Infusion and transfusion therapy: main aspects

The adequate choice of strategy for infusion therapy is an essential component of successful management of critically ill patients. Infusion therapy is one of the main methods of maintai-ning vital functions of patients in the perioperative period. In the practice of a doctor, there are reasonable doubts about the feasibility and safety of various solutions for infusion therapy. Both are fundamental principles of infusion therapy, and the changes that have taken place, of course, need to be understood from the standpoint of evidence-based medicine. Balanced crystalloid solutions were safe and clinically effective, their use is provided by the Bri-tish Consensus Guidelines on Intravenous Fluid Therapy for Adult Surgical Patients.

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THE RESULTS OF A SURVEY OF SURGEONS ON THE SAFETY OF PHARMACOTHERAPY

Kuban Scientific Medical Bulletin ◽

10.25207/1608-6228-2018-25-6-127-134 ◽

2018 ◽

Vol 25 (6) ◽

pp. 127-134

Author(s):

I. N. Ochakovskaya ◽

V. M. Durleshter ◽

O. G. Ni ◽

N. E. Shabanova

Keyword(s):

Decision Making ◽

Medical Errors ◽

Evidence Based Medicine ◽

Deep Understanding ◽

Perioperative Period ◽

Evidence Based ◽

Efficacy And Safety ◽

Quality Of Medical Care ◽

Based Medicine

Aim. The study was conducted to assess the level of awareness of surgeons about the principles of safe perioperative pharmacotherapy.Materials and methods. The survey of surgeons was conducted in 2018 on the basis of a questionnaire made by the authors, consisting of 60 questions and tasks, divided into 6 thematic blocks. The respondents had to demonstrate their knowledge both in the field of general principles of safe pharmacotherapy and private issues of using analgesics, anticoagulants, antibiotics in the perioperative period. The results of the survey were assessed as a percentage (proportion of correct answers) individually for each respondent and in total.Results. The results of the survey showed a lack of a deep understanding of the principles of safe pharmacotherapy in most clinical cases. Despite the fact that a number of answers completely correlated with the positions of evidence-based medicine, in general, there was a lack of systemic knowledge. The survey made it possible to identify those important points that should be first highlighted in the preparation of the training program. Conclusion. Every doctor should strive to minimize the preventable medical errors associated with pharmacotherapy. This is feasible only in the process of continuous daily learning. Practitioners' interest in the efficacy and safety of pharmacotherapy and mastering the basic decision-making algorithms for prescribing, controlling safety and cancelling drugs will improve the quality of medical care.

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Correction of stress hyperglycemia in surgical patients with metabolic syndrome

Ukrainian journal of Perinatology and Pediatrics ◽

10.15574/pp.2020.83.26 ◽

2020 ◽

pp. 26-30

Author(s):

I.G. Kryvorchuk ◽

◽

I.M. Leshchishin ◽

◽

...

Keyword(s):

Diabetes Mellitus ◽

Metabolic Syndrome ◽

Intensive Care ◽

Postoperative Period ◽

Perioperative Period ◽

Surgical Patients ◽

Infusion Therapy ◽

Control Group ◽

Stress Hyperglycemia ◽

Patients With Diabetes

Taking into account that stress and diabetic hyperglycemia is an independent risk factor for increased mortality in surgical patients with metabolic syndrome, an increase in the time spent by patients in intensive care units and the cost of treatment, it is important to carry out treatment, in particular, infusion therapy with the appointment of drugs that do not increase glucose levels and help to reduce the need for insulin in patients with diabetes mellitus in the postoperative period. Aim is to assess the effectiveness of the drug Xylat as an integral component of intensive care for patients with metabolic syndrome in perioperative period. Materials and methods. The study was conducted in 21 women with metabolic syndrome who underwent urgent surgical intervention for tumors in pelvic area. All patients received Xylat (Yuria-Pharm) – 5-6 ml/kg/day, 50-70 drops/min for 3 days in the postoperative period. The control group consisted of 15 women with metabolic syndrome, who underwent surgical treatment in the regional clinical hospital for ovarian tumors, but received alternative infusion therapy during the postoperative period (according to archived case histories). Results. The data of our study showed that the drug Xylatum (Yuria-Pharm) helps to reduce the risk of the severity of stress hyperglycemia, suppresses the risk of lactacidemia, provides energy support for postoperative patients with diabetes mellitus with an insulin+independent metabolism, and stimulates the production of endogenous insulin in critically ill patients. Conclusions. With the use of Xylate, the tolerance to carbohydrates increases. It has a very low glycemic index, antiketogenic properties, does not adversely affect the central nervous system, the exchange of hormones and neurotransmitters. The research was carried out in accordance with the principles of the Helsinki Declaration. The study protocol was approved by the Local Ethics Committee of these Institutes. The informed consent of the patient was obtained for conducting the studies. No conflict of interest was declared by the authors. Key words: surgical patients, diabetes mellitus, hyperglycemia, infusion therapy, metabolic syndrome, Xylatum.

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MAIN TENDENCIES IN ANESTHESIOLOGY DEVELOPMENT FOR THE LAST 10 YEARS

Messenger of Anesthesiology and Resuscitation ◽

10.21292/2078-5658-2019-16-2-25-33 ◽

2019 ◽

Vol 16 (2) ◽

pp. 25-33

Author(s):

V. V. Likhvantsev

Keyword(s):

Heart Failure ◽

Acute Heart Failure ◽

Evidence Based Medicine ◽

Infusion Therapy ◽

Evidence Based ◽

Heart Failure Management ◽

Anesthetic Preconditioning ◽

Based Medicine ◽

Current Stage

The article describes the main tendencies in anesthesiology, which have undergone the greatest changes in the last decade, according to the author. The article speculates on the choice of tactics and the qualitative components of peri-operative infusion therapy. The author gives an assessment of the current stage of studying the phenomenon of anesthetic preconditioning and acute heart failure management. And, finally, the challenges and achievements of the evidence-based medicine in anesthesiology are analyzed.

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STRATEGY OF INFUSION-TRANSFUSION THERAPY IN OPERATIONS WITH MASSIVE BLOODWORK IN CHILDREN WITH TUMOR ABOMALOMAL LOCALIZATION TUMORS

Russian Journal of Pediatric Surgery, Anesthesia and Intensive Care ◽

10.30946/2219-4061-2018-8-2-56-64 ◽

2018 ◽

Vol 8 (2) ◽

pp. 56-64 ◽

Cited By ~ 1

Author(s):

E. I. Belousova ◽

N. V. Matinyan ◽

L. А. Martynov

Keyword(s):

Blood Loss ◽

Malignant Tumors ◽

Electrolyte Imbalance ◽

Coagulation System ◽

Infusion Therapy ◽

Transfusion Therapy ◽

Group I ◽

Crystalloid Solutions ◽

Combined Anesthesia ◽

Balanced Crystalloid

Surgeries for thoracoabdominal tumors in children predispose to water and electrolyte imbalance, imbalance in the coagulation system, etc. In spite of abundance of recommendations for children, the volume of basic infusion therapy is uncertain.Study purpose. To estimate the clinical effectiveness of the conducted infusion therapy with isotonic balanced electrolyte solution in children who underwent thoracoabdominal surgeries accompanied with massive blood loss and a complex estimation of the conducted infusion and transfusion therapy.Materials and methods. The intraoperative and early postoperative (days 1–5) periods were analyzed in 22 patients (ASA II–III) who underwent an operation for thoracoabdominal malignant tumors with massive perioperative blood loss in 2016–2017. Group I included 11 patients who had infusion with balanced crystalloid solutions of 5 to 10 ml/kg/hour under combined anesthesia. Group II includes 11 patients who had infusion with balanced crystalloid solutions of 11 to 20 ml/kg/hour under combined anesthesia.Results. According to the conducted study, a higher hemodynamic stability was observed in patients from the group of basic infusion therapy with balanced crystalloid solutions of 11–20 ml/kg/hour. It was expressed as the decrease of the mean dose of the used vasopressors and volume of the infusion of colloidal solutions. The patients also had a less intense response to stress.

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Perioperative infusion therapy

Clinical nutrition and metabolism ◽

10.17816/clinutr81626 ◽

2021 ◽

Author(s):

Evgeny Skobelev ◽

Igor Pasechnik

Keyword(s):

Perioperative Period ◽

Fine Tuning ◽

Surgical Patients ◽

Critical Conditions ◽

Infusion Therapy ◽

Invasive Monitoring ◽

Colloidal Solutions ◽

Salt Solutions ◽

Treatment Regimens ◽

The Subject

Perioperative infusion support of surgical patients is the main and non-alternative element of treatment. At the same time, the tactics of infusion therapy continues to be the subject of study. Ideas about the optimal quantitative and qualitative composition of the fluid transfused to patients are being revised as ideas about the pathogenesis of critical conditions evolve. The basis of pathogenetic analysis of compensatory hemodynamic capabilities, as a point of application of infusion treatment, previously consisted mainly of invasive monitoring techniques, replaced in recent years by the control of routine parameters with proven high correlation with invasive ones. In current studies devoted to the problems of infusion correction of hemodynamic abnormalities, the most discussed issues are the applicability of isotonic and balanced polyionic crystalloids, less often colloidal solutions in various clinical situations, and the results of such studies do not always allow to unambiguously determine the choice of infusion media, and sometimes simply incomparable. Some researchers advocate the use of isotonic crystalloids, some works prove the best effectiveness of balanced salt solutions. With the volumes of treatment corresponding to the perioperative period, in most studies there are no differences in the effectiveness of the main composite groups of crystalloids at all. We see the reason for this in the peculiarities of randomization methods, when statistical limitations do not allow us to avoid discrete data analysis: their comparative grouping occurs according to the principle of selecting a target parameter, and all the others are classified as auxiliary or secondary. It seems to us that the involvement of arrays of data obtained in real clinical practice as a result of a combination of local theoretical and empirical ideas about corrective treatment regimens correlated with their effectiveness could smooth out the inconsistency of the results of such studies, especially since clinicians have a sample with a volemic load at their disposal, allowing them to predict the hemodynamic reaction of the patient's body to infusion and a set of routine parameters for more fine-tuning of therapy.

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STATINS USE IN THE PERIOPERATIVE PERIOD ACCORDING TO THE EVIDENCE-BASED MEDICINE

Rational Pharmacotherapy in Cardiology ◽

10.20996/1819-6446-2014-10-5-548-553 ◽

2014 ◽

Vol 10 (5) ◽

pp. 548-553 ◽

Cited By ~ 1

Author(s):

V. V. Samoylenko ◽

O. P. Shevchenko ◽

V. I. Burtsev

Keyword(s):

Evidence Based Medicine ◽

Perioperative Period ◽

Evidence Based ◽

Based Medicine

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Analgesic Techniques in Hip and Knee Arthroplasty: From the Daily Practice to Evidence-Based Medicine

Anesthesiology Research and Practice ◽

10.1155/2014/569319 ◽

2014 ◽

Vol 2014 ◽

pp. 1-8 ◽

Cited By ~ 5

Author(s):

Denisa Madalina Anastase ◽

Simona Cionac Florescu ◽

Ana Maria Munteanu ◽

Traian Ursu ◽

Cristian Ioan Stoica

Keyword(s):

Knee Arthroplasty ◽

Evidence Based Medicine ◽

Perioperative Period ◽

Daily Practice ◽

Evidence Based ◽

Major Orthopedic Surgery ◽

Hip And Knee Arthroplasty ◽

Total Knee ◽

Based Medicine ◽

Ageing Populations

Total hip arthroplasty (THA) and total knee arthroplasty (TKA) are major orthopedic surgery models, addressing mainly ageing populations with multiple comorbidities and treatments, ASA II–IV, which may complicate the perioperative period. Therefore effective management of postoperative pain should allow rapid mobilization of the patient with shortening of hospitalization and social reintegration. In our review we propose an evaluation of the main analgesics models used today in the postoperative period. Their comparative analysis shows the benefits and side effects of each of these methods and guides us to how to use evidence-based medicine in our daily practice.

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Haemodynamic effects of central neural blocks

Acta medica Lituanica ◽

10.6001/actamedica.v19i3.2447 ◽

2012 ◽

Vol 19 (3) ◽

pp. 191-194 ◽

Cited By ~ 2

Author(s):

Jurgita Borodičienė ◽

Jūratė Gudaitytė

Keyword(s):

Emergency Situation ◽

Perioperative Period ◽

Haemodynamic Effects ◽

Infusion Therapy ◽

Anticholinergic Drugs ◽

Adequate Treatment ◽

Vital Functions ◽

Appropriate Treatment ◽

Haemodynamic Changes ◽

Excessive Alcohol

Haemodynamic effects are the most important physiological responses to central neural blocks. This article is focused on the etiology of hypotension, bradycardia and asystole understanding of which is essential for the anesthesiologist for successful management in the perioperative period. The main causes of cardiovascular changes are decreased cardiac output, systemic vascular resistance and reflexes related to baroreceptors. Hypotension and / or bradycardia are usually of short duration and easily treatable. However, haemodynamic changes in hypovolaemic, elderly patients with comorbidity, and patients with increased catecholamine production, due to excessive alcohol intake, emergency situation, can be significant with worse outcomes. Therefore it is essential to correct hypovolaemia before surgery. Timely notification, identification and appropriate treatment of haemodynamic changes caused by already performed central neural blockade remain important in the perioperative period as well. Vital functions must be monitored throughout surgery so that adverse cardiovascular reactions could be managed with timely and adequate treatment including elevation of the legs, oxygen and infusion therapy, vasoactive and anticholinergic drugs.

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