[Plasma catecholamines in consciousness recovery in patients with severe traumatic brain injury].

Changes in plasma noradrenalin (NA) and dopamine (DA) levels were evaluated in the stages of consciousness recovery in patients with severe traumatic brain injury with and without deep brain structure damage. Forty-eight patients (36 men and 12 women), aged from 12 to 56 (31,9±10,9) yeas, were enrolled in the study. Two variants of catecholamine (CA) changes were found: 1) a CA-dissociation that was oppositely directed to NA and DA changes was observed in unconsciousness; 2) a CA-dissociation (unidirectional NA and DA changes) that was observed after the restoration of consciousness. In patients with the damage of two frontal lobes and deep brain structures, CA-association periods were seen in the stage of mental confusion with psychomotor agitation or when the brain stem was damaged. The duration of CA-association was negatively correlated with the velocity, quality of consciousness recovery and outcomes evaluated by the Glasgow scale.

[Anesthesiological care in removal of bulky formations from functionally important hemispheric zones: craniotomy in conscious state]. / Anesteziologicheskoe obespechenie pri udalenii ob"emnykh obrazovanii iz funktsional'no vazhnykh zon bol'shikh polusharii golovnogo mozga--kraniotomiia v soznanii.

A method of anesthesia allowing patient's awakening to the level of verbal contact after trephination and opening of the dura mater was used in 37 patients with bulky formations (33 patients with tumors and 4 with arteriovenous malformations) in the speech zones of speech-dominant hemisphere. Speech mapping of the brain, carried out in alert patients, helped eliminate permanent speech deficiency during the postoperative period in all patients. The protocol of anesthesia was as follows: locoregional anesthesia of soft tissues of the head with a mixture of 2% xylocaine and 0.5% marcaine with epinephrine intravenous diprivan at stages requiring no patient's alertness, clopheline, fractionated midazolam (after identification of speech zones). The study showed that this protocol helps solve the problem and adequately protects the organism from surgical stress, provides good conditions for manipulations on the brain, involves no unpleasant sensations for the patient, and in 70% patients helps attain complete amnesia of the perioperative period. The most severe complication is an epileptic attack. Respiratory monitoring (pulse oximetry and capnography in the lateral duct) is obligatory for preventing respiratory disorders in patients on spontaneous respiration who were not intubated.

[Epidural anesthesia in surgical interventions on the spine and spinal cord. I. Comparative analysis of the effectiveness of anesthesiological protection under conditions of epidural anesthesia and neuroleptanalgesia in surgery of the spine and and spinal cord]. / Epidural'naia anesteziia pri operativnykh vmeshatel'stvakh na pozvonochnike i spinnom mozge. Chast' I. Sravnitel'nyi analiz adekvatnosti anesteziologicheskoi zashchity v usloviiakh épidural'noi anestezii i neiroleptanal'gezii pri operatsiiakh na pozvonochnike i spinnom mozge.

The study was carried out in 22 patients operated on for vertebral disk hernias and spinal tumors at lumbosacral level. The patients were divided in 2 groups depending on the type of anesthesia (epidural or neuroleptanalgesia-EA and NLA). In the test group all patients were operated under EA with local anesthetics combined with intravenous sedative drugs (diprivan + relanium) under conditions of spontaneous respiration and O2 inhalation through a mask. In the control group combined total intravenous anesthesia by myorelaxants and tracheal intubation were carried out (relanium + diprivan: induction dose 1.95 +/- 0.5 mg/kg, maintenance dose 5.3 +/- 0.4 mg/kg/h, and phentanyl). The purpose of the study was to compare the efficiency of anesthesiological protection under EA and traditional NLA in interventions on the spine, when surgical injury is inflicted in the immediate vicinity to the central structures responsible for pain impulsation. Only EA ensured adequate protection of the patients from surgical stress, as was seen from hemodynamic (arterial pressure and heart rate) and endocrine metabolic parameters (glucose, epinephrine, norepinephrine, hydrocortisone, and prolactin levels). Hence, EA fully demonstrated its protective properties during operations on the spine, and therefore can be regarded as a method of choice in this patient population.

[Concentration of lactate concentration in experimental glial tumors and brain tissue during brief artificial hyperglycemia]. / Soderzhanie laktata v glial'nykh opukholiakh i mozgovoi tkani v éksperimente pri iskusstvennoi kratkovremennoi giperglikemii.

The authors studied the content of lactic acid in glial tumors of the brain and brain tissue of rats in short-term artificial hyperglycemia. In short-term artificial glycemia the lactic acid content in glial tumors of animals was almost twice the level of this metabolite in the brain tissue, which is due to the high potential rate of glucose consumption by the tumor and the increased glycolytic activity in it in these conditions. The lactate content in the glial brain tumors significantly increases when the sugar concentration in the blood of animals is artificially increased. It is suggested that accumulation of lactic acid in brain gliomas of experimental animals contributes to diminution of tumor cell viability, which will increase sensitivity of the tumor to irradiation.

[Changes in the cerebrospinal fluid lactate concentration of children with cranio-cerebral injuries]. / Osobennosti izmenenii soderzhaniia laktata v likvore u detei s cherepno-mozgovoi travmoi.

Examination of the cerebrospinal fluid in 43 children with craniocerebral trauma revealed a dependence of the lactate content on the degree of the injury (9.2 +/- 1.2 mg% in mild trauma; 13.5 +/- 1.7 mg% in moderate trauma; 18.3 +/- 1.7 mg% in severe trauma) and the clinical course. The cerebrospinal fluid is normalized 7-10 days after a moderate brain trauma, and in 3 weeks after a severe trauma. The findings suggest that the values of the cerebrospinal fluid lactate content are lower in children than in adults (9.7 mg%, on the average, in children under 10 years of age, and 11.3 mg% in those over 10 years of age).

[Assessment of the severity of grave cranio-cerebral injury and its outcome according to the state of energy metabolism in the brain]. / Otsenka tiazhesti techneiia tiazheloi cherepno-mozgovoi travmy i ee iskhoda po sostoianiiu énergeticheskogo obmena v golovnom mozge

A dynamic study of the arteriovenous oxygen and lactic acid content difference, as well as a study of the CSF content of the lactic acid in patients with a severe craniocerebral trauma permitted to evaluate the severity of the pathological process and the results of its treatment. A growing production of lactic acid by the brain and its progressive accumulation in the CSF to a high level as 45-50 mg%, and a sharp dissociation between the increasing lactate level in the CSF and its growing concentration in the venous blood flowing from the brain is a prognostic sign of an unfavourable course and outcome of the disease.