Prediction of Poor Response to Modified Neuroleptanalgesia with Midazolam for Endoscopic Submucosal Dissection for Esophageal Squamous Cell Carcinoma.

BACKGROUND/AIMS: Modified neuroleptanalgesia (m-NLA) with midazolam is often used for sedation and analgesia during endoscopic submucosal dissection (ESD) for gastrointestinal neoplasia. However, interruption due to poor response to midazolam is often experienced during ESD for esophageal squamous cell carcinoma (ESCC) because most patients with ESCC have a history of heavy alcohol intake. We examined the incidence and risk factors for poor response to m-NLA with midazolam and pethidine hydrochloride. METHODS: This retrospective cross-sectional study was conducted at a single institution. Between April 2007 and July 2013, 151 patients with superficial ESCC who underwent ESD under sedation using m-NLA with midazolam and pethidine hydrochloride were enrolled. Poor response to sedation was defined as the use of a second drug when Ramsay Sedation Score 1-2. RESULTS: Poor response to sedation occurred in 66.2% patients. Most cases of poor response were controlled by using additional flunitrazepam. Multivariate logistic regression analysis showed that cumulative alcohol intake and major specimen size were independent risk factors for poor response to sedation (OR 3.63, 95% CI 1.20-10.99, and OR 3.23, 95% CI 1.26-8.25). CONCLUSION: Our study indicated that cumulative alcohol intake and major specimen size were associated with poor response to m-NLA with midazolam and pethidine hydrochloride.

[Evaluation of efficacy and safety of optimized based on the ketamine modified neuroleptanalgesia during operations on the biliary tract and liver].

A comparative analysis of efficacy and safety of the neuroleptanalgesia (NLA) and balanced general anesthesia during operations on the biliary tract and liver. Analysis of the results of comprehensive studies of hemodynamic, humoral homeostasis, liver function and clinical anesthesia showed that the optimized on the basis of ketamine modified NLA provides effective neurovegetative protection during operations on the organs of the hepatobiliary system, accompanied by obscure variations in the studied parameters. Traditional methods of the modified NLA is characterized by insufficient anesthesia, accompanied by pronounced physical inactivity circulation and a large number of "critical incidents".

Treatment of medial condylar fractures of the third metatarsus in three horses with fibreglass casts under standing neuroleptanalgesia.

Minimally displaced condylar fractures propagating into the third metatarsal diaphysis were treated conservatively in one thoroughbred and two Arabian racehorses. In each case a neuroleptanalgesic protocol provided adequate pain relief for a rigid fibreglass cast to be applied in a weight-bearing position. The fractures healed completely and the three horses recovered uneventfully. Two of them returned successfully to racing and the third was used for breeding.

[Clinical application of brain hypothermia therapy for acute brain insults].

Brain hypothermia therapy has been expected to lead to good neurological outcome in acute brain insults. There are a few positive results which have been proven by multicenter randomized clinical trials (RCT) in the cardiopulmonary arrest (CPA) in patients with ventricular fibrillation. Among these clinical trials, early application of hypothermia, maintenance of cerebral blood flow during hypothermia therapy and prevention of quick rewarming are pointed out to result in good outcome from clinical experiences. For brain hypothermia therapy to become an effective method for acute brain insults, indications, brain oriented intensive cares and biomarkers for the therapy must be established. RCT in acute brain insults beside CPA victims are needed in the near future.

[Effect of neuroleptnarcosis on the change of hemodynamic parameters during tissues transplantation].

Changes of the central and peripheral hemodynamics indexes during operation for the tissues purulent-trophic defects closure by free muscular--nerve--vascular flap, arising during neuroleptnarcosis and in immediate postoperative period, were discussed.

[Surgical stress: clinical-and-laboratory parallels under activation of the natural stress-limiting systems]. / Khirurgicheskii stress. Kliniko-laboratornye paralleli v usloviiakh aktivatsii estestvennykh stress-limitiruiushchikh sistem.

Three hundred and eighty-seven patients, who were operated on the scheduled basis for different surgical pathologies, were examined. The purpose of the case study was definition of the clinical-and-laboratory parallels related with pronouncement of surgical stress in an advanced variation of neuroleptanalgesia.

[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.

[Clinical experience with low- and minimal-flow isoflurane in extensive resections of the liver and liver transplantation]. / Klinicheskii opyt ispol'zovaniia izofliurana v rezhimakh low- i minimal-flow pri obshirnykh rezektsiiakh i transplantatsii pecheni.

A comparative study was performed of general balanced anesthesia on the basis of neuroleptic analgesia (NLA) and inhalation low- and minimal-flow anesthesia with isoflurane in anesthesiological management of extensive operations on the liver. A total of 75 anesthesias were conducted. Because of low hepatotoxicity, absence of its metabolites' pharmacological activity, fast elimination from the body unchanged, isoflurane is effective in long and traumatic operations on the liver. Low-flow isoflurane significantly lowers pharmacological load with opiates, myorelaxants which is essential in patients with hepatic diseases. This leads to more rapid recovery of adequate spontaneous respiration and activation of the patient in low risk of postoperative iatrogenic complications.

[Prevention of hemodynamic disorders during anesthesia in middle-aged and elderly patients with essential hypertension. Components of anesthesia. II]. / Profilaktika gemodinamicheskikh narushenii vo vremia anestezii u bol'nykh pozhilogo i starcheskogo vozrasta s soputstvuiushchei gipertonicheskoi bolezn'iu v svete komponentnosti anestezii (Chast' II).

Hemodynamic parameters were evaluated during various stages of anesthesia in two groups of patients aged 60-85 years with mild essential hypertension. In group 1, routine preoperative treatment with hypotensive drugs was carried out and in group 2 differentiated preoperative treatment with calcium antagonists was carried out with consideration for a hemodynamic type. Group I patients were operated on under traditional neuroleptic analgesia (NLA), group 2 under NLA with 40% lower drug doses than in group 1 and with addition of calcium antagonists. To patients with hypo- and eukinetic hemodynamics, nifedipine was injected (bolus injection) in a dose of 14.2 micrograms/kg before induction and then was infused in a dose of 6.0-14.2 micrograms/kg/min. Patients with hyperkinetic hemodynamics were injected verapamil in a dose of 70-140 micrograms/kg (bolus injection) and then the same dose every hour of the operation. Differentiated use of calcium antagonists during anesthesia helped transform the hyper- and hypokinetic types of hemodynamics into a more rational eukinetic type, which was associated with a decrease of MVO2. Calcium antagonists, exerting analgesic, automatic stabilizing, and antihypoxic effects, prevented the hyperdynamic reactions complicating NLA in 30% cases and precluded complications of concomitant ischemic diseases, which were observed in 40% of group 1 patients.

[Anesthetic management of a patient with microcephaly associated with cerebral atrophy].

We describe the management of a 35-year-old female with microcephaly, cerebral atrophy especially in frontal lobes, dwarfism and severe mental retardation. The patient underwent open reduction of fracture of the humerus neck suffered from traffic accident. Authors could not find any article on the anesthetic management of microcephaly but could locate some about mentally retarded patients claiming the difficulty in anesthetic induction as well as emergence and frequent incidence of convulsions. We anesthetized the patient with modified NLA with nitrous oxide-oxygen and interestingly very small doses of fentanyl (1.7 micrograms.kg-1) were required. The anesthetic and surgical courses were uneventful. The patient emerged immediately with intravenously administered naloxone and flumazenil with no excitement nor convulsion. We conclude that fentanyl is the drug of choice for mentally retarded patient with microcephaly and smaller doses per kg.weight are sufficient for orthopedic surgery.

Successful mandibular anesthesia following numerous unsuccessful attempts: a case report.

The management of a very anxious patient who had undergone uneventful dental treatment in the past, but posed a problem when clinicians attempted to secure profound mandibular anesthesia, is discussed. This case report also examines the advantages and disadvantages of the Gow-Gates mandibular block technique, and describes the patient's subsequent management.

Extending patient-controlled analgesia to patient-controlled neuroleptanalgesia.

A trial was conducted (among 22 patients) to assess a new use of patient-controlled devices. Using a patient-controlled analgesia (PCA) pump under the anaesthetist's guidance, the patients self-administered a neurolept mixture consisting of droperidol and alfentanil. The patients were then able to undergo minor surgery (dilatation and curettage). The majority remained detached, sedated and pain-free, while able to control the PCA pump during the procedure. Patient-controlled neuroleptanalgesia or PCNA, as we propose to call this technique, appeared practical, effective and safe. The method was generally well accepted and highly rated by the patients.

[The comparative characteristics of anesthesia methods in operations for tumors located on the extremities]. / Sravnitel'naia khrakateristika metodov obezbolivaniia pri operatsiiakh po povodu opukholei, lokalizovannykh na konechnostiakh.

Seventy patients operated on for malignant tumors located in the extremities have been examined, 30 of them were operated on under conduction anesthesia. The adequacy of anesthesia was assessed using clinical metabolic and electrophysiological techniques. Evident advantages of conduction anesthesia over general anesthesia during short-term interventions have been substantiated. Anesthesia with bupivacaine proved most effective.

[The prospects and problems of drug-induced anesthesia]. / Perspektivy i problemy lekarstvennogo obezbolivaniia.

The problem of pain has a major medico-social significance and necessitates detailed investigation both from the position of etiology and pathogenesis and new therapy methods. Among many methods of pain control drug-induced anesthesia is of great importance. The multiplicity of pain requires optimal use of analgetics and their combination with other agents strictly in coordination with individual needs of the patient. Special anesthesia systems are to be designed for this purpose.