scholarly journals PROLONGED EPIDURAL ANALGESIA AFTER COLORECTAL SURGERY IN ELDERLY PATIENTS

2018 ◽  
Vol 12 (3) ◽  
pp. 175-182
Author(s):  
Alexander V. Savushkin ◽  
E. A Khachaturova ◽  
E. V Balykova
Keyword(s):  
Elderly Patients ◽  
Epidural Analgesia ◽  
Comparison Group ◽  
Enhanced Recovery ◽  
Randomized Study ◽  
Early Mobilization ◽  
Main Group ◽  
Bolus Administration ◽  
Surgical Interventions ◽  
On Demand

Objective: to compare the effectiveness of prolonged epidural analgesia by continuous infusion or bolus administration on demand, as well as the timing and volume of early mobilization with two methods of postoperative analgesia. Material and methods: prospective randomized study enrolled 161 patients with colorectal cancer aged from 60 to 89 years, operated by means of laparotomy and laparoscopy. In the main group (n=80), postoperative prolonged epidural analgesia was carried out using individual pumps with an initial rate of 0.2% ropivacaine solution of 4-6 ml/h. In the comparison group, epidural analgesia was provided by bolus administration of 4-6 ml of 0.2% ropivacaine solution on demand. Results: In the main group with open surgical interventions, in contrast to the comparison group, prolonged epidural analgesia provided a decrease in the intensity of pain on the second (2.7 ± 1.8 and 4.1 ± 1.4 score, p < 0.001), third (2.6 ± 1.6 and 3.9 ± 1.1 score, p < 0.001), fourth day (2.3 ± 1.7 and 3.5 ± 1.2 score, p < 0.001). Prolonged epidural analgesia in the main group allowed more patients to be activated on the second (64.2% (52 of 81), p < 0.001), third (97.5% (79 of 81), p < 0.001) and fourth (100%, p < 0.002) days. The average time of activity in the main group was three times higher on the third day and twice - on the fourth day (p < 0.001). Conclusion: Postoperative prolonged epidural analgesia is highly effective in elderly patients during their treatment with enhanced recovery methods.

scholarly journals Optimization of rehabilitation measures after artificial abortion as the result of immunomodulator aminodihydrophthalasindione sodium apply in comprehensive therapy

2019 ◽  
pp. 156-161
Author(s):  
E. A. Voroshilova
Keyword(s):  
Marked Reduction ◽  
Clinical Effect ◽  
Comparison Group ◽  
Clinical Symptoms ◽  
Randomized Study ◽  
Main Group ◽  
Control Group ◽  
Comprehensive Therapy ◽  
Effect Of Treatment ◽  
Artificial Abortion

The article presents the results of a comparative randomized study, the purpose of which was to evaluate the effectiveness of the use of aminodihydrophthalasindione sodium (Galavit, LLC SELVIM, Russia) in the treatment of patients undergoing an abortion. Included in the study, 48 women were divided into two groups, 24 patients of the main group in addition to the standard rehabilitation were treated with aminodihydrophthalasindione sodium in the comparison group – 24 patients underwent only standard rehabilitation. In this study, all patients (100%) of the main group who were treated with aminodihydrophthalasindione sodium in addition to the standard therapy marked reduction of the clinical symptoms of the disease and positive dynamics was observed at ultrasound. In the control group, the full clinical effect of treatment was observed only in 10 patients (52.6%). 9 women (47,4%) required repeated therapy. Ultrasound studies in 12 patients (63.2%) showed changes equivalent to endometritis.

scholarly journals Standard open operative interventions in surgical treatment of patients, suffering an acute complicated pancreatitis

2018 ◽  
Vol 85 (7) ◽  
pp. 27-29
Author(s):  
V. P. Аndriushchenko ◽  
D. V. Аndriushchenko ◽  
Yu. S. Lysiuk
Keyword(s):  
Surgical Treatment ◽  
Comparison Group ◽  
Surgical Intervention ◽  
Main Group ◽  
Control Group ◽  
Treatment Results ◽  
Surgical Interventions ◽  
Second Stage ◽  
Standard Operations

Objective. To determine the character and optimal volume of standard open surgical interventions in an acute complicated pancreatitis (ACP) with elaboration of the main technical elements of the operations. Маterials and methods. There were operated 96 patients, suffering ACP. The main group consisted of 47 patients, in whom open interventions were performed primarily in 19, and as the second-stage procedure after application of miniinvasive interventional technologies (МIТ) – in 28. The comparison group consisted of 49 patients, in whom standard operations were done only. Results. Application of MIТ have promoted the indications narrowing for performance of primary open operations more than twice. In the main group the arcuate-like subcostal access was applied predominantly - in 26 (55%) observations (χ²=14.287; р=002), while in a control one – a median upper laparotomy – in 37 (76%) observations (χ²=38.43, р < 0.001). The method of closed draining in accordance to procedure of Beger was used predominantly in the main group of patients – in 43% of observations, comparing with a control group - 9% of observations (χ²=12.965; р=0.003). In 23% patients of the main group and in 26% patients of a control one (χ²=0.0013; р=0.05), when the extended purulent-necrotic inflammation process have presented, a staged sanation was applied, using programmed relaparotomies. Some technical elements of the surgical intervention were improved. Conclusion. Application of standard open operations in accordance to elaborated principle is accompanied by improvement of the treatment results in patients, suffering ACP.

INDICATIONS AND CONTRAINDICATIONS FOR REMOVAL OF FOREIGN BODIES OF LUNGS OF FLAMMABLE ORIGIN

2021 ◽  
pp. 43-47
Author(s):  
V. Kupriyanchuk ◽  
Y. Bunin ◽  
R. Mikhailusov ◽  
V. Negoduyko ◽  
E. Khoroshun ◽  
...  
Keyword(s):  
Postoperative Complications ◽  
Foreign Bodies ◽  
Comparison Group ◽  
Gunshot Wounds ◽  
Northern Region ◽  
Main Group ◽  
Surgical Instruments ◽  
Surgical Trauma ◽  
Surgical Interventions ◽  
Surgical Department

Summary. The purpose of the study is to establish the indications and contraindications for the removal of foreign bodies of lungs of gunshot origin. Materials and methods. In the surgical department of the surgical clinic of the Military Medical Clinical Center of the Northern Region, 207 wounded who received gunshot wounds penetrating the chest were examined. The wounded were divided into 2 groups depending on the operational tactics used. The main group of 97 wounded who were treated using modern video endoscopic technology and magnetic surgical instruments. The comparison group consisted of 110 wounded who received traditional treatment. Results and their discussion. Using video endoscopic technologies and magnetic surgical instruments during surgery, 42 (54.5%) in the main group were removed, in the comparison group — 23 (27.4%) foreign bodies. The amount of surgery should not exceed the amount of damage that minimizes surgical trauma. The article presents indications and contraindications to the removal of foreign bodies of pulmonary origin. The differential approach allows to determine the surgical tactics depending on the location of the foreign body, its size and the fit of foreign bodies to the vessels, bronchi, mediastinum. Adherence to the rules of removal of foreign bodies of the lung, depending on the location of its location and size leads to a decrease in inappropriate surgical interventions and postoperative complications. Conclusions. 1. The distribution of foreign bodies by location and size allows you to clearly determine the tactics of treatment and avoid postoperative complications. 2. Surgical interventions to remove foreign bodies should be performed in the first days after stabilization of the patient’s condition using minimally invasive technologies.

scholarly journals Surgical treatment of patients with descending purulent mediastinitis

2021 ◽  
Vol 26 (4) ◽  
pp. 118-123
Author(s):  
I.M. Shevchuk ◽  
S.S. Snizhko
Keyword(s):  
Surgical Treatment ◽  
Pleural Cavity ◽  
Comparison Group ◽  
Postoperative Mortality ◽  
Complete Removal ◽  
Main Group ◽  
Surgical Interventions ◽  
Results Of Treatment ◽  
Minimally Invasive Surgical ◽  
Surgical Tactics

The aim of the study was to improve the results of treatment of patients with descending purulent mediastinitis by means of individualized surgical tactics with the priority use of minimally invasive surgical interventions and developed methods of drainage of the mediastinum and pleural cavity. Examination and treatment of 73 patients with descending purulent mediastinitis receiving treatment in the department of thoracic surgery of Ivano-Frankivsk regional clinical hospital was carried out. Treatment of patients in the main group included intramediastinal administration of antibiotics, the use of the developed method of cascade drainage of the mediastinum and pleural cavity, the priority use of video-assisted thoracoscopy and surgical tactics aimed at anticipating the spread of the purulent process in the mediastinum. The rapid and reliable decrease in the indices of endogenous intoxication in the main group confirms the effectiveness of the developed tactics of surgical treatment of patients with mediastinitis, adequate sanation of purulent mediastinatis, complete removal of the purulent substrate from the mediastinum and pleural cavity. The developed tactics of surgical treatment of purulent mediastinitis allowed reducing the overall postoperative mortality from 26.3% in the comparison group to 11.4% in the main group of patients.

scholarly journals Heart remodeling in elderly patients with isolated systolic arterial hypertension and chronic heart failure with preserved left ventricular ejection fraction

2021 ◽  
Vol 23 (3) ◽  
pp. 331-337
Author(s):  
S. O. Sheiko ◽  
N. O. Kolb
Keyword(s):  
Heart Failure ◽  
Chronic Heart Failure ◽  
Ejection Fraction ◽  
Elderly Patients ◽  
Arterial Hypertension ◽  
Comparison Group ◽  
Left Ventricular ◽  
Main Group ◽  
Volume Index ◽  
Left Ventricular Ejection

The aim of the work was to study the structural and functional state of the left ventricle (LV) in elderly patients with isolated systolic arterial hypertension (ISAH) and chronic heart failure with preserved ejection fraction (CHF with PEF). Materials and methods. After receiving an informed consent, 134 elderly patients with ISAH were enrolled in the study. The main group included 91 patients aged 71.1 ± 3.5 years with ISAH and ejection fraction (EF) of the LV >50 % and a level of natriuretic peptide (NT-proBNP) >125 pg/ml. Among them, there were 61 women (67 %) and 30 (33 %) men. The comparison group consisted of 43 patients (27 women and 16 men aged 70.4 ± 3.7 years) with ISAH, LV EF >50% and NT-proBNP <125 pg/ml. The geometric changes of the LV were evaluated taking into account the LV myocardial mass index and the relative LV wall thickness. Results. Cardiac remodeling in elderly ISAH patients with CHF and PEF was represented by the following geometric variants of the LV. In the main group patients, concentric LV hypertrophy (LVH) prevailed – 73 (80.2 %) patients, while in the comparison group, concentric modeling (CR) – 25 (58.1 %) patients (P < 0.01 by criterion χ2). CR in the ISAH patients with CHF and PEF was diagnosed in 18 (19.8 %) cases. Concentric LVH was verified in 18 (41.9 %) patients of the comparison group (P < 0.01). It was determined that the hyperfunction of the left atrium (LA) in the patients with ISAH without CHF was compensatory. The maximum volume index of the LA (VILAmax.) in these patients was in the range of 27–32 ml/m2. Hyperfunction of the LA in the ISAH patients with CHF and PEF was accompanied by a statistically significant increase in VILAmax. over 34 ml/m2. Conclusions. The prevalence of ISAH among elderly patients is 35.6 %. The formation of a hypertensive heart in the ISAH patients with CHF and PEF is characterized by a predominant concentric LVH (80.2 %) and hyperfunction of the LA. A significant increase in the LA volumes testifies to increase in its contribution to the LV filling with the formation of LV diastolic dysfunction. The presence of concentric LVH and an increase in VILAmax. ≥34 ml/m2 is a criterion for identifying individuals at high and very high risk among elderly ISAH patients with CHF and PEF.

scholarly journals Evaluation of effectiveness of thioctic acid use in combined therapy of angiodistonia and polyneuropathy syndrome

2020 ◽  
Vol 37 (4) ◽  
pp. 17-25
Author(s):  
Natal'ja N. Malyutina ◽  
Arina F. Bolotova ◽  
Roman B. Eremeev ◽  
Dmitriy Yu. Sosnin
Keyword(s):  
Standard Therapy ◽  
Comparison Group ◽  
Combined Therapy ◽  
Randomized Study ◽  
Pain Syndrome ◽  
Main Group ◽  
Thioctic Acid ◽  
Results Of Treatment ◽  
Significant Difference ◽  
Additional Therapy

Objective. The aim of the study was to investigate the effectiveness of the preparation of thioctic acid combined with standard therapy among patients with angiodistonic syndrome and vegetative-sensory polyneuropathy of the extremities due to the influence of general vibration. Materials and methods. A prospective randomized study of two groups of patients with vibration disease was conducted: the main group (n = 30) and the comparison group (n = 30). All patients received standard therapy, while the main group received additional therapy with octolipen (300 mg per os 2 times a day). Results. The results of questionnaires and objective examination of patients did not establish the occurrence of any side effects when including the drug in the therapy. The survey data proved statistically significant differences in the assessment of pain syndrome at rest and in the occurrence of night pains (p = 0.022). At the same time, when assessing the severity of paresthesia, no statistically significant difference was found between the groups (p = 0.5536). The therapy was accompanied by normalization of the antioxidant status (AOS) in both groups: in the main group, the median AOS increased by 1.342 times and in the comparison group by 1.267 times. In the statistical evaluation, the inclusion of thioctic acid in the treatment was accompanied by a statistically significant increase in the AOS not only with the initial data (p 0.00001), but also in comparison with the results of treatment of patients in the comparison group (p = 0.0387). The data from the reovasographic study also showed that the therapy was more effective with additional inclusion of thioctic acid drug to it. Conclusions. Thus, the data obtained justify the feasibility and effectiveness of using thioctic acid preparation in the treatment of angiodistonia and polyneuropathy syndromes.

scholarly journals Potentiation of general multimodal anesthesia by contact laser effects on the body in the red range in patients with lower limb high amputations

2019 ◽  
Vol 6 (1) ◽  
pp. 39-43
Author(s):  
V. S. Shiryaev ◽  
M. A. Grebenkina ◽  
R. D. Mustafaev ◽  
A. I. Guseinov ◽  
V. D. Lyutov ◽  
...  
Keyword(s):  
Lower Limb ◽  
Comparison Group ◽  
Limb Ischemia ◽  
Main Group ◽  
The Body ◽  
Acupuncture Points ◽  
Laser Exposure ◽  
Average Dose ◽  
Surgical Interventions ◽  
The Road

Objective. The aim of the study is to develop a technique of potentiating traditional multimodal anesthesia with contact laser exposure to the body in the red range (650 nm) in patients with critical lower limb ischemia (CLI).Materials and methods. Multimodal anesthesia in the main group was performed with the potentiation of modern laser technology in 70 to 94 years old 35 patients [7 (20.0 %) women and 28 (80.0 %) men] with CLI and associated diseases. As a comparison group, a retrospective group of 23 patients was selected who underwent a high amputation of the lower extremities without potentiation of multimodal anesthesia with laser blood radiation. Multimodal anesthesia was additionally potentiated with quantum hemotherapy sessions. Sessions were carried out using a fifth-generation semiconductor contact laser irradiation of blood LASPOT (PRC) in the form of a wristwatch with an additional effect on the acupuncture points Nei-Guan, Tun-li – the heart meridian, connection with the inner world, Ling-dao – the meridian hearts, the road of the spirit. The first session was performed to patients before surgery — a duration of 15 minutes; the second — during surgery — a duration of 30 minutes.Results. The obtained data on the shifts of peripheral hemodynamic parameters at the stages of surgical interventions in patients of both groups practically did not demonstrate significant differences from the baseline values, reflecting the adequacy of the degree of anesthesiological protection. In patients of the main group, central hemodynamic indices: the cardiac index (CI) significantly increased from 2.81 ± 0.49 to 3.15 ± 0.58 (p < 0.05) l/min∙m2, and total peripheral vascular resistance (TPVR) decreased from 1587.5 ± 494.3 to 1492.7 ± 427.8 dyn∙s∙cm-5. In patients of the comparison group, CI increased during surgery from 2.83 ± 0.53 to 3.02 ± 0.35 l/min∙m2, and at the end of the operation it returned to baseline. Potentiation of multimodal anesthesia with modern laser technologies in patients of the main group made it possible to reduce during surgical interventions the average dose of fentanyl, which was 0.98 ± 0.12 mcg/kg/h, while in patients of the comparison group, the consumption of fentanyl was 3.28 ± 0.18 mcg/kg/h (with traditional combined general anesthesia, the flow rate of fentanyl during surgery is on average 5–12 mcg/kg/h or more).Conclusion. The method of potentiation of the traditional scheme of general combined anesthesia with optical radiation of the red range (650 nm) allows to achieve more pronounced effects of hemodynamic control, makes it possible to reduce the dose of fentanyl, reduce the pharmacological load on the operated patient.

Epidural analgesia diminished pain but did not otherwise improve enhanced recovery after laparoscopic sigmoidectomy: a prospective randomized study

2008 ◽  
Vol 23 (1) ◽  
pp. 31-37 ◽  
Author(s):  
Pertti Turunen ◽  
Monika Carpelan-Holmström ◽  
Pekka Kairaluoma ◽  
Heidi Wikström ◽  
Olli Kruuna ◽  
...  
Keyword(s):  
Epidural Analgesia ◽  
Enhanced Recovery ◽  
Randomized Study ◽  
Prospective Randomized Study ◽  
Laparoscopic Sigmoidectomy

scholarly journals Dynamics of Serum Cytokines During Resection Surgery for Malignant Neoplasms in the Lungs

2020 ◽  
Vol 16 (2) ◽  
pp. 12-21
Author(s):  
A. O. Soloviev ◽  
V. T. Dolgikh ◽  
O. N. Novichkova ◽  
N. V. Govorova ◽  
O. V. Leonov ◽  
...  
Keyword(s):  
Epidural Analgesia ◽  
Comparison Group ◽  
Main Group ◽  
Malignant Neoplasms ◽  
Reference Limit ◽  
Serum Cytokines ◽  
Post Surgery ◽  
Group I ◽  
Mechanical Lung Ventilation ◽  
Upper Reference Limit

Purpose — to carry out a comparative assessment of inflammation based on evaluation of intraoperative and early postoperative dynamics of blood serum cytokines in pulmonary malignant neoplasm patients in different anesthesia and analgesia settings.Material and methods. 24 patients of 45 to 50 years of age divided into 2 groups were examined. All patients suffered from verified new onset malignant neoplasms without true signs of metastases. Tumor differentiation by morphology was not undertaken since that was beyond the study design. Patients did not receive radio- or chemotherapy. In Group I (the main group, n=12), a multimodal combined anesthesia [1] followed by extended postoperative epidural analgesia was applied. In Group II (the comparison group, n=12), a combined general anesthesia including mechanical lung ventilation followed by morphine analgesia was used. 4 study points were determined: prior to induction, and one, 12, and 24 hours post-surgery.Results. 12 hours after surgery completion, the concentration of TNFα in the main group was lesser by 57.1% vs. the comparison group; by the end of the first 24 hours, it fell down by 64.3%. Within the same period, in both groups IL-6 turned out to be significantly higher than the upper reference limit. By the end of the first 24 hours, IL-6 tend to decrease in both groups; however, in the comparison group, this parameter was 15% higher than in the main group. Serum IL-10 was within the reference range in both groups. One hour after surgery, concentrationof IL-10 was exponentially growing in both groups and exceeded multifold the upper reference limit, whereas the content of IL-10 in the main group remained reliably higher: the difference amounted to 35.6% percent.Conclusion. During the postoperative period, patients undergone lung resection displayed significant changes in cytokines concentrations demonstrating an inflammation reaction. Inflammation was significant in patients who received epidural analgesia as evidenced by an altered content of anti-inflammatory cytokines.

scholarly journals Modern approaches to treatment of echinococcal diseases

2021 ◽  
Vol 99 (5-6) ◽  
pp. 333-338
Author(s):  
R. S. Sultanova ◽  
R. T. Mejidov ◽  
S. M. Magomedova
Keyword(s):  
Liver Disease ◽  
Postoperative Complications ◽  
Comparison Group ◽  
Length Of Hospital Stay ◽  
Disease Recurrence ◽  
Main Group ◽  
Long Term Results ◽  
High Tech ◽  
Disease Treatment ◽  
Surgical Interventions

Purpose. To evaluate the results of treatment of echinococcal liver disease, to determine the most effective method of echinococcectomy and its role in the prevention of of the disease recurrence. Material and methods. The analysis of 1072 cases (1358 cysts) of echinococcal liver disease was carried out. Radical (closed) echinococcectomy with the use of high-tech resection devices was performed in 258 patients, including the use of ultrasonic dissectors and aspirators in 105 patients (main group), other resection devices (LigaSure, argon plasmic scalpel) — in 153 patients (comparison group). Results.Length of hospital stay in the main group was 9.4 ± 2.1 bed-days, in the comparison group — 11.6 ± 1.7. Postoperative complications in the main group were recorded in 4.6% of cases, in the comparison group — in 11.0% respectively. Recurrence of the disease in the comparison group was noted in 2.3% of cases, in the main group there was no secondary echinococcusinduced liver injury. The quality of life of patients in the main group was 73.5 ± 1.8 points, in the comparison group — 72.8 ± 1.7 points. There were no deaths among patients who underwent echinococcectomy with the use of resection technologies.Conclusion. The most effective way of echinococcal liver disease treatment is radical echinococcectomy: cystpericystectomy, liver resection. Ultrasound resection technologies are the most optimal for radical surgical interventions, they reduce intraand postoperative complications and improve the immediate and long-term results echinococcal liver disease treatment .

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