BACKGROUND: Perioperative myocardial injury (MI) and MI after noncardiac surgery (MINS) makes a significant contribution to the structure of complications and mortality in non-cardiac surgery, including those in traumatology. Spinal anesthesia (SA) is usually used for hip surgery. It may be accompanied by arterial hypotension, which, under certain conditions, becomes a leading factor in MI development. Features of both hypotension and MI in patients with concomitant cardiovascular pathology operated on for hip injury remain insufficiently studied.
AIM: To determine the frequency of intraoperative arterial hypotension and MI after intraosseous osteosynthesis of the hip under spinal anesthesia in patients with concomitant cardiovascular pathology.
MATERIAL AND METHODS: In 275 patients with concomitant cardiovascular pathology, intraosseous synthesis of the hip was performed with SA. The functional class of the patients was assessed according to the American Society of Anesthesiologists scale and the risk of cardiac complications according to the Revised Cardiac Risk Index scale. Blood pressure, heart rate, electrocardiogram, and ST segment were monitored. Before surgery and 13 days thereafter, the troponin T level was measured. The frequency of MI and surgical outcomes were assessed.
RESULTS: In the studied sample of patients with hypertonic disease, arterial hypotension associated with SA was observed in 34.2% of cases. Its frequency increased from 15.7% in patients without other comorbidities to 42.9% in patients with a combination of hypertonic disease, CAD, and CHF. A significant relationship was noted between arterial hypotension and MI. A highly sensitive troponin test revealed a significant incidence of myocardial damage (18.2%), and the associated 3-day mortality was 4%.
CONCLUSION: SA-induced arterial hypotension is associated with MI risk and appears to be the most dangerous in patients with a combination of hypertonic disease, CAD, and CHF. Monitoring of troponin T levels in patients with risk factors of MI is one of the ways to reduce postoperative mortality and improve surgery outcomes.
The aim of the study was to determine the efficacy and safety of the bilateral suprazygomatic maxillary nerve block for cleft palate repair in children with congenital malformation, cleft palate. The study was carried out on 55 patients with primary cleft palate repair. The average age of the patients was 1 year 8 months6 months. Patients were divided into 2 groups. In the main group, general anesthesia, local anesthesia and bilateral suprazygomatic maxillary nerve block were performed. In the control group, general anesthesia and local anesthesia were performed. The severity of the pain syndrome in children was assessed according to the FLACC scale. In addition, the dose opioid analgesics (tramadol) was taken into account on the 1st day; satisfaction with anesthesia and analgesia. Results for the main group: FLACC indicators were kept longer at a low level; less consumption of opioid analgesics. No complications were observed on the bilateral suprazygomatic maxillary nerve block. The bilateral suprazygomatic maxillary nerve block for primary cleft palate repair in children provides a better quality of anesthesia, and, especially postoperative analgesia.
The 64 patients with severe acute pancreatitis at admission in hospital arterial hypertension, low venous saturation of oxygen (ScvO2), hyperlactemia, oligoanuria and hypercreatininemia were observed. This occurrence became an indication for infusion therapy to recover and optimize hemodynamics. After 6 hours of therapy, 30 patients were lacked increasing of diuresis related to infusion load and hypercreatininemia increased and also significantly increased positive fluid balance s compared to other patients. These 30 patients were additionally applied hemofiltration during 66 hours. The infusion therapy was characterized by difficulty of restoration and optimization of hemodynamic, large volumes of infusion mediums та frequent application of sympathomimetics. In patients without hemofiltration a significant increasing of cumulative fluid balance was added. The hemofiltration permitted to normalize diuresis, to prevent surplus cumulation of fluid and to support blood circulation at the optimal level.
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