[Analgesic and opioid-sparing effects of intravenous paracetamol in the early period after aortocoronary bypass surgery].

The study was to evaluate the analgesic and opioid-sparing effect of intravenous paracetamol injections in cardiosurgical patients in the early postoperative period. Adequate analgesia within the first 12-18 hours of the early postoperative period is very important for a good prognosis of the further course of pain syndrome and for the reduction of a risk for its progression to its chronic form. In early studies, propacetamol lowered morphine use after orthopedic and gynecological operations. The efficacy of paracetamol used in cardiac surgery has been little studied and the results of the studies are conflicting. The randomized, blind, placebo-controlled study included patients after aortocoronary bypass surgery, of them 22 patients received paracetamol and 23 had placebo. The test drug (perfalgan 100 ml or placebo) was intravenously injected 30 min before extubation and then every 6 hours within succeeding 18 hours. The intensity of the pain syndrome was rated by a 5-score verbal scale every 2 hours. With pain score of 2 or more, promedol was intramuscularly administered in a dose of 10 mg. Inspiratory volume was recorded before extubation and the first administration of a drug just after extubation and then every 2 hours. The baseline indices did not differ in both groups. Throughout the observation, the inspiratory volume was lower in the paracetamol group than in the placebo group; however, there was a statistically significant difference (p = 0.012) in the reduction in the manifestations of the pain syndrome (by 81%) only just after tracheal extubation. During this period, inspiratory volume values were higher in the paracetamol group; however, a statistically significant (39%) difference between the groups in the mean values was obtained only during and 2 hours after extubation. In the perfalgan group, the mean total use of promedol was 36% less than in the placebo-group, which was statistically significant (p = 0.019). The early postoperative use of paracetamol after myocardial revascularization reduces the intake of opioids and diminishes the intensity of the pain syndrome within the first hours after extubation, which promotes a higher thoracic excursion, as confirmed by a statistically significant increase in the maximum inspiratory capacity.

[Postoperative period in early activated patients after myocardial revascularization]. / Osobennosti posleoperatsionnogo perioda pri rannei aktivatsii bol'nykh posle operatsii revaskuliarizatsii miokarda.

The specific features of an early postoperative period were studied in 115 patients undergone myocardial revascularization who were divided into 3 groups according to the time of postoperative activation. Group 1 comprised 35 patients in whom tracheal extubation was made in the operating room 30-60 min after the end of the operation. Group 2 included 32 patients extubated 2-8 hours after admission to the resuscitation and intensive care unit (RICU); Group 3 consisted of 48 patients undergone tracheal intubation for more than 8 hours. The patients of this group received traditional anesthesia using ketamine, benzodiazepines, and large-dose fentanyl. The developed combined anesthesia with inhalational and intravenous anesthetics having their better pharmacodynamics, such as isoflurane, diprivan, tracrium, was used in 60.3% of the patients in Groups 1 and 2. The developed type of anesthesia using a high thoracic (T2-T4) epidural blockade as a basic component of anesthesiological maintenance was studied. In Group 2, the preextubation time was twice less than that in a control group (5.2 +/- 0.3 and 10.8 +/- 0.4 hours, respectively, p < 0.05). In groups with early extubation, the incidence of clinically significant cardiovascular disorders was less than that in the controls, which is indicative of better performance of the cardiovascular system. In Group 1, the frequency of reintubations for arterial hypoxemias was 2.8% and that of pneumonias and pulmonary microatelectasis was 2.5 times less as that in Group 3 (9%, p < 0.05). Chills occurred in 6, 4, and 15% of cases in Groups 1, 2, and 3, respectively (p < 0.05). A programme on early activation after aortocoronary bypass surgery could reduce the patients' stay at the RICU on an average by 24 hours without increasing the risk for postoperative complications.

[Principles of prevention of pneumonia associated with the use of artificial ventilation of the lungs in resuscitation and intensive care units]. / Printsipy profilaktiki pnevmonii, sviazannoi s ispol'zovaniem iskusstvennoi ventiliatsii legkikh v otdeleniiakh reanimatsii i intensivnoi terapii.

Pneumonia ranks among the most incident complications associated with forced ventilation of the lungs (FVL). Its incidence depends on FVL duration and according to published reports varies from 9 to 70%. Pneumonia deteriorates the prognosis and essentially increases the mortality in intensive care wards. Based on published reports and their own experience, the authors formulate the fundamentals of prevention of pneumonia in patients on FVL: use of intubation tubes with low-pressure cuffs; minimum duration or no procedures involving the intubation tube cuff blowing off; regular sanitization of the tracheobronchial tree and oropharynx; use of devices for removal of tracheobronchial secretion in the closed contour and of disposable catheters; inhalation of bronchomucolytics and antibiotics through a nebulizer; patient's position in bed with elevated head part; rigid approach to prescription of antacide drugs and H2-receptor blockers; decontamination and regulation of intestinal function; antibiotic therapy with consideration for the results of bacteriological studies; no or minimum exposure to procedures involving the respiratory contour seal opening; use of sterile gloves; use of disposable respiratory contours and hydrophobic bacterial filters instead of humidifiers.

[Clinical experience with the use of gelofusin (gelatin) in anesthesiology, resuscitation and intensive care]. / Klinicheskii opyt ispol'zovaniia gelofuzina (zhelatina) v anesteziologii, reanimatsii i intensivnoi terapii.

Published reports on the use of colloid plasma substitute gelofusin, widely used in practical anesthesiology, intensive care, and resuscitation, are analyzed. The drug is characterized by positive effects on the hemodynamic status and oxygen-transporting function of circulation, with the minimum side effects. It can be used for blood loss compensation, planned normovolemic hemodilution, afferent procedures, and filling the artificial circulation device. Gelofusin is preferable for use in patients with cardiac failure and marked dehydration. No negative effect on renal function and blood clotting system, even in infusions in high volume, are its positive qualities.