[VEGETATIVE REACTIONS AS PROGNOSTIC FACTOR IN POSTERIOR FOSSA SURGERY].

Mortality rate related to posterior fossa tumors resection varies from 1 to 8 percent, according to various authors. It depends on tumor size and its growth characteristics. To determine the physiological acceptability of surgery, physiological significance of vegetative reactions associated with tumors resection has to be assessed. We divide these reactions (centrogenic reactions - CR) into 2 main groups. The first group has a relatively precise morphofunctional structure, similar to the classic reflex arc. They appear due to irritation of local centers or cranial nerves nuclei with mixed motor-vegetative structure. In most cases they are not connected with anatomic damage of CNS structures. The second group of CR is correlated with dysfunction of brain and represents brain s attempt to turn into a new functional state. Their presence should be considered as a functional degradation symptom, which might be even irreversible. Emergence from anesthesia in the operative room is not recommended in this clinical situation. Neurovegetative stabilization should be provided for a period of 6 to 24 hours after tumor resection.

[Neurovegetative stabilization as a pathogenetic therapy for brain damage].

The article deals with neurovegetative stabilization as a pathogenetic therapy for brain damage. The approach is based on hypothesis that pharmacological effecting on central nervous system is able to make a passive protective medical system which can be close to passive protective systems widely represented in the nature. Complex opioid and clonidine administration provides sufficient level of neurovegetative stability on account of effecting on neuro-regulative structures the brain steam. Neurovegetative stabilization should be carry out in order of warning principle. In our opinion optimal doses are fentanyl 0.2-1.4 mkg kg(-1) per hour, clonidine 0.2-0.7 mkg kg(-1) per hour, propofol 0.5-2 mkg kg(-1) per hour, penthonal sodium 1-4 mkg kg(-1) per hour; diazepam 0.4-0.5 mkg kg(-1), and midazolam 0.05-0.2 mkg kg(-1) per hour. A criterion of the therapy sufficiency is a consistency between changes of different functional parameters. We believe the most important that new level of functioning must be maximally integrated and harmonized. It is possible if all pharmacological agents include the most reliable programs of adaptation complex human body reactions.

[The application of the tracheostomy technique in neuroresuscitation].

The objective of the present study was to compare the frequency of complications associated with percutaneous dilatational tracheostomy by the method of Griggs and conventional surgical tracheostomy. The retrospective analysis of 120 critically ill patients maintained by mechanical ventilation and neurorehabilitated following tracheostomies was carried out. The two groups of the patients were matched for the age and severity of their clinical conditions. No difference was documented between the frequencies of complications after the treatment using the two surgical strategies. It is concluded that both percutaneous dilatational tracheostomy and conventional surgical tracheostomy may be recommended for the use in clinical practice.

[Prognostic criteria for tracheostomy in the neuroresuscitation unit].

UNLABELLED: The aim is to specify prognostic criteria for tracheostomy on the basis of long-term (more than 14 days) ALV and prolonged (more than 14 days) trachea canmulation. MATERIALS AND METHODS: Retrospectively were analyzed the medical history of 120 difficult patients with tracheostomy, who spent in ICU more than 72 hours. Was executed multiple logistic regression analysis. RESULTS: In patients with consciousness level of 8 or less points on the Glasgow coma scale and subarachnoid hemorrhage, detected on CT scan of the brain, increases the chances for prolonged ALV versus patients without these signs in 3.93 times. In patients with constrained basal cisterns, detected on CT scan of the brain and to the consciousness level of 8 or less points on the Glasgow coma scale versus patients without these signs increases the chances of the prolonged trachea cannulation in 5 times. CONCLUSION: Prognostic criteria for tracheostomy in patients in neuroresuscitation unit are: criteria for prolonged ALV: level of 8 or less points on the Glasgow coma scale and subarachnoid hemorrhage and criteria for prolonged trachea cannulation: constrained basal cisterns, detected on CT scan of the brain and to the consciousness level of 8 or less points on the Glasgow coma scale.

[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.

[Centrogenic reactions and their prognostic value during surgeries for posterior cranial fossa tumors in children].

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.

[Infectious safety in neurosurgical patients. The specific features of infectious complications in patients with subtentorial tumors, their diagnosis and treatment].

The paper analyzes the incidence of the major infectious complications (regional and systemic) developing in neurosurgical patients (3630 patients with neurosurgical diseases and 872 with abnormalities of the posterior cranial fossa (PCF)) in the postoperative period after removal of subtentorial tumors. Regional pyoseptic complications are shown to occur in patients with PCF abnormalities three times more frequently. The basic diagnostic and therapeutic approaches to pyoseptic complications in neurosurgical patients are also considered.

[The types and clinical significance of centrogenic reactions occurring during removal of tumors of the posterior cranial fossa].

Specific reactions, the so-called centrogenic reactions or short reflexes, occur in patients when intracranial tumors of the posterior cranial fossa are removed. The authors divide centrogenic reactions into two major groups: types 1 and 2 reactions. The study was based on the analysis of 110 case histories of posterior cranial fossa tumors that were at the extracerebral site. In the study group, centrogenic reactions were recorded in all the patients during neoplasm removal. The findings suggest that these reactions occur mainly in giant tumors of the posterior cranial fossa and decompensation conditions. In patients with type 2 centrogenic reactions, complications and progressive neurological deficit were more frequently observed in the early postoperative period than in those who were had type 1 centrogenic reactions.

[Infectious complications after brain tumor removal: some aspects of their prevention, diagnosis, and treatment].

A hundred and fifty-five case histories of neurosurgical patients with the complicated early postoperative period were analyzed. Early postoperative regional pyoinflammatory complications were developed in 21 (4.4%) of 481 patients. There was meningitis in 17 (3.5%) cases, ventriculitis in 2 (0.4%), and wound infection (skin flap suppuration and postoperative wound fistula). Systemic pyoinflammatory complications were observed in 8% of the patients. Among them, there were pyoinflammatory complications in the respiratory system in 30 (6.2%) cases, pyonecrotic cystitis in 5 (1%), and sepsis in 2 (0.4%). Risk factors for regional and systemic complications are shown. Based on the findings, recommendations are given to prevent and treat pyoseptic complications in neurosurgical patients.

[Total intravenous multicomponent anesthesia with diprivan infusion in a specific concentration in neurosurgical patients]. / Total'naia vnutrivennaia mnogokomponentnaia anesteziia s infuziei diprivana po tselevoi kontsentratsii u neirokhirurgicheskikh bol'nykh.

Total intravenous anesthesia (TIVA) with diprivane infusion in a purposeful concentration was carried out in 54 patients for various neurosurgical interventions. Purposeful concentrations of diprivane for induction and maintaining anesthesia were 1.5-2 times lower than those recommended by the manufacturer, which was due to effects of TIVA components fentanyl, clofelin, and diazepam, as well as patient's age, clinical status, and, probably, neurosurgical disease. Anesthesia was controllable and hemodynamically stable, the awakening was early.