The article presents the theoretical justification and comparative experience in the formation of a unilateral spinal block by tachyphylaxis in urgent surgery during operations on the lower extremities. The possibility of influencing the duration and severity of motor blockade on the operated side was established using the tachyphylaxis method for administering the anesthetic without decreasing the quality of anesthesia as a whole and without increasing the amount of anesthetic administered. The possibility of reducing the development time of full anesthesia to a minimum fixation time of anesthetic on nerve tissue (10 minutes) due to preliminary «sensitization» to nerve fiber anesthetics was established. The possibility of reducing the need for postoperative analgesia by increasing the duration of the postoperative painless period has been established. Keywords: unilateral spinal anesthesia, frequency-dependent blockade, motor block.
Introduction: In the present article we draw a comparison between such types of regional anesthesia (RA) as unilateral spinal anesthesia (USA), traditional spinal anesthesia (SA) and block anesthesia of peripheral nerve trunk (block anesthesia of sciatic nerve (BASN) on the side of operative intervention) during surgical treatment of patients with the syndrome of diabetic foot. The aim of the article is to compare effectiveness, reliability and safety of such methods of RA as unilateral and traditional spinal anesthesia, as well as block anesthesia of sciatic nerve on the side of operative intervention. Materials and methods: 96 patients with the syndrome of diabetic foot, who received treatment in the department of purulent surgery, were examined. All patients underwent operative interventions of varying degrees of complexity depending on the nature and seriousness of damage degree of extremities, in terms of RA types under investigation. Effectiveness of regional block anesthesia, the time when anesthesia takes effect, duration and deepness were evaluated. Results: It should be noted that USA, as a variant of pain management during operations of foot, provides the most adequate level of surgical pain management in comparison with the other types of anesthesia. During block anesthesia of sciatic nerve more than half of patients are not provided with 100% surgical analgesia, which can lead to additional medicamentous analgosedation. According to the results obtained, pain sensitivity in patients after BASN is reliably higher than in patients after USA and SA in all stages of the study. Conclusions: RA is the main method of choice during operations on foot in comparison with the methods of general anesthesia. Unilateral spinal anesthesia is carried out with the use of smaller amount of anesthetic than traditional spinal anesthesia and block anesthesia of peripheral nerve trunk, which significantly reduces sympathectomy area and leads to the stable hemodynamic during the peri-operative period.
Актуальність. Захворювання серцево-судинної системи у світі та в Україні посідають одне з перших місць за поширеністю, смертністю та інвалідністю. Згідно з офіційною статистикою, унаслідок мозкового інсульту в Україні щорічно помирає від 40 до 45 тисяч осіб. Мета дослідження. Розробити нові та вдосконалити існуючі методи діагностики та інтенсивної терапії у критичних хворих з ішемічним інсультом. Матеріали та методи. Проведено ретроспективне, нерандомізоване дослідження 56 критичних хворих із гострим порушенням мозкового кровообігу за ішемічним типом, які перебували у відділенні анестезіології з палатами інтенсивної терапії КУ «Запорізька міська багатопрофільна клінічна лікарня № 9». Результати. Інтенсивна терапія застосовувалася згідно з Уніфікованим клінічним протоколом медичної допомоги «Ішемічний інсульт (екстрена, первинна, вторинна (спеціалізована) медична допомога, медична реабілітація)» (наказ Міністерства охорони здоров’я України від 03.08.2012 р. № 602). Висновки. У хворих із транзиторними ішемічними атаками на тлі проведення інтенсивної терапії мало місце покращення неврологічного статусу за шкалою National Institutes of Health Stroke Scale (NIHSS) практично до легкого ступеня ішемічного інсульту, проте відбувалося поглиблення церебральної ішемії. У хворих із первинним ішемічним інсультом у правій та лівій гемісферах головного мозку, руслах правої та лівої середніх мозкових артерій мало місце поглиблення церебральної ішемії за рахунок формування зони некрозу нейронів головного мозку на тлі зменшення неврологічного дефіциту. У хворих із первинним ішемічним інсультом у стовбурі головного мозку на тлі проведення інтенсивної терапії мало місце практичне нівелювання церебральної ішемії, проте неврологічний дефіцит за шкалою NIHSS характеризувався середньотяжким ступенем на всіх етапах дослідження, без тенденції до покращення.
Summary: Evaluation of the effectiveness of antibacterial therapy at different stages of necrotic pancreatitis (NP) is the most important area of scientific and practical research on the course of necrotic pancreatitis and the development of sepsis. The work is based on the results of a comprehensive examination and treatment of 54 patients with necrotic pancreatitis in the intensive care unit of city Hospital № 3, Zaporizhia in 2017-2019 pp. Objective: Optimize the use of antibacterial therapy in the complex treatment of infected forms of NP depending on the microbial spectrum of infection, the course of the disease and the development of sepsis. Material and methods of research. The study included 54 patients with infected forms of NP who were treated in the Department of Anesthesiology and Intensive Care of the 3rd City Hospital. Research results and their discussion. Thus, the analysis of antibiotic sensitivity showed that high activity against pathogens, based on the perception of the main pathogens characteristic of infected forms of NP, is observed in meropenem, taigecycline and tobramycin. When studying the species composition of microorganisms, it was found that the NP is dominated by gram-negative flora: Pseudomonas aeruginosa - 26.5%, Acinetobacter spp. - 21.2%, family Enterobacteriaceae: Klebsiella pneumoniae - 10.2% and Escherichia coli - 15.6%. Resistant strains of Ps were found in 22% of patients. Aeruginosa. The use of detoxification therapy with the inclusion of extracorporeal detoxification methods (discrete plasmapheresis) in combination with two-component antibacterial therapy (meropenem + linezolid) led to a positive trend in the course of the disease. Conclusions. Analyzing the course of the disease in patients with infected NP and its complications on the basis of constant monitoring of bacterial flora with optimal antibacterial therapy, prevention of nosocomial infection and modern strategy of surgical interventions, especially minimally invasive, noted a positive trend in the course of sepsis and sepsis.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.
hi@scite.ai
10624 S. Eastern Ave., Ste. A-614
Henderson, NV 89052, USA
Copyright © 2024 scite LLC. All rights reserved.
Made with 💙 for researchers
Part of the Research Solutions Family.