EFFECT OF SOLUTIONS BASED ON TRICARBONIC ACID CYCLE SUBSTRATES ON TEMPERATURE RATES IN CHILDREN DURING ANESTHESIA.

The article describes some characteristics of temperature homeostasis regulation while intraoperative period and its correction methods by infusions of balanced crystalloid solutions on the basis amino acids and the Krebs cycle substrates. MATERIALS AND METHODS: 107 children of different ages were included into the study. All of them underwent surgery on thoracic or abdominal organs. The average age was 13 (7-16) years. All the operations were performed with total intravenous anesthesia and artificial lung ventilation. 0,9% sodium chloride solution, "Mafusol" "Infezol-40" and "Reamberin" were used in order to correct perioperative hypothermia. Results of the study. It was found that solutions based onfumarate (mafusol) and succinate (reamberin) have a significant positive effect on the temperature homeostasis. This fact means they can be recommendfor a broad usage in clinical practice for the purpose ofprevention and elimination of intraoperative hypothermia.

[FEATURES OF FLUID THERAPY IN CHILDREN WITH SEVERE MAJOR TRAUMA].

BACKGROUND: Fluid and transfusion therapy is proved to be a required component of treating children with severe major trauma significantly influencing the case outcome. OBJECTIVE: To analyze efficiency of fluid and transfusion therapy in children with severe major trauma and assess its correspondence with current recommendations. MATERIALS AND METHODS: 150 children aged from 0 to 18 years getting treatment in intensive care units of children's city hospitals of Saint Petersburg, Archangelsk, Ufa, Samara, and Leningrad region were included in the research. The main course of severe major trauma were car injury and catatrauma. The coefficient according to Pediatric trauma score (PTS) was 6.4 points. The mean duration of hospitalization in emergencies units was 3 (2-7) days, the duration of artificial lung ventilation was 48 ± 99.9 hours, the duration of hospitalization in the department ward was 24 (15-32) days. Favorable outcome (transferring from emergencies units to department wards) was reported in 147 (98%) children, death cases were registered in 4 (2.6%) children. RESULTS: There was determined that the basic crystalloid solutions used for infusion therapy in children were the following: Ringer solution, Plasma-lit solution and 10% glucose solution. "Gelofisin" and "Voluven" had more frequent administration rate among colloidal solutions. Transfusion of blood was performed in 26% patients. The infusion therapy in the first three days did not exceed the necessary physiological requirements that provided stabilization of the patient's condition and did not produce a negative influence on the status of hemodynamics and gas exchange. CONCLUSION: Administration of current well-balanced crystalloid and colloidal solutions to children with severe combined trauma in an amount within the limits of required physiological indicators does not produce a negative influence on the status of gas exchange and the case outcome.

[Severity of the lung disease index in infants with respiratory distress syndrome].

UNLABELLED: Optimization of respiratory support and prevention of ventilator-associate lung injure are the most important problems of neonatal resuscitation and intensive care. THE AIM OF THE STUDY: To improve the results of intensive care for respiratory failure in preterm infants by optimizing respiratory support on the basis of the analysis of the biomechanical characteristics of the lungs and blood gas. MATERIALS AND METHODS: The study included 138 infants with birth weight 1500g (1300-1740g) and a gestational age of 30.5 (29-32) weeks in need of mechanical ventilation. Apgar score at one minute was equal to 5.0 (4.0-6.0) points, and the fifth--7.0 (6.0-7.0) points. Biomechanical properties of light investigated the dynamic lung compliance, aerodynamic upper airway resistance, the coefficient of hyperextension, the time constant and the coefficient of RVR, reflecting the patient's spontaneous breathing pattern were evaluated. RESULTS: It was found that the most significant biomechanical characteristics of lungs, reflecting the severity of the respiratory failure are the dynamic compliance, aerodynamic airway resistance, coefficient C20/C, and the time constant. Correlation between the index of oxygenation, clinical assessment of the severity of respiratory failure and the duration of control mechanical ventilation was demonstrated. CONCLUSION: Rate of hyperextension and time constant are expressed by the correlation with the level of the oxygenation index, which allows them to be used for screening evaluation of severity critically ill patients during admission to the neonatal intensive care unit.

[Diagnostics and treatment of primary and secondary hyperparathyroidism].

The experience of treatment of 41 patients (aged 32-67 years) was presented in the article. The duration of disease was 2-5 years. Primary hyperparathyroidism was diagnosed in 16 patients and secondary--in 25. Diagnostics of the disease included clinical methods of treatment; studying levels of general and ionized calcium, phosphorus, parathormone; an ultrasound of thyroid and parathyroid glands, the substratum scintigraphy. All patients were undergone the operation. Adenomas of parathyroid glands were removed in the case of primary hyperparathyroidism including mini-access. Hyperplastic parathyroid glands (31/2) were disposed in the case of secondary hyperparathyroidism. Good immediate and long-term results were obtained.

[Anti-arrhythmia and hemodynamic effects of allapinin during a course therapy in patients with circulatory failure]. / Antiaritmicheskoe i gemodinamicheskoe deistvie allapinina pri kursovom primenenii u bol'nykh s nedostatochnost'iu krovoobrashcheniia.

The antiarrhythmic effects of allapinine were studied in 57 patients with chronic circulatory failure (CCF) and cardiac arrhythmias by employing 48-hour Holter monitoring. Allapinine was found to suppress premature ventricular contraction, group premature ventricular contraction and 'runs' of ventricular tachycardia by 82.5, 88.6, and 93.1%, respectively. The antiarrhythmic activity of the agent was more pronounced in patients with coronary heart disease, Stages I-IIA CCF and left ventricular ejection fraction greater than 40%. In addition, in Stages I-IIA CCF allapinine increased myocardial contractility and left ventricular ejection fraction, whereas in Stages IIB-III CCF it showed a slight cardiodepressive effect. Thus, when given in the course therapy in patients with CCF, allapinine has a high antiarrhythmic activity and, to a lesser extent, affects central hemodynamics.

[Anti-arrhythmic effectiveness of allapinin in ventricular arrhythmia in patients with circulatory failure]. / Antiaritmicheskaia effektivnost' allapinina pri zheludochkovykh narusheniiakh ritma u bol'nykh s nedostatochnost'iu krovo-obrashcheniia.

Antiarrhythmic efficacy of allapinin was assessed in 15 patients with heart failure combined with ventricular arrhythmias (48 h ECG monitoring). The drug was administered against a background of maintenance therapy with digoxin at a daily dose of 75 mg (digoxin concentration in blood plasma was 1.51 +/- 0.12 ng/ml). The drug was shown to possess marked antiarrhythmic activity causing a decrease of the total number of ventricular extra systoles by an average of 72.3%, group ventricular extrasystoles--by 84.5%. The drug can be recommended in combination with cardiac glycosides to patients with severe heart failure combined with ventricular arrhythmias.

[Changes of parameters of the central hemodynamics during general surgeries in patients with continuous electrocardiostimulation]. / Izmeneniia parametrov tsentral'noi gemodinamiki pri obshchekhirurgicheskikh operatsiiakh u bol'nykh s postoiannoi élektrokardiostimuliatsiei.

Investigations of the central-hemodynamics parameters made in 23 patients with constant pace making showed a hypokinetic blood circulation type in 17 of them. It was during a narcosis-assisted laparoscopic cholecystectomy, that a general trend was pointed out towards essentially changing parameters of the central hemodynamics for the worse; that was more pronounced, when carboxyperitomium was applied, when the patients was positioned in Fovler's posture or when he (or she) was turned to the left side. In herniotomy and in plasty of the anterior abdominal wall, made with epidural anesthesia, changes occurred mostly in the on-side posture and in introduction of naropin test-doses as well as in 30 minutes after anesthesia was over. There was a need, in a number of cases, to reprogram the pacemaker and to get the inotropic support in order to correct the hemodynamic shifts.