[Caudal anesthesia and its determinant factors].

In 130 surgical patients with diseases and injuries in the area of the perineum and lower extremities the clinical effects of three modern local anesthetics: 2% solution of lidocaine, 0.5% solution of bupivacaine, 0.75% solution of ropivacaine and their combinations (2% lidocaine and 0.25% bupivacaine solution 2% lidocaine and ropivacaine 0.375% solution) were followed with regard to the influence of increasing volumes of local anesthetics and different rates of drug administration. It is established that an effective caudal anesthesia is provided with all modern local anesthetics, with increasing use of local anesthetic solution to 40 ml provides duration and the prevalence of sensory and motor blocks, the use of mixture of local anesthetics optimizes the development and maintenance of the caudal blockade.

[Sacral anesthesia, perspectives today].

The paper summarizes the experience of Russian and foreign specialists in dealing with the theoretical and practical aspects of sacral anesthesia. It presents anatomic data and information on the pathophysiological aspects and potentialities of clinical use of sacral anesthesia in modern anesthesiological practice that estimate its perspectives at this stage.

[Efficacy and safety of sevoflurane in various anesthesia modes (according to the results of a multicenter study)].

The paper presents the results of the limited multicenter sevoflurane study initiated by Abbott Lab, which was conducted in 2006. The study was undertaken to examine the efficacy and safety of sevoflurane in various anesthesia modes in patients (ASA I-III) with surgical diseases during surgical interventions into abdominal and thoracic organs and lower extremities. The study covered 96 patients. The analysis indicates that the use of sevoflurane for mask induction and anesthetic maintenance is possible and safe for patients with ASA I-III.

[Use of the epiglottic airway I-gel during anesthetic maintenance: first clinical impressions].

The paper gives a concise account of the evolution of epiglottic airways and the emergence of the new product of this class--I-gel (Intersurgical, United Kingdom). It outlines the structural features of I-gel and the authors' experience in using the latter to maintain airway patency during anesthetic maintenance in 34 patients. Based on a review of the scanty data available in the literature on this airway and their clinical experience, the authors come to the conclusion that there is a great variety of I-gel inherent positive characteristics that make this airway highly promising for the needs of current anesthetic maintenance and, possibly, resuscitative care. The authors consider it expedient to expand the use of I-gel to specify the evaluation of its efficiency and competitive capacity of the epiglottic airways that have already well shown themselves.

[The anesthesiological support for limb segment replantations (20 years' experience)]. / Anesteziologicheskoe obespechenie replantatsii segmentov konechnostei (20-letnii opyt).

Anesthesias for urgent replantations of the limb segments in 1980-1998 are analyzed. A retrospective analysis of case histories and protocols of anesthesia of patients aged 16-64 years is carried out. Specific features of anesthesia for surgery of this kind are demonstrated. The authors suggest an algorithm of preoperative treatment of patients, determined by the severity of injury, and discuss the choice of anesthesia: variants of regional anesthesia, balanced anesthesia based on conduction blocking, and balanced anesthesia with forced ventilation of the lungs. Special attention is paid to components of anesthesia which regulate adequate bloodflow in revascularized segments of the limbs: infusion-transfusion therapy with attaining the hypervolemic hemodilution, maintenance of thermal homeostasis, prevention of "toxic shock" during incorporation of the replanted segment into the bloodflow, and strategy of patient's awakening after long operation and anesthesia.

[Subarachnoidal anesthesia: the limits of its potentials]. / Subarakhnoidal'naia anesteziia: predely vozmozhnostei.

A total of 250 subarachnoidal anesthesias (SA) have been performed in patients operated on the lower limbs, perineum, external genitals, pelvic organs, and anterior abdominal wall at department for plastic and reconstructive surgery. The efficacy and safety of SA in everyday practice has been evaluated. A total of simultaneous 228 SA with three hyperbaric solutions were carried out: 5% ultracaine, 0.75% bupivacaine, 0.5% marcaine, and one isobaric solution 0.5% bupivacaine. Prolonged SA was administered to 10 patients and combined spinal-epidural anesthesia (CSEA) to 19. The sensory block was assessed by the pin prick test and the motor blocking by Bromage score. Of the central segmentary blockades, SA has been preferred for the above-listed interventions in recent years. Hyperbaric and isobaric solutions caused analgesia of different duration, latent period, and dissemination of the anesthetic under different clinical situations. Prolonged SA is justified in patients with limited hemodynamic reserves, and CSEA should be preferred when the expected duration of the intervention is longer than the estimated duration of SA effects. SA is an effective and safe method for surgical anesthesia on condition of proper choice of the local anesthetic, use of high-quality kits, and strict adherence to the protocol of subarachnoidal puncture and injection.

[Shivering and rigor during the awakening period]. / Drozh' i oznob v periode probuzhdeniia.

Muscular hyperactivity presenting as shivering and rigor during the awakening period after 116 surgeries with the use of microsurgical technique under balanced NLA-based anesthesia was studied. In some cases ketamine (0.5 to 0.75 mg/kg) and trilene (0.3 to 0.5 vol.%) were used at the stage of tissue revascularization under conditions of controlled and uncontrolled thermal loss. The efficacy of special drug (ketamine, trilene) and nondrug (warming measures) components of anesthesia preventing shivering and rigor was demonstrated. A correlation between the intensity of muscular hyperactivity and the degree of recovery of pain sensitivity (r from -0.73 to -0.98) and the level of consciousness recovery (r from 0.69 to 0.92) was revealed. The policy of treatment of shivering and chill was selected with due consideration for these data. Efficacies of tramal (96%) and ketamine (80%) were demonstrated. Nubain was found absolutely unfit for the purpose.