[POSSIBILITY OF ENHANCING OF THE TRANSPAPILLARY INTERVENTIONS EFFICACY, APPLYING OPTIMIZATION OF THEIR ANESTHESIOLOGICAL SUPPORT].

In 2015 yr еndoscopic transpapillary interventions (ЕТI), performed for diseases of the hepatopancreatoduodenal zone organs, were done in 697 patients. In 315 (45.2%) of them ЕТI were diagnostic, in 382 (54.8%) ­ performed with treatment objective. Меdicinal support for the ЕТI conduction in 631 (90.5%) patients have included conduction of superficial sedation and local anesthesia of pharynx. Аnesthesiological support was applied in 66 (9.5%) patients, including total intravenous anesthesia ­ in 11 (16.6%), еndotracheal narcosis ­ in 55 (83.4%). Using of general anesthesia in comparison to superficial sedation creates more favorable conditions for the ЕТI performance, what have permitted to reduce their duration and complications rate twice.

Superficial temporal artery-middle cerebral artery bypass using local anesthesia and a sedative without endotracheal general anesthesia.

OBJECT: Superficial temporal artery (STA)-middle cerebral artery (MCA) bypasses have continually evolved, and new strategies have been advocated for reducing anesthetic or surgical morbidity and mortality. Further simplifying, and decreasing the invasiveness of, STA-MCA bypass by performing this operation without endotracheal general anesthesia was believed to be feasible in certain subsets of patients. METHODS: The authors performed STA-MCA bypass using local anesthesia with a sedative in 10 patients with hemodynamically compromised occlusive cerebrovascular disease, as well as multiple comorbidities, between February 2010 and September 2011. The technique is based on the preoperative identification of the point at which the donor and recipient vessels are in closest proximity. Preoperative use of CT angiography allowed the authors to identify the target point precisely and use a minimally invasive procedure. All patients received dexmedetomidine as the sole sedative agent, together with scalp-blocking local anesthesia, with an unsecured airway. RESULTS: Successful STA-MCA bypass surgeries were achieved via a preselected minimally invasive approach in all cases. There was good hemodynamic stability throughout surgery. No airway or ventilation complications occurred, and no patients were converted to general anesthesia. Subjectively, patients tolerated the technique well with a high rate of satisfaction. There were no perioperative morbidities or deaths. Postoperative MR angiography confirmed a patent bypass in all patients. All patients remained symptom free and returned to normal daily life following the operation. CONCLUSIONS: This initial experience confirms the feasibility of performing STA-MCA bypass without endotracheal general anesthesia. This novel technique produced a high degree of patient satisfaction.

[Experience in the use of midazolam in esthetic surgery]. / Opyt primeneniia midazolama v klinike ésteticheskoi khirurgii.

Anesthesias with midazolam are described. The drug has a favorable effect on the course of anesthesia and consciousness recovery. The authors claim that midazolam can virtually supersede other benzodiazepines in anesthesia for esthetic surgery.

[Ophthalmic surgery with local anesthesia or intubation anesthesia at the Leipzig University Ophthalmology Clinic]. / Ophthalmochirurgie in Lokalanästhesie oder Intubationsnarkose an der Augenklinik der Universität Leipzig.

BACKGROUND: Different opinions about the reliability and serious complications after regional anesthesia have been reported. The paper describes our experiences in deciding about regional or general anesthesia for ophthalmic surgery. PATIENTS AND METHODS: For this report we analyzed retrospectively our protocols of all operations performed in 1995. Eight categories of procedures were developed to give an insight in our way of decision for local or general anesthesia. We imagine the applied technique of peribulbaranesthesia. RESULTS: 3184 patients were operated on in 1995, in the regional anesthesia group the age ranges from 17 to 96 years, in the general anesthesia group from 3 months to 85 years. In 69.9% of all patients we performed a local anesthesia and in 30.1% we chose general anesthesia. The spread of cases and the surgical procedure corresponding to one of these eight classes below are described in this survey. CONCLUSIONS: Almost 70% of our patients who underwent an ophthalmosurgical procedure were operated on under regional anesthesia. No serious complications have occurred and no procedure had do be stopped off due to an insufficient analgesia or akinesia. We demonstrate some observations concerning the duration of pain after the injection and our indications for general anesthesia in ophthalmic surgery.

[Choices of anesthesia in operations of extraction of foreign body in esophagus].

In order to probe the anesthetic methods of extracting foreign body in esophagus and improve operative effect, potentiated surface anesthesia and intratracheal intubation anesthesia were applied in operations to 72 cases of foreign bodies in esophagus, and comparative observations were done to these cases. All the cases had their foreign bodies extracted smoothly and no serious complications occurred. We consider that each anesthetic method has its advantage. The former is suitable for the adolescents and adults, the latter is suitable for the young children who have foreign bodies in esophagus and difficult breathing.

[Intubation requirements after rocuronium and succinylcholine]. / Intubationsbedingungen nach Rocuronium und Succinylcholin.

OBJECTIVE: Rocuronium is a new non-depolarising steroidal muscle relaxant with a short onset time. The present study was undertaken to compare intubating conditions as well as onset and clinical duration of a single dose of 0.6 mg/kg (2 x ED95) with a single dose of 1 mg/kg suxamethonium (3 x ED95). METHODS: After obtaining informed consent and approval of the Ethics Committee, 40 adult patients (ASA I-III) participated in this study. After premedication with oxazepam, anaesthesia was induced with fentanyl and propofol and maintained with propofol, N2O and supplements of fentanyl as needed. Muscular relaxation was assessed by EMG recording of adductor pollicis muscle after supramaximal single twitch stimulation of the ulnar nerve every 10 s. Patients were allocated randomly to receive either rocuronium 0.6 mg/kg or suxamethonium 1 mg/kg. The following parameters were measured: intubating conditions 60 s after injection, onset time and clinical duration of neuromuscular block, % block at intubation, heart rate, blood pressure and arterial oxygen saturation. RESULTS: (mean +/- SD). Intubating conditions after rocuronium and suxamethonium were found to be clinically acceptable (excellent or good) in 90% of patients, though there was only a partial blockade of the adductor pollicis muscle with rocuronium (71 +/- 23%) compared to suxamethonium (95 +/- 14%) (p < 0.05). The onset time and clinical duration of relaxation was shorter after suxamethonium (p < 0.05) and occurred at 0.8 +/- 0.2, 7 +/- 2.1 and 3.2 +/- 1.3, 29 +/- 11 min after suxamethonium and rocuronium respectively. CONCLUSION: At a dosage of 0.6 mg/kg, rocuronium has an onset time of about 3 min and a clinical duration of relaxation of nearly half an hour. These data are supported by various studies, while others show shorter times, probably due to different monitoring techniques. In spite of the pharmacodynamic differences between suxamethonium and rocuronium, the intubating conditions after administration of both compounds are comparable and develop at the same rate.

Anestesia balanceda en la cirugía maxilofacial del niño / Balanced anesthesia in pediatric maxillofacial surgery

Sesenta pacientes pediátricos tratados con cirugía maxilofacial fueron operados con anestesia general endotraqueal, utilizando un tipo de"anestesia balanceda". Como agente de inducción se empleó el tiopental sódico, como agentes de mantenimiento al oxígeno y al óxido nitroso combinados con la administración de fentanilo y dehidrobenzoperidol, y como relajante muscular succinilcolina. Además, se utilizó anestesia local infiltrativa en el área quirúrgica. Con esta ténica se logró de una forma armónica y equilibrada la estabilidad en el nivel de anestesia y en el aparato cardiovascular, que permitió ademá una fase posanestésica tranquila, necesaria para proteger las reparaciones quirúrgicas (AU)

Anestesia balanceda en la cirugía maxilofacial del niño / Balanced anesthesia in pediatric maxillofacial surgery

Sesenta pacientes pediátricos tratados con cirugía maxilofacial fueron operados con anestesia general endotraqueal, utilizando un tipo de"anestesia balanceda". Como agente de inducción se empleó el tiopental sódico, como agentes de mantenimiento al oxígeno y al óxido nitroso combinados con la administración de fentanilo y dehidrobenzoperidol, y como relajante muscular succinilcolina. Además, se utilizó anestesia local infiltrativa en el área quirúrgica. Con esta ténica se logró de una forma armónica y equilibrada la estabilidad en el nivel de anestesia y en el aparato cardiovascular, que permitió ademá una fase posanestésica tranquila, necesaria para proteger las reparaciones quirúrgicas

Anestesia balanceda en la cirugía maxilofacial del niño / Balanced anesthesia in pediatric maxillofacial surgery

Sesenta pacientes pediátricos tratados con cirugía maxilofacial fueron operados con anestesia general endotraqueal, utilizando un tipo de"anestesia balanceda". Como agente de inducción se empleó el tiopental sódico, como agentes de mantenimiento al oxígeno y al óxido nitroso combinados con la administración de fentanilo y dehidrobenzoperidol, y como relajante muscular succinilcolina. Además, se utilizó anestesia local infiltrativa en el área quirúrgica. Con esta técnica se logró de una forma armónica y equilibrada la estabilidad en el nivel de anestesia y en el aparato cardiovascular, que permitió además una fase posanestésica tranquila, necesaria para proteger las reparaciones quirúrgicas.

[Interaction between vecuronium and pancuronium].

Interaction between vecuronium bromide (VB) and pancuronium bromide (PB) with regard to a change in duration of action was investigated in 32 elective surgical patients divided into four groups. Initial and supplemental drugs were as follow; group I: VB-->VB, group II: PB-->VB, group III: VB-->PB, group IV: PB-->PB. The muscle response was quantified electromyographically. Anesthesia was induced with thiopental. VB or PB 0.08 mg.kg-1 (initial dose) was given to facilitate endotracheal intubation. Anesthesia was maintained with 66% nitrous oxide and 2% sevoflurane in oxygen. Supplemental dose (0.015 mg.kg-1) of the muscle relaxants was administered at 10% recovery of twitch height. Duration of action was defined as the interval between administration and 10% recovery. Duration of action of supplemental doses of VB was significantly longer in group II than in group I. That of PB was significantly shorter in group III than in group IV. Therefore, it should be noticed that duration of action of supplemental relaxant is largely modified by the initial one.

CT quantitation of tracheal cross-sectional area as a guide to the surgical and anesthetic management of children with anterior mediastinal masses.

Pediatric patients presenting with anterior mediastinal masses between January 1980 and November 1988 were reviewed to assess the correlation between tracheal cross-sectional area and anesthetic risks. Forty-two patients had evaluable computed tomography (CT) scans and underwent a surgical procedure. Thirty-four patients had Hodgkin's disease, six had non-Hodgkin's lymphoma, and two had mediastinal teratoma. Tracheal cross-sectional areas were greater than 75% of expected in 19 cases, greater than 50% to 75% in 16 cases, greater than 25% to 50% in five cases, and less than or equal to 25% in two cases. The presence or extent of symptoms did not correlate well with the degree of tracheal narrowing shown by CT scan except for orthopnea. Local anesthesia was used primarily in patients with significant tracheal narrowing (tracheal size was less than or equal to 56% in 5 of 6 patients). General anesthesia with spontaneous ventilation by mask was performed in four patients with tracheal areas of 33%, 73%, 76%, and 98% of expected. General endotracheal anesthesia was utilized in the remaining 32 patients, only three of whom had tracheal areas of less than 50% of expected (down to 30%, 26%, and 24% of expected) and one received preoperative radiotherapy (26%). None of these 32 patients had symptoms of orthopnea or dyspnea at rest, and only one had dyspnea on exertion. All tolerated anesthesia without difficulty. No patient in this series suffered respiratory or cardiovascular collapse during surgery. Adequate biopsy material was obtained in all cases.(ABSTRACT TRUNCATED AT 250 WORDS)

Local anaesthesia for fibreoptic bronchoscopy: comparison between intratracheal cocaine and lignocaine.

In a double-blind study of 60 patients undergoing fibreoptic bronchoscopy we have compared the local anaesthetic effects of intratracheal injections of cocaine (4 ml, 2.5%) and lignocaine (4 ml, 4%). The two local anaesthetics were equally effective in terms of cough suppression, requirement for extra local anaesthetic, patient discomfort and operator acceptability.

[An evaluation of the effect of certain factors on the hemodynamics during anesthesia induction in stomach cancer patients]. / Otsenka vliianiia nekotorykh faktorov na gemodinamiku v period induktsii v anesteziiu u bol'nykh rakom zheludka.

Hemodynamic response to induction to anesthesia and tracheal intubation was assessed in 132 patients with gastric cancer divided into groups depending on the method of induction. Group I was administered thiopental sodium at a dose of 4-5 mg/kg, group II--thiopental sodium at the same dose and fentanyl (1.5 micrograms/kg), group III--thiopental sodium at the same dose with local laryngeal anesthesia using a 10% lidocaine solution, group IV--propanidid (4-5 micrograms/kg), and fentanyl (1.5 micrograms/kg), group V--thiopental sodium at the same dose and fentanyl (3-5 micrograms/kg), group VI--diazepam (15-20 mg) and fentanyl (3-5 micrograms/kg). Tracheal intubation followed dithylin injection without premedication. It has been established that adequate analgesia achieved by fentanyl (3-5 micrograms/kg) administration is the main factor that has a stabilizing effect on circulation during induction to anesthesia involving tracheal intubation. Lower drug doses and local laryngeal anesthesia proved effective in less than one third of patients. Circulatory response to pressor-depressor induction factors depends significantly on the baseline cardiac output and BP values and to a lesser extent on circulating blood volume (CBV) deficiency. Preoperative volume expansion with 12-15 ml/kg infusions stabilizes circulation parameters even in the absence of CBV deficiency, which confirms the functional nature of hypovolemia in patients with gastric cancer.

[Anesthesia in the surgical treatment of fractures of the proximal end of the femur]. / Obezbolivanie pri operativnom lechenii perelomov proksima'lnogo otdela bedrennoi kosti.

The article generalizes experience in anesthesiological management of 178 elderly and old-aged patients with fractures of the proximal segment of the femur in endoprosthesis with a Mura-Cito prosthesis, 3-flange nail, Shesterni's fixation device, arched nail, etc. In contrast to endotracheal anesthesia and local anesthesia with neuroleptanalgesia potentiation, prolonged epidural anesthesia in 51 patients produced adequate intra- and postoperative anesthesia without causing respiratory complications and depression and facilitated early activation of the patient. Prolonged epidural anesthesia had advantages over other types of anesthesia in this category of patients.

[Decrease in paO2 following intratracheal application of a local anesthetic and a 0.9% sodium chloride solution. A prospective study on the use of fiberoptic bronchoscopy in ventilated patients during local anesthesia]. / paO2-Abfall nach intratrachealer Applikation von Lokalanaesthetika und 0.9%iger Natriumchloridlösung. Eine prospektive Untersuchung zur Anwendung der Fiberbronchoskopie bei beatmeten Patienten in Lokalanaesthesie.

Flexible fiberoptic bronchoscopy of intubated patients can be performed in general or local anesthesia (LA). Up to now, no results have been published on the effects of LA for bronchoscopy in ventilated patients. We studied the hemodynamic changes caused by bronchoscopy under LA in mechanically ventilated patients and the effect of LA on the endoscopic decline in arterial pO2. Differences between the widely used agents lidocaine and oxybuprocaine hydrochloride were also studied. We found a decline in paO2 after the administration of LA and further investigated the influence of bronchial lavage on paO2. METHOD. A total of 70 ventilator patients, excluding patients with atelectasis, massive mucous-plug retention, and those under muscle relaxants, were examined in a surgical intensive care unit. In 40 long-term ventilator patients bronchoscopy was performed with either oxybuprocaine hydrochloride 1% (Novesin) (group 1; n = 20) or Lidocaine 1% (Xylocaine) (group 2; n = 20) (2-3 ml LA in repeated doses into the trachea and main bronchi; total amount 10 ml). We looked for hemodynamic changes and effects of LA on the bronchoscopic decline in paO2. In 15 long-term ventilator patients (group 3), LA was applied without bronchoscopy to investigate the duration of the LA-caused decline in paO2. In 15 intubated patients (group 4), the influence of intratracheal administration of 10 ml normal saline was examined. Patient data are shown in Table 2. Measurements were performed in groups 1 and 2 before and after LA, immediately after bronchoscopy and 15, 30, and 60 min after bronchoscopy and in groups 3 and 4 before and 5, 15, 30, and 60 min after LA. RESULTS. There was no effect on cardiocirculatory function during bronchoscopy in LA, but we found a decrease in paO2 after administration of LA in all patients (median in group 1 from 100 to 78 mmHg in group 2 from 104 to 86 mmHg). The subsequent bronchoscopy caused only a small, nonsignificant further decline in paO2. The administration of LA without bronchoscopy (group 3) was followed by a fall in paO2 from 86 +/- 12.5 to 69 +/- 11.7 mmHg (mean +/- SD) with oxybuprocaine hydrochloride and from 87 +/- 12.4 to 72 +/- 8.7 mmHg with lidocaine. Even after 30 min the paO2 had not returned to the initial value. The intratracheal application of 10 ml 0.9% NaCl caused a decline in paO2 from 101 +/- 20 to 78 +/- 12 mmHg (mean +/- SD), which also persisted for more than 30 min. CONCLUSIONS. The study shows that in ventilator patients undergoing fiberoptic bronchoscopy in LA, the administration of the LA is an essential factor in the decline in paO2 associated with bronchoscopy. A similar fall in paO2 is observed by intratracheal