hemodynamic complications when anesthetization is made during both elective and emergency cesarean sections in pregnant females with preeclampsia.

Objective: to study the specific features of hemodynamic responses in females with gestosis in the perioperative period; to evaluate the impact of intensive care on the basis of co-administration of dalargin, dexamethasone, pen-toxifylline, and reamberin.Materials and methods. A Diamant KM-AP-01 rheograph (Saint Petersburg) was used to study hemodynamic parameters in 142 patients in whom surgical delivery was made under spinal anesthesia. A control group comprised 30 patients with uncomplicated pregnancy; Group 1 included 26 females with moderate gestosis; Group 2 consisted of 27 females with moderate gestosis who received the developed intensive care regimen; Group 3 comprised 29 females with severe gestosis; Group 4 included 30 females to whom the developed intensive care regimen was applied on the basis of the concurrent use of dalargin, dexamethasone, pentoxifylline, and reamberin.Results: A neurogenic mechanism prevails in females with moderate gestosis. The decreased baseline cardiac index is mostly due to a high postload. Surgical stress does not deteriorate postoperative circulatory parameters, which suggests that females with moderate gestosis have adequate capacities for self-regulation. As gestosis progresses to a severe degree, a role of humoral mechanisms increases in the maintenance of arteriolar spasm. Arteriolar spasm and hypokinetic hemodynamics are retained within 5 postoperative days, which is indicative of the inadequacy of self-regulation and compensatory mechanisms in overcoming two stressors: severe gestosis and surgical aggression.Conclusion: the intensive care regimen developed on the basis of combined use of dalargin, dexamethasone, pentoxifylline, and reamberin favors a more intensive (the promptest) normalization of circulatory parameters after surgical delivery in females with moderate and severe gestosis.

The paper gives the data of preoperative evaluation of autonomous nervous system tone and its correction, pharmacokinetics of local anesthetics in the subarachnoidal space, as well as the optimization of a procedure for spinal anesthesia in patients operated on for lumbosacral radiculitis.

Background: Current trends in the anesthesiology require a change in the perioperative management of patients, with a consideration of new approaches to anesthesia and the introduction of methods that reduce the stress response to surgery., Aim: To introduce the "fast-track" concept with the analysis of systemic hemodynamics and stress markers at the perioperative stage in children with urological diseases., Materials and Methods: A prospective and retrospective analysis of the results of 42 children with urological disorders treated from 09.2016 to 04.2021 under spinal anesthesia (SA) was carried out. In each case, perioperative parameters were evaluated, including central hemodynamics and biochemical markers of stress response., Results: Hemodynamic stability under SA in young children has an evidence base and a physiological explanation. Changes in stress response markers in various anesthesia methods revealed a more pronounced stress-protective effect in SA than in general anesthesia., Conclusions: Our data have shown that combined SA for urological procedures in children allows to more effectively and reliably prevent and block the manifestations of stress-induced reactions of hemodynamics and metabolism than general anesthesia. The introduction of fast-track approach in pediatric urology resulted in the faster postoperative recovery and shorter length of stay.

Introduction: Cesarean section is vastly used for child bearing. Spinal analgesia is a preferable method in Cesarean because of its fewer complications. Adding opioid to the anesthetic medicine improves the analgesic potency and quality of spinal analgesia. The purpose of this study was to evaluate the effect of regular-dose of bupivacain (marcain) and low-dose of bupivacain plus fentanyl in spinal anesthesia on neonatal apgar score and time of regression of sensory block in elective cesarean section under. Methods: This clinical trial was performed on 100 pregnant women who had chosen elective cesarean section under spinal analgesia in 2010. Patients were divided into two equal groups of 50 persons: first group received 12 mg intra theca hyperbaric bupivacain and second group received 8 mg bupivacain with additional 25 microgram of fentanyl spinal injection. Considering parameters including: duration and level of sensory block, neonatal apgar score, hemodynamic stability, and other side effects; both groups were evaluated and compared. Gathered data were analyzed by SPSS software version 11.5, T-Test, Man-Whitney and qui-square tests. P value less than 0.05 was considered statistically significant. Results: Mean age of all the participants were 28.18±5.4 (minimum age 16 and maximum age 41). Both groups were similar in age, weight, height, and hemodynamic condition. All patients had satisfactory anesthesia. The time of sensory-block regression was not statistically different in both groups (p=0.482), but the level of sensory block was higher than T4 in the first group. Median of blood pressure, pulse rate and PO2 saturation were similar in both groups (p>0.05). Ephedrine requirement (because of decrease of blood-pressure) and nausea were significantly more in the first group, (p=0.017 and p=0.014, respectively). There was no significant difference between two groups in the first minute of neonatal apgar score, but the 5th minute apgar score was significantly less in the first group (p=0.043). Conclusion: Adding fentanyl to low-dose of bupivacain provides good spinal anesthesia for cesarean section with fewer side effects, and satisfactory sensory block level but it has no adverse effect on neonatal apgar score. [ABSTRACT FROM AUTHOR]