[Clinical application of dexmedetomidine in patients after thoracic and abdominal surgeries].

OBJECTIVE: To study efficacy and safety of dexmedetomidine application for long-term (more than 12 hours) artificial lungs ventilation (ALV) and for psychomotor agitation. METHODS: We studied 57 patients after thoracic and abdominal surgeries. The patients were divided into three groups. Patients of a group-1 (n=18) received ALV under 12 hours, patients of group-2 (n=26) received ALV more than 12 hours. Patients of group-3 (n=13) received dexmedetomidine due to delirious state. Dexmedetomidine was administered by infusion 0.7 mkg/kg during the first hour. The rate of administration was corrected after the first hour. We recorded the level of sedation according to RASS, need of additional sedative drugs use, duration of ALV duration of ICU stay. RESULTS: Dexmedetomidine infusion provides target level of sedation from 0 to -3 according to RASS in 91% of patients requiring prolonged ALV after thoracic and abdominal surgeries. Bradycardia occurred in 15% of patients and arterial hypotension in 12% of patients. Bolus administration of dexmedetomidine should be avoided.

[Comparison of analgesics using two devices for the patient-controlled analgesia].

INTRODUCTION: A pilot unicenter blind placebo-controlled study comparing different analgesics was conducted in parallel groups, by concurrently using two patient-controlled analgesia (PCA) apparatuses in one patient, was conducted Subjects and methods. The study included patients after laparotomy. Group I patients (n=22) were proposed 2 PCA apparati, one of which contained trimeperidine solution and the other did placebo. Group 2 patients (n=17) were proposed 2 PCA apparatuses, one of which contained trimeperidine solution and the other did lornoxycam. PCA was adjusted in the same manner in both apparati. The patients were asked to determine which analgesic is best in providing 24-hour analgesia. RESULTS: There were no differences in the intensity of pain between the groups. The latter did not differ in the number of adverse reactions. Comparison showed no significant differences in the use of trimeperidine between Groups 1 and 2 patients. Among Group 1 patients, 61% considered trimeperidine as the best analgesic and 22% did placebo; 17% called none. Group 2 patients chose trimeperidine in 41% of cases and lornoxycam in 41%, none was called in 18%. CONCLUSION: Comparative assessment of analgesics, by employing 2 PCA apparatuses in one patient, allows evaluation of the efficacy of analgesics added to the conventional methods.

[Does pre-emptive analgesia really pre-empt?].

The paper discusses the theoretical background and practical rationale for a concept of pre-emptive analgesia. It gives the results of studying the efficacy of lornoxicam that outstrips the infliction of a surgical injury in different anesthesia modes (combined total and intravenous combined multicomponent anesthesia with epidural block). A hundred thirty-seven patients who had undergone laparoscopic cholecystectomies (Group 1) and expanded interventions for colorectal cancer (Group 2) were examined. The examination provided no evidence for the efficiency of pre-emptive analgesia with lornoxicam during perioperative anesthesia in patients undergone moderately and highly traumatic abdominal interventions.

[Efficacy and safety of lornoxicam in an early postoperative period].

AIM: To compare quality of anesthesia with opioid drug and nonsteroid anti-inflammatory drugs in 123 patients after extensive operative interventions of the lungs and trachea, abdominal organs, lower limbs. MATERIAL AND METHODS: Patients of group 1 took lornoxicam for relief of postoperative pain syndrome, those of group 2--promedol. Quality of anesthesia was assessed by visual-analogue and verbal scales, day dose of analgetic drug, administration of promedol, side effects incidence. RESULTS: Lornoxicam in a dose 8 mg intravenously has comparable with 20 mg promedol analgetic effect. This justifies its use as a basic analgetic for treatment of acute pain after extensive surgery. Lornoxicam allows surgeons to do without opioids in 10-45% patients or to reduce their dose by 32-65%. CONCLUSION: Adequate anesthesia with lornoxicam and promedol early after surgery on the chest and abdominal organs, major vessels of the lower limbs occurs in 82 and 87% patients, respectively. Lornoxicam administration as continuous intravenous infusion and controlled analgesia in older patients eliminates the need in opioid analgetics in 45% cases and is well tolerated.

[Clinical aspects of analgesia with intravenous paracetamol in the early postoperative period].

This open one-center study included 40 patients operated on the abdomen and chest, who had moderate resting pain in the immediate postoperative hours. Paracetamol was used as a dropwise intravenous 1-g infusion for 10-15 min; the dose of the agent was 4 g. The interval of paracetamol re-infusion was not early than 4 hours. If additional analgesia was required, opioid analgesics (promedol, tramadol) were administered. As a whole, assessment of analgesia within 24 hours showed excellent and good results reported by patients in 85% of cases; and in 71% of the patients the intensity of postoperative pain was less than they had expected before surgery. The use of opioid analgesics was required in 65% of the patients and 25% did not need these agents. The remaining 10% of the patients received a combination of nonsteroidal anti-inflammatory drugs, paracetomol, and opioids. Postoperative analgesia based on the intravenous infusion of paracetamol in a single dose of 1 g (4 g/day) caused a reduction in the intensity and duration of pain. The intravenous formulation of paracetamol should be regarded as one of the essential nonopioid components of multimodality therapy for pain in patients in the early postoperative period.

[Clinical aspects of using patient-controlled analgesia with nonsteroidal anti-inflammatory agents in postoperative period]. / Klinicheskie aspekty primeneniia kontroliruemoi patsientom analgezii nesteroidnymi protivovospalitel'nymi sredstvami v posleoperatsionnom periode.

We used lornoxicam (n = 16) and ketorolac (n = 20) to study the possibilities of applying the non-steroid anti-inflammatory drugs within the postoperative patient-controllable analgesia (PCA). With respect to a used analgetic, the frequency rate of good PCA anesthetic results was found, on day 1, to be 60-77%. The good anesthetic results were registered in 25% of patients when the routine scheme was in use. Non-steroid anti-inflammatory agents (lornoxicam, ketorolac) can be prescribed within the early postoperative PCA as basic analgetics, which essentially reduces the need in promedol without worsening the analgesia efficiency.

[Study of analgesic efficacy of propacetamol in the postoperative period using a double blind placebo controlled method]. / Izuchenie anal'geticheskoi éffektivnosti propatsetamola v posleoperatsionnom periode dvoinym slepym platsebo-kontroliruemym metodom.

The efficiency and safety of postoperative use of propacetamol was estimated in 30 patients by means of double blind placebo controlled method. The first group consisted of 15 patients to whom propacetamol was introduced intravenously in single dose of 2 g along with patient controlled anesthesia with promedol. Placebo in combination with patient control anesthesia were used in 15 patients from the 2nd group. Intravenous introducing of propacetamol in dose of 2 g in 15 minutes provides relief of pain intensity in postoperative period. So it permits to consider propacetamol as basic non-opioid analgesic. In early postoperative period combination of propacetamol and opioid analgesic (promedol) reduces demands in the latter by 44%.

[Use of lornoxicam for analgesia in the early postoperative period]. / Primenenie lornoksikama dlia obezbolivaniia v rannem posleoperatsionnom periode.

Lornoxicam was used for analgesia in 64 patients on days 1-2 after extensive interventions. The drug efficiency and safety were evaluated depending on the dose and route of administration. Intravenous infusion of lornoxicam in a daily dose of 24 mg (basic therapy) did not involve the use of opioids in 35% patients and its analgesic effect was higher than that of promedol monotherapy. Combined therapy with lornoxicam and promedol allows reduction of promedol dose by 25-50% and the incidence of untoward effects by 27-44%.

[The problem of adequate analgesia in the postoperative period]. / Problema adekvatnogo obezbolivaniia v posleoperatsionnom periode.

Despite numerous methods of drug and non-drug analgesia, acute pain relief remains a pressing problem, particularly for the postoperative period. Individual protocols of analgesia are still to be developed. Standard doses of analgesics, administered in some intensive care wards, may be inadequate in some patients. An increase of an opioid dose may lead to untoward reactions. Therefore, we consider therapy with nonsteroid antiinflammatory drugs (ketorolac) justified. An important trend in improvement of the efficacy of drug analgesia is evaluation of a sufficient analgesic dose. Patient-controlled analgesia (PCA), administered in accordance with the patient's request, is an alternative to the traditional analgesia administered according to indications (planned analgesia). The main advantage of PCS in comparison with traditional administration of analgesics are effective analgesia meeting the individual requirements of a patient, rapid desired effect, a shorter period without analgesia, stable concentration of the analgesic in the plasma, time saving for the staff, and a lower incidence of side effects. PCA has been used in 227 patients in intensive care wards of Research Center of Surgery. The majority of patients appreciate this method high, which results in adequate analgesia in 82-95% cases.

[Use of tramal for prevention of motor hyperactivity during r fiber bronchoscopy in patients in the postoperative period]. / Primenenie tramala dlia preduprezhdeniia motornoi giperaktivnosti pri provedenii fibrobronkhoskopii u patsientov v posleoperatsionnom periode.

The efficacy of tramal for preventing motor hyperactivity is assessed in patients on spontaneous respiration after surgery during fiber bronchoscopy under a short-acting hypnotic ethomidate. Group 1 consisted of 22 patients to whom 100 mg of tramal was injected intravenously 30 min before fiber bronchoscopy, group 2 of 10 patients subjected to fiber bronchoscopy without preliminary tramal. Ethomidate caused manifest 20-45-sec myoclonus in the distal parts of the upper and lower limbs in 80% of cases. Pretreatment with tramal (100 mg intravenously) decreased the severity and incidence of myoclonus to 18.2%, did not affect gas exchange, and stabilized hemodynamics during fiber bronchoscopy.

[Methods of the use of ketorolac tromethamine in patients during the early postoperative period]. / Metody primeneniia ketorolaka trometamina u bol'nykh v rannem posleoperatsionnom periode.

Analgesia with nonsteroid antiinflammatory drugs (NSAID) becomes a pressing problem today. One such drug is ketorolak tromethamine (KT), characterized by expressed analgesic activity comparable with that of opioid analgesics morphine or promedol. Our purpose was to assess KT efficacy in analgesia performed by different methods, including analgesia controlled by the patient (ACP) after surgery. In medium severe and strong pain KT was used in group I (n = 60) "as needed" in a dose of 30 mg up to 3-4 times a day, in group 2 (n = 12) by the ACP method, in group 3 (n = 16) KT was incessantly infused in a daily dose of up to 120 mg, and in group 4 (n = 11) KT was injected 3-4 times a day in a dose of 30 mg in combination with morphine ACP. The results indicate a high efficacy of KT: 83% after a single injection. Combined use of KT and promedol decreased the dose by 40-50%. Side effects were observed in 15% of patients: most often it was a sense of fever and sweating (in 4% of patients), nausea and vomiting (in 2%), insomnia (in 2%). ACP and planned injections in a daily dose of 90-120 mg is the optimal method of analgesia in patients after extensive surgical interventions.