[The use of a fixed combination of diclofenac and orphenadrine for postoperative pain relief in orthopedic patients]. / Primenenie fiksirovannoi kombinatsii diklofenaka i orfenadrina dlya posleoperatsionnogo obezbolivaniya u ortopedicheskikh bol'nykh.

OBJECTIVE: To evaluate the efficacy and safety of using a fixed combination of diclofenac and orphenadrine for early postoperative pain relief in orthopedic patients following hip prosthetics. MATERIAL AND METHODS: A prospective comparative study enrolled 65 patients with primary total hip replacement in the setting of spinal bupivacaine anesthesia. Patients were divided into 2 groups - study (39 patients) and control (26 people). The study group underwent Neodolpasse infusion (orphenadrine 30 mg + diclofenac 75 mg) after the end of surgery and morphine infusion in a patient-controlled analgesia (PKA) regimen. The control group underwent morphine monotherapy in the PKA regimen. The intensity of pain syndrome was compared on a visual-analog scale (VAS) from 0 to 100, the total amount of morphine administered, the number of bolus requests, the change in kidney function and the side effect were assessed. RESULTS: In the control group, the duration of the intervention was shorter and amounted to 70 [59; 82] minutes, in the study group - 83 [65; 94] minutes (p=0.05). No significant difference was found in the number of bolus requests (32 [22; 38] and 23 [15; 36], p=0.085 and pain intensity 2 and 12 hours after the start of therapy (5 [4; 6] and 3 [2; 4] and 5 [4; 6] and 2 [2; 3] points) in the control group and in the study group. When assessing the intensity of pain syndrome 24 hours after the start of therapy, differences were found in the groups - in the control group 30 [2; 3] mm, in the study group 20 [2; 3] mm (p=0.05). There was no nephrotoxic effect on Neodolpasse. Complications of analgesic therapy in the form of nausea, vomiting, pruritus were recorded in both groups in equal amounts, which is explained by the administration of morphine in both groups. CONCLUSION: 1. The use of a fixed combination of orphenadrine 30 mg + diclofenac 75 mg as part of postoperative pain relief after operations of primary hip prosthetics improves the quality of postoperative pain relief according to the subjective assessment of patients. 2. The use of a fixed combination of orphenadrine 30 mg + diclofenac 75 mg did not lead to the development of side effects and complications.

[THE COGNITIVE STATUS DYNAMIC OF CARDIOSURGICAL PATIENTS AND THE PREDICTORS OF ITS DISTURBANCE].

UNLABELLED: AIM OF RESEARCH: To estimate the cognitive status dynamics ofpatients during the early postoperative period after cardiac interventions and to reveal predictors of cognitive functions deterioration at this category of patients. MATERIALS AND METHODS: 118 cardiac patients were tested of neurocognitive functions one days before operation, and then for the 2-3rd days after operation by means of the MMSE test, the FAB test, Shulte's test, a questionnaire of a depression of CES-D, the BATTERY OF FRONTAL DYSFUNCTION TEST. Data of the perioperation's period was analyzed. RESULTS: Deterioration of results in the 2nd and more tests were registered at 61% of patients. The main distinctions between patients with postoperative deterioration of testing results and without it were: parameters of mehanical ventilation (tidal volume/ideal body weight, airways pressure), initial condition and existence of signs of initial deficit of blood circulation (decrease in the cardiac index and O2 delivery, increase of level of a lactate), decrease in cerebral oksimetry, existence of respiratory alkalosis dekompensation during CPB. Administration of the Dopamine before CPB and use of Desfluran demonstrated the positive influence to the cognitive status. CONCLUSIONS: 1) Neurocognitive dysfunction during the early postoperative period after cardiac surgery is tipical for 30-70% of patients. 2) The most significant predictors of deterioration of neurocognitive function in the postoperative period are the excessive depth of anesthesia and significant intraoperative decrease in the cerebral oxygenation. 3) Influence of the mehanical ventilation parameters on postoperative neurocognitive function is revealed, use of the large tidal volumes is especially negative. 4) Existence of the blood circulation deficit and decrease in oxygen delivery without timely intraoperative correction, and also an intraoperative hyperglycemia worsen a neurocognitive function in the postoperative period. 5) Desfluran administration has positive impact on the neurocognitive function.

[POSSIBILITIES OF PHARMACOLOGICAL NEUROPROTECTION IN CARDIAC PATIENTS DRUGS NOT INTENDED FOR GENERAL ANESTHESIA].

The following paper is the second part of pubished review which reveals today state of pharmacology in neuroprotection issue. In the first part of the review we discussed neuroprotective possibilities of anesthesia medicine, but there is also another trend in pharmacological neuroprotection which is on high demand today: medicine that are not general anaesthesia drugs. This paper surveys medicines from different pharmacological groups and possible neuroprotective properties of these medicine are widely discussed in medical media. Unlike anesthetic medicine, most drugs mentioned in the second part of the review, can be used both for primary and secondary neuroprotection. The survey presents data from experimental and clinical studies of medicines neuroprotective properties.

[A hybrid operation for chronic type III B aortic dissection].

Presented herein is a clinical care report of a successful hybrid reconstruction (i.e., an open operation and endovascular intervention) for a chronic type III B aortic aneurysm in the setting of the renal and lower-limb arteries malperfusion syndrome. Of obvious interest are the circumstances of the operation performed in a 36-year-old male patient who was subjected to a simultaneous reconstruction of the supra- and inter-renal portion of the aorta and endovascular treatment for lower-limb chronic ischaemia. A detailed description thereof is followed by a brief review of the literature related to appropriate decision-making regarding the scope of the reconstruction in the pathology involved.

[Impact of protamine sulfate on hemostasis system after operations with artificial circulation].

Effects of different doses and lots of protamine sulfate on hemostasis system after cardiac operations with artificial circulation are analyzed. Overall 982 patients underwent cardiac operations with artificial circulation. Quality and purity of protamine may be the causes of side effects. Negative effect of high doses of protamine on hemostasis system is demonstrated. Thrombocyte dysfunction is the main cause of intensive postoperative bleeding after administration of protamine high doses.