[COMBINED SPINAL-PARAVERTEBRAL ANESTHESIA IN TOTAL HIP ARTHROPLASTY.]

BACKGROUND: Optimizing analgesia in total hip arthroplasty contributed to the idea of combined use of spinal and paravertebral anesthesia. THE AIM: the clinical evaluation of combined spinal-paravertebral anesthesia in patients undergoing total hip ar- throplasty. MATERIALS AND METHODS: 67 patients were divided into groups: at the first a combined spinal-paravertebral anesthesia (KSPA) was used, the second - a combined spinal-epidural anesthesia (CSEA). The location of the lumbar plexus was determined by ultrasound scan. Spinal component was provided 0.5% ropivacaine solution. In the perioperative period propofol infusionfor sedation was used. After operation infusion of 0.2% ropivacaine solution at a rate of5-6 ml/hour was started through the catheter for 48 hours. The postoperative period was assessed pain intensity on a 10-point visual analog scale (VAS), the needfor analgesics, incidence of complications and patient satisfaction with the quality of anesthesia. RESULTS: The lumbar plexus at the L2-3 level was in 29,9%- immediately after the release ofthe intervertebral holes, in 67.2%- in the psoas major muscle at L4-5 level of 80.1% in the psoas major muscle. In both groups postoperative pain intensity within 48 hours does not exceed 3, VAS scores. The frequency of complications in the postoperative period was against the background of paravertebral blockade of 18.2%, against the backdrop of epidural analgesia - 26 5%. 90.1% ofpatients in the first group and 82.4% ofpatients in the second group were fully satisfied with the chosen method of anesthesia (p> 0.05). CONCLUSIONS: Combined spinal-paravertebral block for total hip arthroplasty is an effective and safe method of pain relief.

[Professional dysadaptation syndrome in anesthetists-resuscitators].

The professional dysadaptation syndrome (PDS) has just recently been recognized in Russian medicine and regarded as a response to long-term professional stresses. PDS has a high tropicity for educated anesthetists-resuscitators (AR) whose profession is socionomic and high-technonomic. Irrespective of the length of service, psychoemotional stress in AR is significantly higher than that in surgeons. Typical PDS, the so-called alexithymia, the psychological characteristics of a personality, which includes a difficulty in defining and describing his/her own emotions, was identified in 82% of anesthetics and in only 57% of surgeons. Alexithymia is considered as a risk factor of cardiovascular and gastrointestinal diseases. Its correction assumes psychotherapeutic care in the conventional forms. However, only 7.6% of the respondents agreed to be questioned.

[The Foundation for European Education in Anesthesiology (FEEA): the first steps in Russia].

The mission, structure, and working schedule of the Foundation for European Education in Anesthesiology (FEEA), an international non-profitable organization with 70 regional centers in Europe, Central and South America, Africa, and Asia, which are organized in 2006-2007 in Saint Petersburg by the Association and Society of Anesthesiologists and all the Anesthesiology Departments of the city are given. Today's geography of FEEA, dedicated to ESA diploma (DESA) exam training, is expanding in Russia.

[Prophylactics of postpuncture syndrome after central neuroaxial blockades].

The article presents data of an analysis of anesthesiologic maintenance of 3410 cesarean sections under conditions of spinal and epidural anesthesia. A detailed examination of 378 women has shown that frequency of the development of postinjection syndrome depends on the area of the defect of dura mater and the volume of lost cerebrospinal fluid. Postinjection syndrome can be prevented by using special needles leaving a less defect in dura mater and by introduction of 10-15 ml of sterile isotonic solution of sodium chloride into the epidural space.

[Correction of hemodynamic changes during aortofemoral bifurcation bypass surgery under combined epidural anesthesia].

Assessment of hemodynamic parameters in 50 patients before aortofemoral bifurcation bypass surgery could identify 3 types of baseline central hemodynamics and differentiate methods for correcting its disorders. It was ascertained that the development of the intraoperative reperfusion phenomenon during epidural block might predispose to the low cardiac output syndrome for which correction ganglionic blockers are effective at the stage of aortic ligation and a combination of inotropic agents and venous vasodilators is beneficial at the stage of reperfusion.

[Regional anesthesia: combined spinal epidural anesthesia].

The review deals with the promising method of regional anesthesia--combined epidural anesthesia. It gives indications for anesthesia, the specific features of its technical performance, and possible complications.

[European Foundation for Education in Anesthesiology (FEEA): the first steps in Russia].

The mission, structure, and working schedule of the Foundation for European Education in Anesthesiology (FEEA), an international non-profitable organization with 70 centers being located in Europe, Central and South Americas, Africa, and Asia, are described in the article. The first FEEA seminars in Russia were organized in St. Petersburg in 2006-2007 by the Association and Society of Anesthesiologists and by all the anesthesiology departments of the city. Today's geography of FEEA seminars dedicated to European Society of Anesthesiology diploma exam training is expanding in Russia.

[Effects of epidural blockade on the indices of central hemodynamics in operations of the aortofemoral bifurcation shunting].

The aim of the investigation was to study the mechanisms of arterial hypotension in the development of epidural blockade and to work out differentiated correction of disorders of the central hemodynamics at the stage of surgical intervention depending on the initial state of the cardio-vascular system. Three main types of the preoperative state of the central hemodynamics indices were defined in patients after operation on the abdominal part of the aorta. To prevent hemodynamic shifts in response to epidural anesthesia it is necessary to carry on differential therapy depending on the type of the preoperative state of hemodynamics including dosed infusion therapy, and for the development of syndrome of low cardiac output an inotropic support with Dobutamin is to be used.

[The clinical evaluation of some preparations for postoperative epidural anesthesia]. / Klinicheskaia otsenka nekotorykh preparatov dlia posleoperatsionnoi épidural'noi anestezii.

The drugs under study may be disposed as follows according to the efficiency of postoperative epidural anesthesia: pyromecain, clophelin, trimecain-albumin complex. Most effective are clophelin and trimecain-albumin complex. All the three drugs exert an inconsiderable influence on indices of central hemodynamics. The use of clophelin and trimecain-albumin complex reduces loading the medical personnel. Clophelin is most expedient economically.

[Use of central analgesia in emergency abdominal operations]. / Primenenie tsentral'noi anal'gezii pri ekstrennykh abdominal'nykh operatsiiakh.

In 48 patients urgent operative interventions on organs of the abdominal cavity were performed against the background of the adequate central analgesia by phentanyl (0,02 mg/kg). The authors think the method to be inexpedient in operative interventions shorter than 60 min.