[Using of tranexamic acid (Tranexam) for prevention and correction of coagulopathy during brain tumors removal].

The aim of the study is to estimate clinical effectiveness of fibrinolysis inhibitor Tranexam in neurosurgical patients with intracranial tumors. The medication was prescribed to 78 patients from 27 to 65 years old. The control group consisted of 57 patients. The following criteria were assessed to estimate the impact of the medication on hemostasis: APPT, PT index, TT, fibrinogen, ATIII activity, factor XII-derived fibrinolysis, spontaneous euglobulin lysis. Blood sampling was drawn at the following stages: after the induction of anesthesia, before Tranexam injection, 30 minutes after Tranexam injection, on the next day after the surgery. Blood from jugular and peripheral veins was analyzed simultaneously. The medication caused significant decrease of fibrinolytic activity. The use of Tranexam was followed by bleeding reduction in the wound. The duration of surgical hemostasis in the main group was 11,7 +/- 3,3 minutes which is significantly lower than in the control group (18,1 +/- 3,1 minutes) (p = 0,034). Drainage blood loss was lower in the main group (267 +/- 23 ml a day) than in the control group (340 +/- 28 ml a day). Medication injection during diffuse bleeding from small vessels led to quick and visible bleeding reduction. Thus Tranexam decreases the risk of intraoperative blood loss in the patients with brain tumors.

[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.

[The role of rivastigmine (exelon) in the treatment of consequences of cranial-brain trauma].

The use of rivastigmine in the rehabilitation of patients with cognitive disturbances after cranial-brain trauma (CBT) is reviewed. Replacement of cholinergic deficit exerts a positive effect on sanogenetic process in the brain, facilitate consolidation and learning of afferent information in the restoring brain. The authors emphasize that the administration of neuromediator preparations needs the level of organization of integrative brain activity which is sufficient for the formation of awakening reaction (opening of eyes - awakening from coma). It is suggested that neuromediator preparations, in particular cholinesterase inhibitor rivastigmine, should be used after the acutest CBT period, i.e. at least 2-3 weeks after CBT, when the main acute processes have been stabilized.

[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.