THE USE OF DEXMEDETOMIDINE IN COMBINATION NEFOPAM FOR POSTOPERATIVE ANALGESIA AFTER LAPAROSCOPIC CORRECTION OF MORBID OBESITY.

AIM: To study the possibility of using a combination of dexmedetomidine with nefopam for postoperative analgesia in patients with morbid obesity after bariatric surgery in anesthesia quality aspects and theimpact of the study on the combination during the inflammatory response to surgical trauma. SUBJECTS AND METHODS: A prospective cohort study of 48 patients with obesity. RESULTS: Based on the analysis of hemodynamic parameters, evaluation of pain using a numeric rating scale pain concluded that selective agonist of o-2 adrenergic dexmedetomidine in combination with nefopam provides effective postoperative pain relief in patients who underwent bariatric surgery, and is not a factor for suppression of postoperative inflammatory response Unlike the effects of ketorolac tromethamine, do not always provide a sufficient level of analgesia and reduce the rate of growth in the level of IL-6. CONCLUSION: The combination of dexmedetomidine with nefopam provides sufficient analgesic effect after bariatric surgery, with noted a more rapid onset of analgesia than with ketorolac. Postoperative analgesia and dexmedetomidine nefopam, unlike the use of ketorolac tromethamine, are not violated ratio of interleukins 1 and 6 was not a factor and suppression of postoperative acute phase inflammatory response.

TRA.NSTHORACIC PUNCTURE BIOPSY IN DIAGNOSTICS OF FOCAL LESIONS OF THE LUNG.

The transthoracic puncture biopsy was performed under surveillance of X-ray computed tomography in order to verify diagnoses in 80 patients with lung tumors. This procedure allowed verification of diagnosis and choice of treatment strategy in 95% of cases. The complications obtained as result of intervention didn't bring severe character and were arrested in term of two days.

[Treatment of complete pancreatic ruptures and their complications]. / Lechenie polnykh razryvov podzheludochnoi zhelezy i ikh oslozhnenii.

24 victims with complete ruptures of the pancreas underwent operations of the occlusion of pancreatic ducts, distally to the site of injury. There were no lethal outcomes in these cases. 16 patients were examined in follow-up period from 2 to 10 years, no signs of endocrine insufficiency were revealed in any case; moderate exocrine insufficiency was detected in 2 patients. There were no signs of chronic posttraumatic pancreatitis in any of the examined patients.

[Use of calcium channel blockers for prophylaxis of multiple organ failure in acute destructive pancreatitis]. / Blokatory kal'tsievykh kanalov v profilaktike poliorgannoi nedostatochnosti pri destruktivnom pankreatite.

The purpose of this study was to investigate effectiveness of the usage of calcium channels blockers and plasmaleukopheresis in prophylaxis of the syndrome of polyorganic insufficiency (SPI) in patients with acute destructive pancreatitis. 30 patients operated on for pancreonecrosis were divided into 2 groups: study group (13 patients) and control one (17 patients) matched for sex, age, extent and character of changes in the pancreas. Taking into account a substantial role of hyperactive neutrophils in pathogenesis of SPI, Verapamil (dose of 0.5 mg/kg/day) and discrete plasmaleukopheresis were included in the complex of treatment for patients of the study group. Effectiveness of the treatment was assessed according to the quantity of complications, lethality values of leukocytosis and leukocyte index of intoxication (LII) as well as by the scale of the severity of sepsis (SSS). Complicated postoperative course was seen in 41.18% of cases in the control group and 23.07%--in the study one. Lethality in the control group made up 11.8% (2 patients); there were no lethal outcomes in the study group. Anearlier decrease in leukocytes count, LII and SSS in the study group was significant. The conclusion is made on effectiveness of the use of calcium channels blockers and discrete plasmaleukopheresis for prophylaxis of SPI in acute destructive pancreatitis.

[Occlusion of pancreatic ducts in pancreonecrosis]. / Okkliuziia protokov podzheludochnoi zhelezy pri pankreonekroze.

The article deals with the results of treatment of acute experimental necrosis of the pancreas by occlusion of its duct system with Adgenol. This led to authentic reduction of the level of trypsin, amylase, and middle mass molecules and improvement of the microhemocirculation parameters. The microscopic organization in the regional lymph nodes was normalized 3 hours after occlusion of the pancreatic ducts. The ultramicroscopic anatomy of the endothelial cells of the microvessels in the lymphatic sinuses was stabilized, leading to restoration of effective transendothelial transport. The method was used in 11 patients in the clinic. A good clinical effect was produced in 10 patients. There were no fatal outcomes.

[The surgical treatment of malignant tumors of the head of the pancreas and of the periampullary area]. / Khirurgicheskoe lechenie zlokachestvennykh opukholei golovki podzheludochnoi zhelezy i periampuliarnoi oblasti.

Under analysis are results of pancreatoduodenal resections in 71 patients. In patients with mechanical jaundice lymph drainage with sorption and return of lymph into the vascular bed was used during the preoperative preparation. Occlusion of the duct system of the pancreas stump with glue KL-3 was performed on 62 patients, in 9 patients choledochocholecysto-anastomosis was used in order to improve the quality of the biliodigestive opening. A cryoprocedure on the nonremoved portion of the tumor was performed in 3 cases on the posterolateral surface of the portal vein. These measures allowed the postoperative lethality to be reduced up to 11.2%.

[Surgical tactics in acute cholecystitis]. / Khirurgicheskaia taktika pri ostrom kholetsistie.

More active surgical tactics is recommended in acute cholecystitis, which consists in a tendency to solve the question of an emergency operative intervention in the first 24 hours after admittance to the clinic and the performance of postponed operations on the 3rd-5th day. This leads to increase of surgical activity, decrease of the frequency of complicated forms of acute cholecystitis and total and postoperative mortality and postoperative complications, and a shorter period of hospital stay.

[Continuous peridural anesthesia in thoraco-abdominal surgery in children]. / Prodlennaia peridural'naia anesteziia v torakoabdominal'noi khirurgii detskogo vozrasta.

The authors have generalized the experience of using continuous peridural anesthesia in 204 children of different ages after operations on thoraic and abdomenal organs in acute pneumonias and marked enteroparesis. The efficiency of this method (96,1%) is shown. The authors believe the continous peridural anesthesia to be the method of choice after injuring operations and in stable enteropareses caused by peritonitis, pneumonia.