Anaesthesia, Pain & Intensive Care最新文献

{"title":"LEGAL ASPECTS OF PROTECTION OF MEDICAL WORKERS DURING PROFESSIONAL ACTIVITY","authors":"A. Shevel, S. Dubrov, Y. Lisun, E. I. Uglev","doi":"10.25284/2519-2078.2(95).2021.238328","DOIUrl":"https://doi.org/10.25284/2519-2078.2(95).2021.238328","url":null,"abstract":"The issues of protection of the rights of medical workers have recently become especially relevant. Modern medical legislation is due to the imperfection of the legal framework and, consequently, the lack of resources to improve the legal literacy of health professionals, in connection with which they often find themselves in difficult situations. The article highlights the main legal acts that regulate the interests in the field of health care and form a model of the doctor-patient relationship.Objective: to prove in an accessible form to health professionals the main legal acts to maintain their knowledge in the legal field and to explain the mechanisms for minimizing conflict situations during professional activities.","PeriodicalId":7735,"journal":{"name":"Anaesthesia, Pain & Intensive Care","volume":"31 1","pages":""},"PeriodicalIF":0.2,"publicationDate":"2021-06-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"80645412","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":"PECULIARITIES OF THE COURSE OF POST-TRAUMATIC STRESS DISORDERS, DEPENDING ON THE TYPE OF ANESTHESIOLOGICAL PROVISION, DURING THE IMPLEMENTATION OF RECONSTRUCTIVE SURGICAL INTERVENTIONS AFTER FIREARMS WOUNDS OF THE LIMBS","authors":"V. Horoshko, I. Kuchyn","doi":"10.25284/2519-2078.2(95).2021.238310","DOIUrl":"https://doi.org/10.25284/2519-2078.2(95).2021.238310","url":null,"abstract":"In combatants who have received firearms wounds during hostilities in the East of Ukraine, treatment of post-traumatic stress disorders (PTSD) in 82.1% does not have a positive result. The peculiarities of its course are not studied, depending on the type of anesthesia during the implementation of reconstructive surgical interventions. In the long run, after such surgical interventions, the intensity of pain in the postoperative period may cause deepening of the PTSD and the development of its resistance to the intended treatment.","PeriodicalId":7735,"journal":{"name":"Anaesthesia, Pain & Intensive Care","volume":"9 1","pages":""},"PeriodicalIF":0.2,"publicationDate":"2021-06-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"79661728","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":"CHOICE OF THE OPTIMAL METHOD OF PERIOPERATIVE ANESTHESIA AT THORACOTOMIA","authors":"H. Slavuta, S. Dubrov, P. Poniatovskkyi, O. Havrylenko","doi":"10.25284/2519-2078.1(94).2021.230612","DOIUrl":"https://doi.org/10.25284/2519-2078.1(94).2021.230612","url":null,"abstract":"Introduction. Lung cancer occupy an advanced place among malignant neoplasms. It is more common in men aged 30 to 74 years. Almost all lung cancer patients need surgical treatment. Pulmonary dysfunction is caused by impaired evacuation of bronchial secretions, and the diaphragm dysfunction due to the pain. Postoperative pain is one of the main reasons for the development of complications. There are many methods of postoperative pain control, but the search for a better method is still ongoing.Objective. Improve results of perioperative analgesia in patients undergoing thoracotomy by choosing the optimal method of analgesia.Маterials and methods. 45 patients with lung cancer who underwent thoracotomy. Patients were randomized into 4 groups. Group A: according to the concept of pre-emptive analgesia, patients received 1000 mg of paracetamol intravenously 1 hour before incision, 50 mg of dexketoprofen intravenously and epidural analgesia: 40 mg of 2% lidocaine solution when placing a venous catheter, in the postoperative period - 2 mg / ml (3-7 ml / h) of ropivacaine. Group B: epidural analgesia: 40 mg of 2% lidocaine solution when placing a venous catheter, in the postoperative - 2 mg / ml (3-7 ml / h) ropivacaine. Group C: according to the concept of pre-emptive analgesia, patients received 1000 mg of paracetamol intravenously 1 hour before incision and of 50 mg of dexketoprofen intravenously. Group D: Without pre-emptive analgesia and epidural analgesia. The severity of the pain syndrome was assessed using a numerical rating scale (NRS) after 3, 6, 12, 24 and 32 hours.Results and discussion. No statistically significant differences were observed in the subgroups by age, body weight, duration of surgery and blood loss (p> 0.05). Patients in group A did not require additional morphine analgesia and reported lower pain intensity using NRS. After 32 hours, the data were significantly different from groups B, C, and D (p <0.05). There was no significant difference between groups B and C in the assessment of the NRS (p <0.05), but in the group C only one patient required additional morphine analgesia.Conclusion. The effectiveness of the combination of pre-emptive analgesia and epidural analgesia indicates sufficient level of analgesia in patients after lung surgery. A multimodal approach to perioperative analgesia for patients undergoing thoracic surgery without epidural analgesia reduces opioid use compared to epidural analgesia alone.","PeriodicalId":7735,"journal":{"name":"Anaesthesia, Pain & Intensive Care","volume":"70 1","pages":""},"PeriodicalIF":0.2,"publicationDate":"2021-05-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"85635549","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":"PAIN CARE ESSENTIALS","authors":"L. Ali","doi":"10.35975/APIC.V25I2.1495","DOIUrl":"https://doi.org/10.35975/APIC.V25I2.1495","url":null,"abstract":"The best kept secret in pain management is in your own hands. Pain Care Essentials offers the readers a fingertip access to numerous topics in still emerging   field of pain medicine, including physical rehabilitation in pain management, peripheral nerve blocks, neuropathic pain, pediatric and elderly pain. This book provides an overview of pain mechanisms as currently understood, and details a variety of approaches to pain management used across a wide range of complementary disciplines. \u0000Divided into four convenient sections; the book addresses Fundamentals and Evaluation, Treatment Modalities (including opioids, interventions and alternative medicine), common Chronic Pain and Urgent Pain Problems. Integrative care concepts are presented, emphasizing multi-disciplinary approaches to address the pain. Expert contributors describe therapeutic approaches of various pain conditions and implementing self-care management options.","PeriodicalId":7735,"journal":{"name":"Anaesthesia, Pain & Intensive Care","volume":" ","pages":""},"PeriodicalIF":0.2,"publicationDate":"2021-04-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43717264","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":"PROLONGED SYSTEMIC SPINAL ANESTHESIA IN ORTHOPEDICS AND TRAUMATOLOGY (clinical study)","authors":"O. M. Strogush","doi":"10.25284/2519-2078.1(94).2021.230617","DOIUrl":"https://doi.org/10.25284/2519-2078.1(94).2021.230617","url":null,"abstract":"Introduction. The task of providing anesthesia for long-term operations on the lower extremities in the traumatology and orthopedics is resolved by different ways. Prolonged systemic spinal anesthesia (SA) using oral clonidine (clophelin) deserves a special attention. Aim is to study the duration of SA using oral clonidine (clophelin) in orthopedic and traumatic patients who were undergoing prolonged surgery on the knee joint and the proximal tibia epi-metaphysis. Materials and Methods: The study involved 43 patients who were divided into two groups - group without clophelin (22 patients) and group with clophelin (21 patients) use. Operations in both groups were performed under conditions of SA (0.5% solution of isobaric bupivacaine at a dose of 13 mg in combination with 40 mg of 2% solution of lidocaine). In group with clophelin the premedication included the addition appointment of oral clophelin at a dose of 4 μg / kg (approximately 300 μg) 60 minutes before surgery. There were determined the SA duration, the total duration of intraoperative anesthesia, the total duration of the pneumatic harness action, a state of hemodynamics during the operation and postoperative period. Results and Discussions. There were no statistically significant differences in duration of operations in the group without clophelin and in group with clophelin that amounted to 228.63 ± 51.59 minutes and 241.04 ± 48.46 minutes, respectively (p = 0.24). SA duration in the group with clophelin statistically significantly exceeded the duration in group without clophelin and consisted of 236.38 ± 39.76 minutes and 204.77 ± 38.92 minutes, respectively (p = 0.011). The pulse rate in the clophelin group, comparing to the group without clophelin was significantly lower during the operation, in 6 hours after surgery and did not reach the level of critical bradycardia. The mean arterial pressure in the group with clophelin, comparing with group without clophelin was significantly lower during the operation, in 24 hours after surgery and did not reach the level of critical hypotension.Conclusions. The duration of SA by bupivacaine in combination with lidocaine using oral clonidine (clophelin) before surgery at a dose of 4 μg / kg (about 300 μg) in orthopedic and traumatic patients undergoing the knee joint surgery was increased by an average of 32 minutes. Against the background of prolonged systemic SA with the use of oral clonidine (clophelin), these operations can be performed for up to 4 hours. The detected hemodynamic changes against the background of clonidine use were not critical and are not considered as complications.","PeriodicalId":7735,"journal":{"name":"Anaesthesia, Pain & Intensive Care","volume":"81 1","pages":""},"PeriodicalIF":0.2,"publicationDate":"2021-03-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"79324690","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":"USE OF ULTRASOUND DURING CATHETERIZATION OF CENTRAL VEINS (experience of anesthesiological department of the department of intensive therapy of general profile of KMKLSHMD, Kyiv)","authors":"O. V. Bobrovnik, K. I. Tsimbalenko","doi":"10.25284/2519-2078.1(94).2021.230610","DOIUrl":"https://doi.org/10.25284/2519-2078.1(94).2021.230610","url":null,"abstract":"The article is devoted to the use of ultrasound during catheterization of the central veins, the advantages of this technique, the experience of KMCLSHMD physicians and the prospect of developing this technique","PeriodicalId":7735,"journal":{"name":"Anaesthesia, Pain & Intensive Care","volume":"12 1","pages":""},"PeriodicalIF":0.2,"publicationDate":"2021-03-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"81307369","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":"HEART RATE VARIABILITY IN ANESTHESIOLOGICAL PRACTICE","authors":"E. I. Uglev, O. Muravsky, Y. Lisun","doi":"10.25284/2519-2078.1(94).2021.230609","DOIUrl":"https://doi.org/10.25284/2519-2078.1(94).2021.230609","url":null,"abstract":"Introduction. Patient safety in optimal working conditions of the surgeon is the main task of the anesthesiology service. Neurovegetative homeostasis is the goal of the anesthesiologist [9, 19, 20, 49]. Full-fledged examination, identification of clear contraindications, extended monitoring; ensure joint and effective work of the team. The depth of anesthesia depends on a significant number of exogenous and endogenous factors. Many methods are used to assess the function of the cardiovascular system, which contributes to the performance of safe anesthesia. Much depends on the effect of the drug, but the effect of afferent noc- and antinociceptive systems, which behave extremely unstable, may require significant adjustment of the standard calculated dose. The adequacy of the effect of drugs and technological means on vital functions during anesthesia is sometimes difficult to assess based on standard monitoring methods, which forces us to consider the effect of surgical stress on the ANS. Maintaining a balanced pharmacological protection of all vital systems, in particular, the autonomic nervous system (ANS) before, during and after anesthesia is of great practical interest [7, 10].","PeriodicalId":7735,"journal":{"name":"Anaesthesia, Pain & Intensive Care","volume":"24 1","pages":""},"PeriodicalIF":0.2,"publicationDate":"2021-03-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"88351620","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":"USE OF INTRAVENOUS IMMUNOGLOBULIN G IN COMPREHENSIVE TREATMENT OF COVID-19 SEVERE PATIENTS. SERIES OF CLINICAL CASES","authors":"S. Dubrov, M. Denysiuk, S. Sereda, V. Borisova, G. Slavuta, Y. Zaikin, S. Cherniaiev","doi":"10.25284/2519-2078.1(94).2021.230620","DOIUrl":"https://doi.org/10.25284/2519-2078.1(94).2021.230620","url":null,"abstract":"Introduction. The incidence of COVID-19 continues to rise rapidly worldwide, leading to significant socio-economic damage to health and economic systems.Objective. To determine the effectiveness of intravenous immunoglobulin G (IVIG) in combination with a basic therapy in severe COVID-19.Materials and methods. A retrospective cohort study of 8 case histories of patients with severe COVID-19 for the period from 27.08.2020 to 20.03.2021 was conducted in the intensive care unit (ICU) of the infectious diseases department of the Municipal Non-Profit Enterprise «Kyiv City Clinical Hospital №17» (MNE KCCH №17).Results and discussions. During the period from 27.08.20 to 20.03.21 in the intensive care unit (ICU) of the infectious department of the Municipal Non-Profit Enterprise «Kyiv City Clinical Hospital №17» (MNE KCCH №17) there were 163 patients, of whom 79 died and the mortality rate was 48.4%. The mean age of patients was 63.5 ± 12.9 years (19 to 95 years). The mean age of death was 66.9 ± 9.9 years (40 to 87 years).During the study period, 8 patients received IVIG (5%) together with a basic therapy. The mean age of patients was 51.4 ± 14.7 years (from 29 to 69 years). Mortality among patients receiving IVIG was 37.5%.Conclusions. Mortality of patients who received IVIG in addition to a basic therapy was significantly lower compared to patients who received only basic therapy, 37.5% and 48.4%, respectively.","PeriodicalId":7735,"journal":{"name":"Anaesthesia, Pain & Intensive Care","volume":"41 1","pages":""},"PeriodicalIF":0.2,"publicationDate":"2021-03-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"73273362","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":"COMPARISON OF THE EFFECTS OF COMBINED NEURAXIAL ANESTHESIA AND MULTICOMPONENT LOW-FLOW INHALATION ANESTHESIA IN THE STRUCTURE OF PERIOPERATIVE ANESTHETIC MANAGEMENT IN PATIENTS UNDERGOING ARTHROSCOPIC INTERVENTIONS ON THE KNEE JOINT","authors":"V. Yevsieieva, Y. Skobenko, L. Zenkina, M. Malimonenko, S. Savchenko","doi":"10.25284/2519-2078.1(94).2021.230615","DOIUrl":"https://doi.org/10.25284/2519-2078.1(94).2021.230615","url":null,"abstract":"Abstract. Arthroscopic knee surgery (AKS) is one of the most common types of surgery in the world. But there is still a debate about the optimal type of anesthetic management for this type of orthopedic surgery. The purpose of the study was to improve the quality of anesthetic management of arthroscopic interventions on the knee joint by introducing personalized perioperative anesthesia management. Materials and methods: 142 patients, aged 18-78 years, who were planned for AKS, took part in the study. The patients were randomized into 2 groups according to the type of anesthesia chosen by the patient. In the first group (n1 = 82) patients underwent neuraxial anesthesia in combination with intravenous administration of dexmedetomidine, in the second group (n2 = 60) – multicomponent low-flow inhalation anesthesia with sevoflurane in combination with multimodal analgesia. Before the operation, the level of preoperative stress was assessed. During the first 24 hours after surgery, the level of postoperative pain was assessed by the VAS, the incidence of PONV, and overall patient satisfaction with the surgery. Results: the level of pain according to the VAS, the incidence of PONV, the level of satisfaction in the study groups did not differ significantly. Conclusions: Neuraxial and general anesthesia for arthroscopic knee surgery has advantages and disadvantages. The patient’s choice of one or another type of anesthetic aid was significantly influenced by the level of preoperative stress. Decision-making on the method of anesthesia should be based on the patient’s wishes and possible previous surgical experience.","PeriodicalId":7735,"journal":{"name":"Anaesthesia, Pain & Intensive Care","volume":"17 1","pages":""},"PeriodicalIF":0.2,"publicationDate":"2021-03-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"75492462","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":"STRATEGIES FOR PERIOPERATIVE FLUID THERAPY: GOAL-DIRECTED VS LIBERAL AND RESTRICTIVE (literature review)","authors":"V. Lysenko, E. Karpenko, Y. Morozova","doi":"10.25284/2519-2078.1(94).2021.230601","DOIUrl":"https://doi.org/10.25284/2519-2078.1(94).2021.230601","url":null,"abstract":"The review highlights the analysis of modern literature data from randomized multicenter controlled trials conducted in the world in order to determine the optimal strategy for perioperative fluid therapy in both planned and urgent interventions. To date, despite a large number of studies on the effect of perioperative infusion therapy volumes on treatment outcome in abdominal operations, conflicting data have been obtained. There is no convincing evidence about the benefits of restrictive, liberal regimes or goal-directed fluid therapy, although from both theoretical and practical points of view, none of the researchers doubts the fact that maintaining an optimal balance requires an individual approach, which could reduce many postoperative complications. Recently, researchers have pointed out the advantages of goal-directed infusion therapy as one of the components of the ERAS protocol, the strategy which based on the regulation of cardiac output (SV) and stroke volume (UO) and achieving intraoperative zero fluid balance, especially in high-risk patients with concomitant diseases of cardio-vascular system. Recent multicenter studies such as RELIEF compared the restrictive and liberal regimes of fluid therapy and concluded that perioperative fluid management in extensive operations should be achieved using a “conditionally liberal regimen” with positive water balance of one to two liters by the end of the operation. Researchers are revising the concept of fluid loss in the “third space” and the need for its compensation. The role of endothelial glycocalyx in maintaining the integrity of the endothelium, as well as the reaction of atrial natriuretic peptide (ANP) to volumetric fluid overload, which provokes platelet aggregation, increases vascular permeability and, as a result, manifests tissue edema, is shown. Large-scale RELIEF and OPTIMISE studies are continuing in this direction in order to offer the optimal regimen of perioperative fluid therapy for various surgical interventions.","PeriodicalId":7735,"journal":{"name":"Anaesthesia, Pain & Intensive Care","volume":"481 1","pages":""},"PeriodicalIF":0.2,"publicationDate":"2021-03-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"77502100","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}