[Effect of small-doses ketamine on postoperative pain management with combinations morphine/ketoprofen or lidol/ketoprofen after major gynecological surgery] [corrected].

We examine the potential beneficial effect of small-doses ketamine on postoperative pain management with combinations morphine/ketoprofen or lidol/ketoprofen after major gynecological surgery. After patient written consent, 50 healthy women, which were scheduled for abdominal gynecological surgery were randomly allocated into two groups depending of postoperative analgesic technique--morphine/ ketoprofen or lidol/ketoprofen. The quality of postoperative analgesia, total opioid consumption for the first postoperative day and unwished side effects were assessed. Demographic and surgical data were identical in the groups. Using ketamine during the anesthesia improve quality of postoperative analgesia in accordance with less opioid consumption for the combination morphine/ ketoprofen, but not for the combination lidol/ketoprofen. Adding small doses ketamine to combination morphine/ketoprofen improve postoperative analgesia; reduce morphine consumption and incidences of morphine-related side effects after major gynecological surgery.

[Diprivan versus midazolam in combined anaesthesia with ketamin for minor gynecological surgery].

We tested the hypothesis that diprivan/ketamine (D/K) anesthesia would offer advantages compared to midazolam/ketamine (M/K) in patients undergoing minor gynecological surgery. After patient written consent, 60 healthy women, which were scheduled for elective termination of pregnancy were randomly allocated into two groups. Operating conditions, recovery, pain, postoperative nausea and vomiting (PONV) and patient's satisfaction to anesthesia were assessed. Demographic and surgical data were identical in the groups. Immediate recovery was faster with patients given diprivan than midazolam. Patients receiving M/K experienced more PONV in recovery room. D/K is preferable method of anesthesia for ultra-short gynecological procedure compared to M/K because of faster recovery and decreased incidence of PONV.

[Immunological aspects of postoperative analgesia after abdominal hysterectomy].

BACKGROUND: Prostaglandins modulate cytokine release though increases in cAMP, regulating interleukin-6 and interleukin-10. Ketoprofen inhibits cyclo-oxygenase activity and hence prostaglandin production. AIM: We hypothesized that ketoprofen would affect release of IL-6 and IL-10 and modulate the immune response. METHOD: We have evaluated 40 women, divided into four groups by the model of postoperative pain treatment: control group (only opioid) and experimental group (combination of i.v. ketoprofen and opioid). Serum IL-6 and IL-10 were measured before surgery, 24 and 72 hours after skin incision. Due to days in hospital we detected temperature and severe complications. RESULTS: IL-6 increased at 24h and normalized at 72h. In contrast IL-10 did not change significantly. CONCLUSION: The two models of postoperative analgesia have both modulated immune response after abdominal hysterectomy in same way.

[Usage of the new parenteral selective cox-2 inhibitor dynastat in the gynecologic practice].

A follow-up of 180 women was carried out. The patients having endured different gynecological operations (laparoscopy, laparohysterectomy, etc.) were divided into two main groups: half of them were treated with Dynastat (new selective COX-2 inhibitor) and the others were treated with Profenid (conventional nonsteroidal anti-inflammatory drug). The groups were compared by the quality of the achieved analgesia and appeared side effects, especially postoperative nausea and vomiting. These parameters were assessed by both medics and patients. In conclusion we accept that the new COX-2 selective inhibitor Dynastat does not have advantages over traditional nonsteroidal anti-inflammatory drug as Profenid especially for postoperative nausea and vomiting and quality of analgesia.

[Modern aspects of perioperative analgesia by using nonsteroidal anti-inflammatory drugs in gynecology (Part II)].

It is an actual problem how to treat acute postoperative pain by using nonsteroidal anti-inflammatory drugs. Modern concepts for perioperative administration of these drugs are very important for the usual practice. The possibilities for optimal application of nonselective or selective COX-2 inhibitors are examined in this review.

[Modern aspects of perioperative analgesia by using nonsteroidal anti-inflammatory drugs in gynecology (Part I)].

It is an actual problem how to treat acute postoperative pain by using nonsteroidal anti-inflammatory drugs. Modern concepts for perioperative administration of these drugs are very important for the usual practice. The possibilities for optimal application of nonselective or selective COX-2 inhibitors are examined in this review.

[Use of low molecular weight heparin (Clexane) together with selective COX-2 inhibitor (Dynastat--once or twice per day)].

A follow-up of forty women was carried out. The patients having endured a gynecological operation (laparohysterectomy) were divided into two groups: group A--treated with Dynastat (40 mg/24h) and group B--treated with Dynastat (80mg/24h) which was combined in both groups with Clexane. The hematological and hemostatic parameters were evaluated during the early postoperative period--the first 24 hours. The women were followed until they were discharged from hospital. No significant changes of these laboratory parameters were noticed and the clinical stability of the patients in both groups was unaffected. The results showed that Dynastat/Clexane combination could be applied in the clinical practice as it proved great extend of safety for usage after gynecological operations.

[Progress in methods of therapeutical abortions during the second trimester in gynecological clinic "Umbal - Pleven"].

The aim of the authors is to discover the progress in the methodology for the interruption of pregnancy by medical indications during the second trimester in Gynecological clinic in UMBAL - Pleven. A retrospective study has been performed for the used methods in the last 10 years. For the same period were performed abortions in 49 women by medical indications. The interruption of pregnancy until the 16th gestational week (g.w.) of gestation was performed in one-stage. From the 16th g.w. to the 20th g.w., the most common method till the year 2001 was intraamniotic instillation of 25% solution of NaCl by Aburel (1934). After the 20th g.w. the pregnancy was interrupted either by metrierasis (using balloon catheter), or by sectio parva. After the 2001 was described radical change in conduct by therapeutic abortion during the second trimester, after the beginning of the prostaglandins use in obstetrical practice. The authors analyze the results of the use of prostaglandins describing the type, dosage of used medicine, period of abortion, contraindications and the risk for the mother. They reach to the conclusion that the prostaglandins are presently suitable means for therapeutical abortion during the second trimester, which fully replace the classical, traumatically and risky methods for the pregnant woman.

[Enteral versus parenteral administration of a single dose of profenid after gynecological laparoscopy].

The aim of our study is to compare analgesic effect of single dose Profenid (Sanofi-Aventis)--100 mg administered per rectum or intravenously in woman endured gynecological laparoscopy (LS). We have evaluated 40 woman (divided into two groups each one of 20) sustained planned laparoscopy in department of gynaecology. The effect of administered Profenid over the postoperative pain has been estimated after standard general anaesthesia due to different objective and subjective parameters. As a result of our study we consider that postoperative analgesia with Profenid applied intravenously or by suppository is effective enough method for postoperative analgesia after laparoscopy in gynecology.

[Administration of Perfalgan (paracetamol) for postoperative analgesia in obstetrics and gynaecology].

The aim of our study is to determine the quality of postoperative analgesia by using of Perfalgan (injectable paracetamol)--alone or in combination with other analgesics for different operations in obstetric and gynecology. We have evaluated 60 women, divided into four groups each one of 15 according to the kind of surgical intervention: section cesarean, laparoscopy, laparohysterectomy or cystectomy. The effect of administered Perfalgan over postoperative pain was estimated by different objective and subjective parameters after standard general anesthesia. As a result of our study we consider that postoperative analgesia with Perfalgan is suitable enough after section cesarean and laparoscopy. As a component of multimodal analgesic combination it gives a good quality of postoperative pain relief in condition of laparohysterectomy or cystectomy. It is very important that this is without any adverse effects.

[Profenid or veral for the postoperative analgesia in gynaecology]. / Profenid ili veral za sledoperativno obezboliavane v ginekologiiata.

We present our results for study and assessment of efficacy in accordance with postoperative analgesia with single dose Profenid (ketoprofen) or Veral (diclofenac) administrated per rectum. We studied 60 patients divided in two groups--group 1 (analgesia with Profenid) and group 2 (analgesia with Veral). All patients received standard endotracheal anesthesia for elective gynaecologic operations. We have assessed quality of the postoperative analgesia by: Ta--time of analgesia (time for first want of analgesics by patient), VRS (verbal rating score), VAS (visual analogue score), PONV (postoperative nausea and vomiting) and sedation rate.

[Antibiotic prophylaxis on treatment outcome after gynecologic surgery]. / Vliianie na antibiotichnata profilaktika vurkhu izkhoda ot lechenieto sled ginekologichni operatsii.

The aim of our study is to estimate advantages and disadvantages of some antibacterial drugs which were used for prevention from infections in the early postoperative period. Our study is retrospective and involved all women which were undergoing different operations in department of gynaecology for the period January 2000 until June 2004. Due to a large number of patients and long period of time which were evaluated our study shows assume data for efficacy of different antibacterial drugs and drug combination when we using them for prevention. It is very interesting for the authors result about relationship between price-efficacy-durance ot hospital being.

[Ketamine at low doses + etomidate or diazepam--a comparative clinical study of anesthesia in urology]. / Ketamin v niski dozi + etomidat ili diazepam--sravnitelno klinichno prouchvane na obezboliavaneto v urologiiata.

Eighty urological patients, divided in two equal groups, are anesthesized using two anaesthetic combinations: small dose kaliposol + etomidate, or diazepam. The obtained results point to a stability of the arterial pressure and pulse rate and prompt recovery, rendering the kalipsol-etomidate combination an alternative to the kalipsol-diazepam one which is well affirmed in urological practice.

[The clinical and anesthesiological aspects of ambulatory pediatric urological operations]. / Klinichni i anesteziologichni aspekti na ambulatornite detski urologichni operatsii.

Over a five-year period, a total of 838 children, aged 0.5 to 15 years, undergo surgical treatment in the urological clinic, accounting for 16.49 per cent of all operations performed. Of the total number of children subjected to surgery, 772 (92.12 per cent) are operated on an outpatient basis which is 15.19 per cent of all operations. In case of correct assessment of the indications and contraindications, the postoperative anesthesiological and clinical complications prove to be rather low--less than 0.5 per cent, and what is more, they are of a mild nature and do not threaten the life and health of the patient. The combination ketalar+diazepam, administered intravenously at small doses, is recommended as the most suitable anesthesia for outpatient urological operations in pediatrics. It secures good anesthesia with a residual analgetic effect lasting 3-4 hours postoperatively.

[Ketamine analgesia with low (subanesthetic) doses during endoscopic urological operations]. / Ketaminova analgeziia s malki (subanestetichni) dozi pri endoskopski urologichni operatsii.

The aim of the study is analgesia of patients in urologic practice with unusual (subanesthetic) ketamine doses from 0.5 to 1 mg/kg body mass. It was applied in 50 men 50 to 70 years of age for the period 1986-1988--in 40 for transurethral resection (TUR) and in 10 for urethrotomy. The average duration of the operative interventions was 25 minutes. After standard premedication--droperiodol, phentanyl, atropine, 30 to 40 minutes before the operation ketamine 0.5--1 mg/kg and diazepam 0.2 mg/kg were administered intravenously and in case of need--maintenance dose from 0.25 to 0.50 mg/kg. Pulse rate, breathing rate and arterial pressure were followed up. Analgesia was evaluated by anesthesiologist, operator and patient. The disadvantages, which have been avoided and the advantages over other types of anesthesia, as well as the final positive assessment, allow recommendation of this form of anesthesia in urologic practice.