[Combined anaesthesia in reconstructive operations on carotid arteries].

MATERIAL AND METHODS: The authors analysed the protocols of anaesthesia in a total of 100 patients operated on carotid arteries. Depending upon the method of anaesthesiological management, the patients were subdivided into 4 groups comparable by age, gender, physical status, and the scope of the intervention. Group One patients received only propofol-fentanyl total intravenous anaesthesia (TIVA). Group Two, Three and Four patients received combined anaesthesia which was as follows: in Group Two - TIVA based on propofol and fentanyl with superficial cervical plexus block (SCPB), in Group Three - combined anaesthesia based on sevoflurane in a combination with SCPB, and in Group Four - combined anaesthesia based on isoflurane and fentanyl in a combination with SCPB. Analysing the results, we assessed the parameters of arterial pressure, BIS values, also calculating the doses of the anaesthetics and demand for narcotic analgesics during anaesthesia. The quality of the postoperative period was evaluated according to the 5-point vertebral rating scale (VRS). RESULTS: Comparing the need in fentanyl for maintaining general anaesthesia revealed considerably higher doses thereof in Group One patients. Analysing the dynamics of the parameters of mean arterial pressure showed their higher stability in Groups 2, 3 and 4, which was conditioned by better antinociceptive protection with SCPB added. The degree of the postoperative pain syndrome within 48 hours according to the VRS in Group One patients was higher as compared with that in Groups Two, Three and Four patients who additionally received SCPB. CONCLUSION: TIVA based on propofol and fentanyl combined with SCPB provides better analgesia in the area of the operation and decreases the demand for narcotic analgesics. Combined anaesthesia provides better stability of the haemodynamic parameters at the stages of surgery, also decreasing the degree of postoperative pain.

[The effect of the cervical plexus block on anti-nociceptive protection during surgeries on the interior carotid arteries].

MATERIALS AND METHODS: 77 anaesthesia protocols during a. carotis interna (ACI) operations were analyzed. All the patients were divided into 3 groups. In the 1-st group a total intravenous anaesthesia - TIV4 (propofol and fentanyl) was used. In the 2nd and 3rd groups was used combined anaesthesia: in the 2nd - TIVA + superficial CPB, in the 3rd - combined anesthesia (sevortane+fentanyl+CPB). When analyzing the results, BP, BIS data, anaesthetic doses and the need for opioid analgesics were evaluated. Assessment of the postoperative pain quality was conducted within 48 hours of the postoperative period on a verbal assessment scale (VAS). RESULTS: The need for fentanyl was considerably higher in the 1st group. The analysis of the BP data dynamics showed better stability in the 2nd and 3rd groups. CONCLUSIONS: TIVA + CPB provides better analgesia and reduces the need for opioid analgesics; greater stability of hemodynamic parameters during operation stages, as well as the best brain perfusion during a. carotis interna occlusion; postoperative analgesia and allows to avoid the early appointment of systemic analgesics.

[Problem of neuromuscular block reversion: neostigmine and sugammadex].

The review covers the history of neuromuscular block reversal. It states that indications for decurarization have been changed due to the extremely high rate of residual curarization even after the use of average-acting myorelaxants. The paper provides the pharmacological characteristics of sugammadex, a new selective relaxant-binding agent for aminosteroids (rocuronium and vecuronium) with the unique mechanism of action. It also gives data on the efficacy and safety of sugammadex versus anticholinesterase agents and estimates the prospects for its clinical application.

[Possibilities of estimating the depth of myorelaxation by a frontal electromyogram].

The authors studied the changes occurring in a frontal electromyogram (fEMG) recorded by commercial anesthesia depth monitors (Alaris AEP Monitor/2, Aspect A-2000 XP, and CSM 2) as a criterion for evaluating the reduction of a neuromuscular block. Two hundred and two patients who had undergone various abdominal and colorectal interventions under total intravenous anesthesia (TIVA) or combined balanced anesthesia using volatile anesthetics were examined. The findings allow a preliminary conclusion that fEMG shows a moderate diagnostic accuracy in predicting relaxation release particularly under TIVA. fEMG is as a useful complement to clinical criteria for myoplegia management, but it is not an alternative to traditional accelerometry.

[Use of different types of target propofol concentration-control infusion: theoretical and practical aspects].

Examinations were made in 105 patients who had undergone total intravenous anesthesia on the basis of the immune circulating components (ICC) of propofol by different pharmacokinetic models--Marsh and Schnider, by aiming at plasma or an effector zone. Along with good controllability of ICC-anesthesia, with theoretical and practical differences of the employed models are shown. The capacities of an up-to-date universal perfusor are demonstrated, by using Asena PK as an example. Practical recommendations on its application are given. The prospects of anesthesia automation are briefly discussed.

[Epidural block as a component of anesthesiological provision during abdominal operations].

Two modes of general anesthesia with artificial ventilation in combination with epidural block differing in a hypnotic component (inhalational or intravenous) were studied in 27 patients. A combination of general and epidural anesthesia afforded the best protection from surgical stress during major abdominal operations. Inhalational or intravenous anesthetics may be equally used to induce unconsciousness. The fact that there may be blood loss is not an absolute contraindication to epidural anesthesia. The safety and controllability of combined anesthesia increase when its individual components are monitored and the protocol is strictly observed. There is a need for further development of objective criteria for efficient regional block under general anesthesia.

[Use of average-acting nondepolarizing myorelaxants in abdominal surgery].

The efficiency and safety of use of average-acting nondepolarizing myorelaxants, such as atracurium, vecuronuim, rocuronium, and cisatracurum, during abdominal surgical interventions under general anesthesia (combined or total intravenous anesthesia) were investigated in 162 patients. There is evidence that the use of the above agents ensures a qualitative myorelaxation during different types of operations (laparoscopic and laparotomic) and no impact on hemodynamics (according to the data of continuous non-invasive monitoring) allows these myorelaxants to be used in patients with concomitant cardiovascular diseases. Rocuronium is the myorelaxant of choice for rapid tracheal intubation. The high degree of predictability of the duration of an effect produced by atracurium and cisatracurium enables these myorelaxants to be used without monitoring neuromuscular conduction. With the equally good quality of myoplegia and with virtually comparable consumed diseases, the infusion procedure of relaxation maintenance is preferable for early activation of patients. Insignificant effects on histamine release make it possible to use vecuronium, rocuronium, and cisatracurium in patients with the compromised immune system.

[Safety and quality of myoplegia in different types of abdominal surgeries]. / Bezopasnost' i kachestvo mioplegii pri razlichnykh tipakh abdominal'nykh vmeshatel'stv.

The efficiency of new non-depolarized myorelaxants, i.e. of rocuronium and cisatracurium, in abdominal surgery with general anesthesia (combined or total intravenous anesthesia) of 114 patients was evaluated clinically and accelerometrically. The use of the above drugs at 2 x ED95 was confirmed to ensure a high-quality myorelaxation in different surgery variations (laparoscopy or laparotomy). A lack of effect on the hemodynamics (according to continuous non-invasive monitoring) and release of histamine (according to radioimmunology assay) make it possible to use the myorelaxants in patients with concurrent cardiovascular disease and with burdened allergic history. A bigger degree of prognosticated effect duration is typical of cisatracurium versus rocuronium, whereas the latter is a myorelaxant of choice in case a fast trachea intubation is needed.

[New russian myorelaxant vero-pipecuronium (pipecuronium bromide) used for the anesthetic management of operations on the thorax and abdomen organs]. / Novyi otechestvennyi miorelaksant vero-pipekuronii (pipekuronii bromid) v anesteziologicheskom obespechenii operatsii na organakh grudnoi i briushnoi polosti.

The experience of clinical use of the new Russian myorelaxant of the non-depolarizing action vero-pipecuronium (pipecuronium bromided) manufactured by "Veropharm" is described. Vero-pipecuronium was found to ensure splendid and good conditions for the intubation of the trachea and to maintain reliably myorelaxation. The recommended doses and availability of an antidote (prozerine) provide for a sufficiently controllable myorelaxation. Vero-pipecuronium does not virtually exert any effect on the parameters of hemodynamics and can be successfully used in patients with a high anesthetic risk including heart surgeries. Thus, Russian vero-pipecuronium has now an effective and safe myorelaxant manufactured inside the country, whose parameters are not inferior to those of pipecuronium bromide (arduan) manufactured by "Gedeon Richter", Hungary. Since the described drug is made in Russia, one can hope it will be highly effective both economically and pharmacologically.