Pain, Anaesthesia and Intensive Care最新文献

{"title":"THE STORY OF ONE PATIENT: MULTIPLE TRAUMA, ECMO, THE PATH TO LUNG TRANSPLANTATION AND ...","authors":"Виктория Юрьевна Борисова, О. В. Галієв, С. О. Дубров, А. М. Моренко, А. Д. Висоцький","doi":"10.25284/2519-2078.4(93).2020.220703","DOIUrl":"https://doi.org/10.25284/2519-2078.4(93).2020.220703","url":null,"abstract":"The mortality rate for multiple trauma in combination with severe chest trauma according to Abbreviated Injury Scale (AIS) > 3 is very high: 15.1% for all ages and 28.4% for people 65 years and older [7].  Severe contusion of the lungs can lead to massive hemothorax and severe tracheobronchial bleeding.  If, for hemothorax, urgent surgery is performed based on chest drainage only, it is relatively difficult to find the source of tracheobronchial bleeding at an early stage of injury due to positive airway pressure ventilation.  Due to lung contusion, a huge amount of tissue factor is released, which worsens coagulopathy and leads to increased bleeding.  Worsening respiratory failure can also be caused by blood flow to the area of intact lungs from the area of the injured lungs.  The incidence of acute respiratory distress syndrome in trauma patients ranges from 4.3 to 8.5%.  In such cases, it is very difficult to maintain respiratory function only by standard ventilation control.  Over the past two decades, a number of treatments have been developed that have improved the survival rate of patients with ARDS.  Titration of lower tidal volumes and positive end-expiratory pressure (PEEP) significantly reduces mortality compared to traditional mechanical ventilation with high tidal volumes.  In recent years, neuromuscular blocks and prone positioning have been introduced, demonstrating the mortality benefits of ARDS. Other supportive therapies are used, such as inhalation of prostacyclin, as well as alternative ventilation modes, such as bi-level ventilation or reduced airway pressure ventilation (APRV).  Despite these advances in emergency therapies, some patients continue to deteriorate, and in such cases, veno-venous extracorporeal membrane oxygenation (IV-ECMO) becomes the best option as a last resort to save the lives of these patients.In this article, we presented a case of severe multiple trauma in a 35-year-old man with massive contusion of the lungs and continuing tracheobronchial bleeding, which led to the development of ARDS, destructive processes in the lungs and became the reason for the connection and long-term presence of the patient on VV-ECMO, due to the impossibility of providing with the help of mechanical ventilation gas exchange in the lungs.","PeriodicalId":355172,"journal":{"name":"Pain, Anaesthesia and Intensive Care","volume":"52 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2020-12-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"127124912","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"«NONSURGICAL» ASPECTS OF SUCCESSFUL IMPLEMENTATION OF FAST TRACK PRINCIPLES INTO A SURGICAL CLINIC: OUR EXPERIENCE","authors":"О. П. Стеценко, О. Ю. Іоффе, М. С. Кривопустов, Т. В. Тарасюк, А. В. Андерс","doi":"10.25284/2519-2078.4(93).2020.220681","DOIUrl":"https://doi.org/10.25284/2519-2078.4(93).2020.220681","url":null,"abstract":"Introduction. The main postulate of Fast track surgery according to H. Kehlet is the reduction of negative moments in the postoperative period by reducing the intensity of the body’s stress response to surgery.The purpose of the work. Evaluate the effectiveness of the implementation of Fast track principles in the work of the surgical clinic.Materials and methods. In the period from September 2011 to January 2019, we performed 623 planned surgeries using the principles of Fast track surgery, including the use of multimodal analgesia (MMA) and nutritional support for patients.Results. In the control group on the subjective scale of VAS, patients rated the pain level at 6.26 ± 1.52 points, in the experimental group – at 2.74 ± 1.05 (P <0.001). The average length of stay in the hospital was 4.99 ± 0.45 and 4.10 ± 0.60 days, respectively. The indicator of general weakness in the control group was 6.47 ± 1.26 points, in the experimental group – 2.26 ± 0.86 (P <0.001). Depressive states in the first days after surgery are the result of the above complaints and feelings, in the control group, this figure averaged 4.79 ± 1.07 points, at the same time, in the experimental – 1.50 ± 0.86 (P <0.001).Conclusions. The use of the principles of Fast track surgery, namely multimodal analgesia in the perioperative period in combination with preoperative oral carbohydrate loading and early recovery of oral nutrition with adapted mixtures significantly affects the level of pain impulses in the first postoperative day.","PeriodicalId":355172,"journal":{"name":"Pain, Anaesthesia and Intensive Care","volume":"66 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2020-12-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"123950468","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"ANALYSIS OF TREATMENT OUTCOMES IN TRAUMA PATIENTS IN POLYTRAUMA CENTER","authors":"В. М. Лянскорунський, О. А. Бур’янов, Т. М. Омельченко, Д. В. Мясніков, М. В. Вакулич, С. О. Дубров","doi":"10.25284/2519-2078.4(93).2020.220677","DOIUrl":"https://doi.org/10.25284/2519-2078.4(93).2020.220677","url":null,"abstract":"Introduction. Severe trauma is one of the leading causes of disability and mortality in all age groups. Long bone fractures of lower extremities, in particular the femur, have increased risk of complications. The choice of surgical treatment tactic, timing and methods of fixing of long bone fractures of lower extremities in patients with severe associated trauma is relevant and controversial issue.Objective: to conduct a retrospective analysis of injury structure in polytrauma center and evaluate treatment outcomes in polytrauma patients with multiple long bone fractures of lower extremities, frequency of complications and mortality.Materials and methods: the retrospective study was conducted, included a group of patients had applied to the admission department of Kyiv City Clinical Hospital No17 during the period from January 2010 to December 2019.Results: the study included 54,613 patients at the first stage. 69.3% of patients were received outpatient care, 30.7% were hospitalized. Among all patients, 13.7% were diagnosed with polytrauma, of which 80.2% had chest injury, 78.4% had traumatic brain injury, and 71.1% had musculoskeletal injuries. In the structure of musculoskeletal system trauma the multiple bone fractures of lower extremities were in 16.7% of patients, among them long bone fractures were in 57.6%.The study included 220 patients at the second stage. The incidence of pulmonary embolism occurred in 4.1% of patients, fat embolism – 12.7%, nosocomial pneumonia was diagnosed in 38.2% of patients, acute respiratory distress syndrome (ARDS) – 16.8%. The incidence of sepsis, according to the criteria of definition «Sepsis II» was 30.9%, according to the criteria «Sepsis III» – 9.5%, multiple organ failure (MOF) – 18.6%.The duration of mechanical ventilation was 19.1±10.8 days. The length of stay in intensive care unit was 24.8±12.6 days and the hospital length of stay was 48.9±22.4 days. The mortality rate was 22.3%. Among the main causes of death – hemorrhagic shock (46.9%), MOF (34.7%), refractory septic shock 18.4%.Conclusions: the frequency of polytrauma was 13.7% in trauma structure and frequency of polytrauma with combined multiple long bone fractures of lower extremities – 0.5%. Most common localizations of injuries were chest trauma (78.6%), traumatic brain injury (73.6%), injuries of musculoskeletal system (71.1%). Multiple bone fractures of lower extremities were in 16.7% of patients in the structure of musculoskeletal system trauma, among them fractures of long bones were in 57.6% of patients.Ultrasound examination according to the protocol «Focused Assessment with Sonography for Trauma» (FAST) and whole body computed tomography were not performed after patient hospitalization in 100% of cases, as required by international protocols. The frequency of Early Total Care tactics application – 1.4% that was too low, the definitive osteosynthesis in some cases was performed unreasonably late, and 17.2% of primary and definitive cases","PeriodicalId":355172,"journal":{"name":"Pain, Anaesthesia and Intensive Care","volume":"19 4","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2020-12-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"121016756","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"PRACTICAL ASPECTS OF ORGAN TRANSPLANTATION BASED ON THE REGULATORY DOCUMENTS AND CLINICAL PRACTICE AT THE COMMUNAL NON-PROFIT ENTERPRISE “LVIV CLINICAL EMERGENCY HOSPITAL”","authors":"Н. В. Матолінець, О. О. Самчук, С. О. Дубров, А. М. Нетлюх","doi":"10.25284/2519-2078.4(93).2020.220654","DOIUrl":"https://doi.org/10.25284/2519-2078.4(93).2020.220654","url":null,"abstract":"Introduction. Organ transplantation is an established form of treatment that is recognized as the best and often the only life-saving therapy for final organ replacement. The increased number and quality of organ and tissue transplant allows suggesting that in the future, transplantation will take a central stage in the routine clinical practice.Evidence of obtained information. The analysis of literature for the past 15 years has been made using MEDLINE, Google Scholar, Researchgate medical databases dedicated to brain death diagnostics and regulating organ transplantation; own data processed in the form of the presented clinical case.Evidence synthesis. The implementation of regulatory documents and guidelines into the clinical practice allows clear and coordinated execution of all medical and legal procedures aimed at intra-vitam and post-mortal human organ retrieval and transplantation. Brain death confirmation is a multi-disciplinary procedure. Both medical outcomes of organ retrieval and transplantation, and their ethical aspects and legal consequences depend on its adequate conduct.In the past six months, brain death was confirmed 7 times in Lviv, with two cases of multi-organ retrieval and transplantation (2 hearts, 4 kidneys and 1 pancreas (exitus letalis). In addition, two kidneys were transplanted from family members.In total, 5 heart transplants were performed in Ukraine, 4 of which were performed under the leadership of Oleh Samchuk, the current Head of the Communal Non-Profit Enterprise “Lviv Clinical Emergency Hospital”.Conclusions. Organ transplantation is possible in multi-field general hospitals provided that the process is clearly organized, the requirements of current legislation and regulations are carefully observed.","PeriodicalId":355172,"journal":{"name":"Pain, Anaesthesia and Intensive Care","volume":"2013 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2020-12-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"128194175","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"DURATION OF BLOCKADE OF PERIPHERAL NERVES WITH LOW CONCENTRATED BUPIVACAINE SOLUTION DEPENDING OF THE ADJUVANTS","authors":"М. М. Барса","doi":"10.25284/2519-2078.3(92).2020.211431","DOIUrl":"https://doi.org/10.25284/2519-2078.3(92).2020.211431","url":null,"abstract":"Background. In recent years, anesthesiology has shown a tendency to reduce the use of narcotic analgesics intra- and postoperatively. This is due to respiratory depression and as a result – hypoxia in the postoperative period. In addition, the use of narcotic analgesics does not allow the patient to mobilize in the early postoperative period, which in turn increases the risk of thromboembolic complications, especially in elderly patients and patients with obesity. However, withdrawal from a narcotic analgesic should not affect the patient’s postoperative comfort and pain-relief. The rapid progress in the development of regional methods of analgesia has significantly reduced the use of narcotic analgesics intra and post operatively and has provided sufficient pain relief for patients. Despite the results achieved, we continue to search for the perfect combination of local anesthetic and adjuvants to ensure long-lasting and safe analgesia. Objective. Suggest a new combination of local anesthetics and adjuvants, compare the duration of postoperative analgesia after peripheral nerve blocks with low concentration bupivacaine solution with dexamethasone and low concentration bupivacaine with dexamethasone and epinephrine. Explore the possibility of orthopedic surgery without using narcotic anesthetics. with solution of bupivacaine 0,375% and dexamethasone 0,02%; Group 2 – patients whose blockade was performed with a solution of bupivacaine 0,375% with dexamethasone 0,02% and epinephrine 0,00018%. The duration of the blockade was estimated by puncturing the skin with a needle. Pain intensity was assessed at the 6th, 12th, 24th and 36th hours after blockade using a VAS scale. The amount of narcotic anesthetic used in the postoperative period were also recorded. In addition, patients underwent electromyography of the innervation area of the blocked nerve before the surgery and 24 and 36 hours after surgery. Results. The duration of blockade in Group 2 was longer by 10 hours, the intensity of pain (VAS) was significantly higher after 24 hours (1.65 ± 1.35 in Group 2 and 5.3 ± 1.26 in Group 1). According to electromyography, 24 hours after the blockade conductance in Group 1 was restored by 95-100%, unlike Group 2, where conductivity was restored by only 47-59%. Conclusions. The proposed combination of local anesthetics and adjuvants provides both adequate anesthesia during surgery and prolonged post-operative analgesia.","PeriodicalId":355172,"journal":{"name":"Pain, Anaesthesia and Intensive Care","volume":"26 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2020-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"132849886","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"HEMODYNAMIC CHANGES IN CHILDREN WITH ACUTE RESPIRATORY FAILURE DURING WEANING FROM MECHANICAL VENTILATION","authors":"О. В. Філик","doi":"10.25284/2519-2078.3(92).2020.211471","DOIUrl":"https://doi.org/10.25284/2519-2078.3(92).2020.211471","url":null,"abstract":"Background. Acute respiratory failure is accompanied by increasing load on cardiovascular system. The aim of the study was to investigate functional parameters of cardiovascular system and oxygen delivery in children with acute respiratory failure at different strategies of mechanical ventilation. Materials and methods. We conduct prospective, randomized, non-interventional, single-center controlled trial among patients 1 month – 18 years old. All patients were divided into a control group, which included 75 patients who underwent short-term ventilation during elective surgery and who were weaned immediately after surgery and restoration of physiological functions after anesthesia, and patients of the study group with acute respiratory failure (n = 162), who required invasive mechanical ventilation via endotracheal tube. Patients in the study group were randomized into study group I (83 patients) and received traditional ICU monitoring and treatment and study group II (79 patients), in which we used in addition to traditional monitoring and treatment, proposed by us methods of monitoring and treatment strategy. To assess age-dependent data, patients were divided into age subgroups: 1 subgroup – children 1 month – 1 year; 2 nd subgroup – children 1 – 3 years; 3 subgroup – children 3 – 6 years; 4 subgroup – children 6 – 13 years; 5 subgroup – children 13 – 18 years. Stages of the study: 1st day (d1), 3rd day (d3), 5th day (d5), 7th day (d7), 9th day (d9), 14th day (d14), 28th day (d28). The evaluation criteria were heart rate, non-invasive blood pressure (systolic, diastolic and mean), stroke volume, stroke volume index, cardiac output, cardiac index, oxygen delivery. Results. The features of hemodynamics in patients of II study group at weaning from mechanical ventilation, depending on age, were: in the 2nd and 3rd age subgroups in hypoxemic and hypercapnic-hypoxemic forms of respiratory failure – decrease in heart rate at stage d3 by 33% and 40 %, compared with I group patients (p = 0.05 and p = 0.04); reduction of cardiac index by 25% (p = 0.001) in 2nd age subgroup at stage d3 and by 31% (p = 0.02) in the 3rd age subgroup at stage d5. In the 1st and 4th age subgroups of the II study group in hypoxemic and hypercapnic-hypoxemic respiratory failure were stroke volume index decreasing from stage d3, up to 21% (p = 0.04) and up to 37% (p = 0.05 ) for the 1st and 4th subgroups, respectively, together with significant decrease in cardiac output at stage d5, in comparison with I study group. For patients of 5th age subgroup with hypoxemic and hypercapnic-hypoxemic respiratory failure typically were significant decreasing of systolic and mean blood pressure at stage d1 by 17% (p = 0.04) and 24%, respectively (p = 0.001), in comparison with I study group; growth of cardiac output and cardiac index at stage d3 by 13% and 14% (p = 0.05 and p = 0.04). Oxygen delivery rates in patients of the 1st and 3rd age subgroups were significantly decreased from stage","PeriodicalId":355172,"journal":{"name":"Pain, Anaesthesia and Intensive Care","volume":"57 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2020-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"122978325","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"EXPERIENCE OF DEXMEDETOMIDINE USE IN SURGERY IN PATIENTS WITH THYROTOXICOSIS","authors":"Володимир Черній, Анатолий Иванович Денисенко","doi":"10.25284/2519-2078.3(92).2020.211474","DOIUrl":"https://doi.org/10.25284/2519-2078.3(92).2020.211474","url":null,"abstract":"Сучасне поняття тиреотоксикозу пов'язане з невідповідно високою активністю тиреоїдних гормонів (тетрайодтироніну - FТ4 та трийодтироніну - FТ3) у тканинах, що зазвичай, обумовлено високим їх рівнем в крові внаслідок високої функціональної активності щитоподібної залози. Це призводить до підвищеного обміну речовин в організмі, спричиняючи посилений катаболізму жирів і білків, що веде до гіперметаболізму, гіпертермії, підвищенню чутливості адренорецепторів до катехоламінів з ураженням серцево-судинної та нервової систем. При відсутності ефективного лікування, це може призвести до тиреотоксичного кризу зі швидкою декомпенсацією органів і систем пацієнта, швидко прогресуючих проявів синдрому поліорганної недостатності. Проведення тотальної екстрафасциальної тиреоїдектомії є найбільш ефективним хірургічним лікуванням цього захворювання. І в цьому сенсі, заслуговує на увагу вивчення можливості застосування сучасного седативного засобу дексмедетомідину в якості внутрішньовенного ад'юванта при загальному знеболюванні під час тиреоїдектомії у таких пацієнтів. Дексмедетомідин є високо селективним агоністом α2А-адренорецепторів з широким спектром фармакологічних властивостей, включаючи седативний ефект, аналгезію, анксіоліз та блокування симпатичного тонусу. Крім того, дексмедетомідин може послабити периопераційний стрес, ступінь запалення та захистити імунну систему у пацієнтів хірургічного профілю.","PeriodicalId":355172,"journal":{"name":"Pain, Anaesthesia and Intensive Care","volume":"19 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2020-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"116766206","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"ПРОФЕСОРУ ЛІСЕЦЬКОМУ ВІТАЛІЮ АДАМОВИЧУ 80 РОКІВ!","authors":"Сергій Олександрович Тарасенко","doi":"10.25284/2519-2078.2(91).2020.205606","DOIUrl":"https://doi.org/10.25284/2519-2078.2(91).2020.205606","url":null,"abstract":"","PeriodicalId":355172,"journal":{"name":"Pain, Anaesthesia and Intensive Care","volume":"216 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2020-06-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"115207383","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"EXPERIENCE WITH THE DEXMEDETOMIDINE FOR SEDATION IN PEDIATRIC NEUROSURGERY IN THE EARLY POSTOPERATIVE PERIOD","authors":"Л.В. Гаврилова","doi":"10.25284/2519-2078.2(91).2020.205597","DOIUrl":"https://doi.org/10.25284/2519-2078.2(91).2020.205597","url":null,"abstract":"","PeriodicalId":355172,"journal":{"name":"Pain, Anaesthesia and Intensive Care","volume":"37 2","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2020-06-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"131456071","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"SUPPRESSION OF THE SMALL INTESTINE SHRINKABLE ACTIVITY AFTER USAGE OF THE ANESTHETIC KETAMINE","authors":"Д. О. Дзюба, М. І. Мельник, Д. О. Дринь, О. А. Лоскутов, О. В. Жолос","doi":"10.25284/2519-2078.2(91).2020.205598","DOIUrl":"https://doi.org/10.25284/2519-2078.2(91).2020.205598","url":null,"abstract":"The work is devoted to the problem of general anesthetics side effects during surgical interventions. In particular, some of the common complications of anesthetics usage are intestinal motility disorders (eg, ileus), nausea and vomiting. We analyzed a clinical data of 60 patients who underwent analgosedation (AS) during coronary artery stenting. They were divided into 2 groups (1 group - AS with Diazepam and Fentanyl, 2 group - AS with Ketamine, Fentanyl and Propofol). Significantly more frequent manifestations of nausea in the perioperative period were identified in the group where ketamine was used. This formed the basis of the study of the molecular and cellular mechanisms of the effects of ketamine on the contractile activity of the smooth muscles of the small intestine. Anesthetics are known to interact with receptors, G-proteins and ion channels, including transient receptor potential channels (TRP channels). The member of this superfamily, TRPC4 channel, which is coupled to muscarinic receptors (M2/M3 type) through G-protein activation and causes cholinergic excitation and contraction of small intestinal smooth muscles, may be a potential target for ketamine. Thus, we aimed to investigate the effects of ketamine (100 μM) on the muscarinic cation current (mICAT), which underlies cholinergic excitation-contraction coupling of visceral smooth muscles. All experiments were performed on single ileal myocytes freshly isolated from the longitudinal layer of the mouse ileum using patch-clamp techniques in the whole-cell configuration. mICAT was recorded using symmetrical Cs+ solutions (containing Cs+125 mM). [Ca2+]i was ‘clamped’ at 100 nM using 10 mM BAPTA/4.6 mM CaCl2 mixture. Measurements of isometric contractile force of the small intestinal smooth muscles were recorded using tensiometry techniques. It was showed that 100 μM ketamine inhibits mICAT . mICAT initiated by the application of CCh (50 μM) was suppressed on 64% (n=5) and mICAT, induced by intracellular GTP γ s (200 μM) that interacts directly with the G-proteins (when muscarinic receptors are bypassed) was inhibited on 42% (n=5). Ketamine inhibited intestinal smooth muscle contractions evoked by carbachol (50 μM) by about 40 % (n=5). Thus, we can conclude that both muscarinic receptors and G-proteins (or their coupling) are affected by ketamine, but the main sites of ketamine action appear to be the G-proteins. These data will provide basis for the molecular mechanisms of postoperative motility disorders and thus may be important for the development of novel approaches to the correction of such states.","PeriodicalId":355172,"journal":{"name":"Pain, Anaesthesia and Intensive Care","volume":"15 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2020-06-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"132989148","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}