[Intraoperative and early postoperative complications of puncture-dilation tracheostomy in neurosurgical patients].

The paper provides a detailed analysis of the most common and clinically significant complications due to percutaneous dilation tracheostomy performed in 479 patients with neurosurgical diseases in 2002-2007. It also considers such complication of the technique, which is specific to neurosurgical patients, as elevated intracranial pressure (ICP), and describes a procedure of tracheostomy in patients with elevated ICP. Percutaneous dilation tracheostomy made by a skilled surgeon is shown to be effective and safe.

[Intensive care using hypervolemic hypertensive hemodilution in the acute period of subarachnoidal hemorrhages in patients with arterial aneurysms].

Cerebral vasospasm and its associated ischemia are one of the main causes of death in 23% of patients with prior aneurysmal subarachnoidal hemorrhage (SAH). At present, a diversity of approaches to treating vasospasm has been developed, among them hypertensive hypervolemic hemodilution (deriving its abbreviated name 3H-therapy) offers certain advantages. At the same time a number of aspects of application of this approach remain unclear. Fifty-four patients with significant cerebral arterial spasm (elevated linear systolic blood flow velocity > or = 200 cm/s) who had been operated on in the acute period of aneurysmal SAH were selected. Of them, 18 patients had undergone hypervolemic hypertensive hemodilution (3H-therapy) under guidance of systemic hemodynamics, by using a Swan-Ganz catheter (these patients formed a study group). Thirty-six patients who had not undergone 3H-therapy under invasive monitoring of systemic hemodynamics constituted a control group. Hypervolemic hypertensive hemodilution was performed by means of continuous intravenous infusion of a combination of colloid-crystalloid solutions. The therapy was considered to be adequate by meeting the following requirements: maintenance of cardiac index not less 3.5 l/min/m2, pulmonary capillary wedge pressure below 14-16 mm Hg or central venous pressure under to 8-10 mm Hg, packed cell volume below 28-32%, and systolic blood pressure under 200 mm Hg. Hypervolemic hypertensive hemodilution (3H-therapy) applied to patients operated on in the acute period of aneurysmal SAH was effective in increasing cardiac output, central venous pressure, systemic arterial pressure and hence cerebral perfusion with the minimum number of complications unassociated with the use of this technique. This permitted a reduction in mortality rates in patients with baseline Hunt-Hess grade I-III SAH. At the same time, it should be emphasized that 3H-therapy may be used in neurosurgical patients, by thoroughly monitoring the parameters of central hemodynamics, blood coagulation system, cerebral circulation and, desirably, intracranial pressure.

[Transcutaneous dilation tracheostomy in children].

The paper presents the experience of transcutaneous dilatation tracheostomy (TDT) in 16 children. Up to date, childhood has been a contraindication for TDT. The experience gained at the Department of Resuscitation, Institute of Neurosurgery, in performing TDT in more than 300 adult patients has permitted this procedure to be also used in childhood. Based on the analysis of the outcome of 16 TDTs, the authors have posed indications for TDT, its performance modification, approaches to preventing perioperative complications, by taking into account the anatomic and physiological characteristics of childhood.

[A rating scale and therapeutic strategy in dysphagia in patients with brain stem damage].

Dysphagia appears in 15-17% of cases after removal of tumors of the posterior cranial fossa (PCF), which is one of the most life-threatening postoperative complications due to a risk of acute airway patency impairment, possible aspiration, bronchopulmonary infectious complications. This makes prognosis workse and complicates a patient's rehabilitation. Based on the results of fibrolaryngotracheoscopic study and treatment of 1653 patients operated on for PCF tumors, the authors have developed a scale for rating the severity of bulbar disorders. The proposed scale promotes decision making on the expediency of performing tracheostomy and on the necessity of evaluating the efficiency of performed therapy (trends in bulbar disorders) and predicting the course of a postoperative period.

[Transcutaneous dilation tracheostomy in the acute period in patients with penetrating craniofacial injury complicated by intracranial hypertension].

Early tracheotomy is well founded in severe brain injury involving the facial skeleton and skull case. Intracranial hypertension interferes with the safe performance of an operation. The authors developed a procedure for safe paracentetic dilatation tracheostomy (PDT) in the acute phase of severe brain injury. The study covered 15 patients with severe brain craniofacial injury. Surgery was made under intravenous anesthesia (with hypnotics, myorelaxants, narcotic analgesics, and cholinolytic agents). PDT was performed by the combined procedure developed by Sigley and Griegse ("Portex and COOK") under endoscopic guidance (Karl Storz 11001 BN1), by displaying the images. The patient is put to bed, without placing a bolster under the shoulders, the bed head end being elevated at an angle of 30 degrees. Bronchoscopic monitoring was made discretely (20-60 sec) under artificial ventilation through a special connector. There were 3-6 sessions of bronchoscopies. Tracheostomy lasted as long as 24 hours in 5 patients, 48 hours in 12 patients; surgery was made in 7 patients on day 3 after injury. Prior to tracheostomy, a horizontalization test was conducted, which revealed an elevation of intracranial pressure (> or = 20 mm Hg). There were no episodes of intracranial hypertension during tracheostomy. PDT can be safely made in patients with intracranial hypertension when they are put to bed, without placing a bolster under the shoulder, the bed head end being elevated at an angle of 30 degrees under discrete bronchoscopic guidance.