Culture of mesenchymal stem cells isolated from the bone marrow of primates by their characteristics met the requirements of stem cells. It was shown that transplantation of allogeneic mesenchymal stem cells (2 million cells per 1 kg body weight) immediately after ligation of the left anterior descending coronary artery between the middle and upper thirds led to neovascularization and capillarization of the ischemic myocardium.
During the postoperative period, cardiological complications occupy the first position regarding morbidity and mortality rates. They depend on various factors such as compromised cardiovascular history and type of surgical intervention, features and type of anesthesia, water balance and postoperative care of the patient. To prevent complications, one should reply two questions: is there a risk of cardiovascular complications in the perioperative period and how to avoid them. The article presents a review of the literature on current views on the perioperative assessment of cardiac risks in patients undergoing noncardiac surgery.
Objective. Assessment of the efficacy and safety of epidural morphine in patients with severe concomitant injury.
Material and methods. 70 patients with severe combined injury (1745 points for ISS) were divided into two groups: in group 1 (n = 37), 2 mg of morphine was administered epidurally followed by morphine infusion 0.4 mg / h, in the 2nd group (n = 33), intravenous administration of fentanyl was used at a rate of 50100 g / h. The level of pain syndrome was assessed by a 10-point visual analogue scale (VAS). The mean arterial pressure (MAP) and heart rate (HR) at rest and with activation were recorded, the gas composition of the blood (pH, SaO2, PaCO2) was measured, and the vital capacity (VC) was measured. The evaluation of delirium was carried out according to the RASS and CAM-ICU scales. In addition, they recorded the frequency of itching.
Results. The intensity of a pain syndrome at rest was more expressed at patients of the 2nd group (p 0.05). Against the background of activation of 10,8% of patients of the 1st group and 36,4% of patients of the 2nd group experienced a pain syndrome intensity of 47 points on VAS. In patients of the 2nd group, with activation, there was an increase (p 0.05) in the indices of MAP and HR. VC in patients of the 1st group was 45.4 5.8%, in the 2nd 41.3 4.7% (p 0.005). Patients of the 1st group had a lower level of PaCO2 (p 0.05) compared with the 2nd group. Postoperative delirium developed in the 1st group in 16.2%, in the 2nd in 30.3% of patients (p 0.05). Pruritus occurred in the 1st group at 21.6% and was absent in the group with systemic administration of opioids. Opioid-induced ileus, nausea and vomiting in the 1st group were not recorded, in the 2nd group were noted in 18.2% and in 9.1% of cases (p 0.05), respectively.
Conclusion. The use of epidural morphine in patients with severe traumatic injury effective pain relief was observed, not accompanied by of the respiratory depression and changes in blood gas composition. Epidural administration of morphine in patients undergoing massive blood loss and hemorrhagic shock was not accompanied by arterial hypotension. Effective anesthesia contributed to reducing the incidence of postoperative complications.
Extracorporeal membrane oxygenation (ECMO) has been used for more than 20 years in the treatment of severe respiratory distress syndrome. However, ECMO in some categories of patients is not sufficiently covered in the literature, due to a small number of registered cases. This group includes pregnant women and women in labor. During the intensive care of such patients, the entire available range of therapeutic manipulations and measures that can favorably affect the outcome of the disease should be used. We have describe a clinical case of successful ECMO in a patient with novel coronavirus disease (COVID-19) and obstetric sepsis developed in the early postpartum period.
The authors admit the risks of blood transfusion, as well as the fact that the blood is a limited resource. These conclusions became the basis of the research in order to make an analysis and develop transfusion strategies in the hospital. An assessment of blood components application was performed in specific cases. There was changed the management of blood transfusion and further monitoring was continued. It was shown that the efficacy of an introduction of a new transfusion strategy confirmed the decrease of the rate of inappropriate blood transfusions, the quantity of patients who obtained transfusion of allogenic blood components and as a result, the new methods reduced the number of blood transfusions.
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