RESUMEN
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.
Asunto(s)
Anestesia/métodos , Monitoreo Intraoperatorio/métodos , Procedimientos Neuroquirúrgicos/métodos , Cuidados Preoperatorios/métodos , Neoplasias de la Base del Cráneo/cirugía , Base del Cráneo , Adolescente , Adulto , Anciano , Anestésicos/administración & dosificación , Anestésicos/efectos adversos , Humanos , Persona de Mediana Edad , Evaluación de Resultado en la Atención de Salud , Flujo Sanguíneo Regional , Base del Cráneo/irrigación sanguínea , Base del Cráneo/patología , Base del Cráneo/cirugía , Neoplasias de la Base del Cráneo/metabolismo , Neoplasias de la Base del Cráneo/patología , Equilibrio HidroelectrolíticoRESUMEN
The purpose of the study was to define the parameters of intraoperative monitoring, which allowed the prediction of complications due to surgery for posterior cranial fossa in children and the planning postoperative treatment tactics. The hypnotic propofol and a combination of the narcotic analgesic fentanyl and alpha 2-adrenoblocker clofelin were used to induce and maintain anesthesia. All patients were operated on in the sitting position. Hemodynamic parameters, arterial blood saturation, end-expiratory carbon dioxide tension, and central venous pressure were intraoperatively studied. As electrophysiological monitoring, the authors studied electroencephalograms and brainstem auditory evoked potentials by an Indeaver monitor (Nicolet). The investigators analyzed readings and data on admission to the operating suite, at the stages of anesthesia maintenance and surgery. The findings were used to define indications for anesthesia using the narcotic analgesic fentanyl and alpha 2-adrenoblocker clofelin in the postoperative period.
Asunto(s)
Presión Sanguínea/fisiología , Frecuencia Cardíaca/fisiología , Monitoreo Intraoperatorio/métodos , Procedimientos Neuroquirúrgicos/métodos , Neoplasias Supratentoriales/cirugía , Adolescente , Anestesia Intravenosa/métodos , Bradicardia/diagnóstico , Bradicardia/etiología , Niño , Preescolar , Fosa Craneal Posterior/cirugía , Electroencefalografía , Humanos , Lactante , Procedimientos Neuroquirúrgicos/efectos adversos , Valor Predictivo de las Pruebas , Taquicardia/diagnóstico , Taquicardia/etiologíaRESUMEN
An investigation of the clinical picture of 4671 patients with associated cranio-cerebral traumas treated at the hospitals of Saint Petersburg in 2004 has shown that the clinical picture of associated traumas unlike that of isolated cranio-cerebral traumas have an atypical character with the development of pseudo-syndromes of injury of the brain. Extracranial injuries also have atypical manifestations with little symptoms. The diagnosis of associated cranio-cerebral trauma must include radial and little-invasive methods of examination.
Asunto(s)
Traumatismos Craneocerebrales/diagnóstico , Electroencefalografía/métodos , Traumatismo Múltiple/diagnóstico , Ultrasonografía Doppler Transcraneal/métodos , Adolescente , Adulto , Femenino , Estudios de Seguimiento , Humanos , Masculino , Persona de Mediana Edad , Pronóstico , Estudios Retrospectivos , Índices de Gravedad del Trauma , Adulto JovenRESUMEN
Clinico-statistical characterization of 661 subjects who died from combined cerebro-cranial traumas in hospitals of St. Petersburg in 2004 is presented with an analysis of the quality of medical care rendered to them. Most of those subjects had severe combined injuries with dominating or markedly seen signs of combined cerebro-cranial traumas. The main cause of death was most frequently a severe combined trauma of the body (52%) and different complications of trauma disease (36.3%). In the process of complex expert assessment of the quality of medical care each case was referred to one of three categories of outcomes: avoidable, conventionally avoidable and unavoidable. The groups of subjects with avoidable and conventionally avoidable outcomes (53.6%) are considered to be a substantial reserve for improvement of the results of treatment of combined cerebro-cranial traumas.
Asunto(s)
Lesiones Encefálicas/epidemiología , Lesiones Encefálicas/terapia , Mortalidad Hospitalaria/tendencias , Traumatismo Múltiple/epidemiología , Traumatismo Múltiple/terapia , Calidad de la Atención de Salud , Población Urbana , Adolescente , Adulto , Femenino , Humanos , Masculino , Estudios Retrospectivos , Federación de Rusia/epidemiología , Índices de Gravedad del TraumaRESUMEN
An analysis of clinico-neurological and electrophysiological examinations of 88 patients before and during the operation enabled the authors to establish substantial pathomorphological and functional distinctions of gunshot and not gunshot injuries of the nerves, difference in results of various operative procedures.
Asunto(s)
Traumatismos de los Nervios Periféricos , Heridas por Arma de Fuego/diagnóstico , Plexo Braquial/lesiones , Plexo Braquial/cirugía , Terapia Combinada , Terapia por Estimulación Eléctrica , Electromiografía , Humanos , Terapia por Láser , Examen Neurológico , Nervios Periféricos/cirugía , Cuidados Posoperatorios , Técnicas de Sutura , Resultado del Tratamiento , Heridas por Arma de Fuego/terapiaRESUMEN
The investigation of blood flow in injured nerves in 14 patients by the method of hydrogen clearance has revealed substantial difference of the blood flow value in children and adults. The authors consider that it may be of significance for the interpretation of differences in the course of regeneration in patients of different age.