[The intraoperative prophylaxis of local ischemical brain damage in neurosurgical patients with cerebral aneurysm]. / Intraoperatsionnaia profilaktika lokal'nogo ishemicheskogo povrezhdeniia golovnogo mozga u neirokhirurgicheskikh patsientov s tserebral'noi anevrizmoi.

AIM: To study the effectiveness of intraoperative administration of Cytoflavine for the prevention of ischemic brain injury during cerebral aneurysm (CA) clipping with temporary occlusion of the leading artery under general anesthesia. MATERIAL AND METHODS: The prospective cohort single-center study included 40 patients with CA ( the main group - 27 patients with intraoperative administration of cytoflavine; the comparison group -13 patients without use of cytoflavine), who underwent aneurism clipping with temporary occlusion of the afferent artery. We assesed the intraoperative state of the brain, the time of awakening and extubation of patients after surgery, neurological deficit and local ischemic changes in the area of surgery according to the CT of the brain in the early postoperative period, resuscitation bed-day and the relationship of these indicators with the duration of temporary occlusion of the afferent artery in the selected groups of patients. RESULTS: In intergroup comparison, patients of the main group treated with intraoperative cytoflavin showed a reduction in the time of awakening (p=0.013) and the time of extubation (p=0.01) both with temporary occlusion of the afferent artery and in patients without temporary occlusion (p<0.05). The duration of resuscitation bed-day decreased in the main group of patients receiving intraoperatively cytoflavine (p=0.01), as well as in patients in the comparison group without temporary occlusion (p<0.05). CONCLUSION: Temporary occlusion of the afferent artery with short intervals of vessel occlusion in combination with intraoperative intravenous administration of cytoflavine expands the tolerability to artery occlusion in patients operated in the 'cold' period, reduces the possibility of neurological deficit, reduces the recovery period and resuscitation bed-day after surgical clipping CA.

[Clinical case of cesarean, combined with convexital giant meningioma resection in adolescent girl].

The article deals with a case of successful surgical treatment of 16 years old patient with giant meningioma of right temporal, parietal and frontal lobes. Patient was on a 32 week of pregnancy and she had a Caesarean section before meningioma treatment. The article discusses the problems of anaesthesiological, surgical and obstetric tactics.

[Specific features of anesthetic management of surgical treatment of malignant tumors of the skull base].

Neurosurgical interventions on the skull base including craniofacial block-resections were fulfilled on 36 patients aged from 16 through 73 years. Preoperative management of the patients was made mainly at the intensive therapy room. It included correction of water-electrolyte, protein metabolism, anemia. The key moments in the anesthetic management of such operations were maintenance of an adequate level of neurovegetative blockade, sufficient level of volemia by means of creating hypervolemic hemodilution, prophylactics of air embolism.

[Pre-emptive analgesia in the complex of multicomponent general anesthesia in pediatric neurosurgery].

The study enrolled 30 patients aged 2 to 18 years, who had been operated on at the Prof A. L. Polenov Russian Neurosurgical Institute in 2008-2009. The patients had undergone total intravenous anesthesia with the opioid analgesic fentanyl (3.5 microg/kg x hr), the central alpha 2-adrenoblocker clofelin (1.2 microg/kg x hr), recofol (3 mg/kg x hr) under myorelaxation (arduan, esmeron) and artificial ventilation. Assessment of a neuroendocrine response and postoperative analgesia levels by the physiological and self-appraisal scales showed the high efficacy of pre-emptive analgesia using paracetamol in the complex of multicomponent anesthesia using the central alpha 2-adrenoblocker clofelin.

[Using solutions of hydroxyethyl starch (6% HES 200/0.5 (refortan) and 6% HES 130/0.4 (voluven)) in neuroanesthesiology].

The paper provides the results of a complex experimental and clinical study of the effects of infusion solutions of hydroxyethyl starch (HES 200/0.5--Refortan and HES 130/0.4--Voluven) on hemostatic and systemic hemodynamic parameters in patients operated on for neurosurgical pathology of the brain. The HES solutions are shown to have a more pronounced volemic effect and a slightly higher hypocoagulation effect on the hemostatic system (as compared with physiological solution); the latter does not, however, achieve its clinical value with the used doses of the solutions.

[Experience with using of solutions of hydroxyethyl starch (refortan and voluven) in neuroanesthesiology].

The investigation has shown that solutions of hydroxyethyl starch included in complex infusion therapy facilitate stabilization of hemodynamics in neurosurgical patients during surgery. Refortan exerts a more pronounced effect on the indices of hemodynamics as compared with voluven, but its modifying action on the hemostasis system is also more pronounced. These medicines used in doses 6-8 ml/kg fail to have substantial effects on efficiency of hemostasis in the brain wound and do not increase risk of postoperative hemorrhagic complications.

[Total intravenous anesthesia with propofol, fentanyl and clopheline in young children with occlusive hydrocephalus during ventriculoperitoneal shunting]. / Total'naia vnutrivennaia anesteziia s ispol'zovaniem propofola, fentanila i klofelina u detei rannego vozrasta s okkliuzionnoi gidrotsefaliei pri operatsiiakh ventrikuloperitoneal'nogo shuntirovaniia.

Total intravenous anesthesia with propofol, fentanyl, and clonidine was used in infants aged under 1 year operated on for occlusive hydrocephalus. The course of anesthesia in 18 patients with the hypertensive hydrocephalus syndrome is analyzed. Four of these patients with an extremely grave premorbid history and body weight of 1-3 kg were operated on before the age of 2 months. Propofol can be used in infants aged under 1 year, including physiologically immature small-for-date infants. Clonidine, an alpha 2-adrenoagonist, used in older neurosurgical patients and adults for stabilizing cerebral perfusion pressure, is allowed in infants, too. The authors analyze the time course of central hemodynamics during anesthesia with propofol, fentanyl, and clonidine and anesthesia by other drugs (combined anesthesia with ketamine and opioid analgesics, neuroleptanalgesia).