scholarly journals Ensuring the effectiveness and safety of peripheral blockades

2021 ◽  
Vol 6 (6-1) ◽  
pp. 105-112
Author(s):  
I. G. Oleshchenko ◽  
D. V. Zabolotsky ◽  
V. A. Koriachkin ◽  
V. V. Pogorelchuk
Keyword(s):  
Surgical Intervention ◽  
Muscle Relaxation ◽  
Complex Structure ◽  
Pain Syndrome ◽  
Perioperative Period ◽  
Anatomical Structures ◽  
Advantages And Disadvantages ◽  
Pterygopalatine Ganglion ◽  
Therapy Of Pain ◽  
Transmission Stage

Adequate analgesia determines the success of the performed surgical intervention. In modern surgery, most of postoperative complications are directly related to ineffective therapy of pain syndrome in the perioperative period. The main principle of modern analgesia is its multicomponence, when analgesia, neurovegetative blockade and relaxation are achieved and potentiated by different drugs and methods. The blockade of nociceptive impulses with a local anesthetic at the transmission stage provides effective, targeted analgesia, hyporefl exia and muscle relaxation, prevents the sensitization of neuroaxial structures, hyperalgesia and the development of postoperative chronic pain syndrome. At the same time, providing analgesia with drugs of central action leads to the ineffectiveness of therapy in 80 % of cases, which has serious consequences.The aim. According to the literature review, to evaluate the effectiveness and safety of peripheral blockades on the example of performing a blockade of the pterygopalatine ganglion.Conclusion. The pterygopalatine blockade has broad indications for use in ophthalmology, which is explained by the complex structure of the pterygopalatine ganglion and the possibility of simultaneous infl uence on sympathetic, parasympathetic and nociceptive innervation. All the presented methods of pterygopalatine blockade performance have their advantages and disadvantages. Ultrasound navigation eliminates technical difficulties and the possibility of damage of the pterygopalatine fossa anatomical structures, ensuring the effectiveness and safety of the pterygopalatine blockade.

Surgical approaches in juxtarenal and pararenal aortic aneurysms repair

2021 ◽  
pp. 021849232199738
Author(s):  
Eduard R Charchyan ◽  
Anna B Stepanenko ◽  
Andrey P Gens ◽  
Nail A Galeev ◽  
Yuri V Belov
Keyword(s):  
Operative Time ◽  
Surgical Intervention ◽  
Pain Syndrome ◽  
Reliable Data ◽  
Aortic Aneurysms ◽  
Retroperitoneal Approach ◽  
Surgical Approaches ◽  
Midline Laparotomy ◽  
Advantages And Disadvantages ◽  
Case Basis

Background In this study, surgical tactic features and juxtarenal and pararenal treatment immediate results were analyzed depending on the use of various surgical approaches. Methods Between 2015 and 2019, a total of 89 patients received surgical treatment, of which 52(58%) had juxtarenal aneurysms and 37 (42%) – pararenal aneurysms. During repairs, three types of surgical approaches were used: midline laparotomy, extended retroperitoneal approach and thoraco-phreno-retroperitoneal approach. The patients were divided into three groups accordingly. Results At the immediate postoperative period, mortality rate equaled 2 (2.2%). The reasons were pulmonary embolism and sepsis. Statistically reliable data were obtained, confirming the advantages of midline laparotomic approach over the lateral retroperitoneal ones, which consisted in a shorter operative time, less pronounced pain syndrome, lesser blood loss, fewer postoperative days. The disadvantages were that enteroparesis occurred more often when the midline laparotomy was used in comparison to extended retroperitoneal or thoraco-phrenoretroperitoneal approaches. Conclusion Thus, open repairs of juxtarenal and pararenal aortic aneurysms have some specific technical and strategical features which are associated with intraoperative renal ischemia. During open surgical intervention, it is important to first consider the possibility of repair with midline laparotomy. However, lateral retroperitoneal approaches can also be used on a case-by-case basis noting their advantages and disadvantages.

Preoperative preparation of alcohol and psychoactive substances-addicted patients

2011 ◽  
Vol 58 (2) ◽  
pp. 151-155
Author(s):  
Ivan Dimitrijevic ◽  
Zoran Zoricic ◽  
Miodrag Milenovic ◽  
Ivan Palibrk ◽  
Draga Dimitrijevic ◽  
...  
Keyword(s):  
Substance Abuse ◽  
Postoperative Care ◽  
Surgical Intervention ◽  
Elective Surgery ◽  
Perioperative Period ◽  
Psychoactive Substance ◽  
Preoperative Preparation ◽  
Psychoactive Substances ◽  
Key Issues ◽  
Proper Diagnosis

Proper diagnosis of psychoactive substance abuse and addiction, as well as acute intoxication, withdrawal syndrome and overdosing are of great importance in patients who are preparing for surgical intervention. There are some specific details in their preoperative preparation whether they underwent emergency or elective surgery. Good knowledge of the characteristics of psychoactive substance abuse and addiction, interaction of psychoactive substances and anesthetics and any other drugs that could be used in the perioperative period is important especially for anastesiologist. In this work we present key issues for recognizing theese patients as well as some guidelines for adequate preoperative preparation and postoperative care.

scholarly journals General anesthesia with remimazolam in a patient with mitochondrial encephalomyopathy: a case report

2021 ◽  
Vol 7 (1) ◽  
Author(s):  
Yuji Suzuki ◽  
Matsuyuki Doi ◽  
Yoshiki Nakajima
Keyword(s):  
Lactic Acidosis ◽  
General Anesthesia ◽  
Mitochondrial Disease ◽  
Muscle Relaxation ◽  
Anesthetic Management ◽  
Perioperative Period ◽  
Mitochondrial Encephalomyopathy ◽  
Anesthesia Induction ◽  
General Anesthetic ◽  
Anesthetic Agents

Abstract Background Systemic anesthetic management of patients with mitochondrial disease requires careful preoperative preparation to administer adequate anesthesia and address potential disease-related complications. The appropriate general anesthetic agents to use in these patients remain controversial. Case presentation A 54-year-old woman (height, 145 cm; weight, 43 kg) diagnosed with mitochondrial encephalomyopathy with lactic acidosis and stroke-like episodes underwent elective cochlear implantation. Infusions of intravenous remimazolam and remifentanil guided by patient state index monitoring were used for anesthesia induction and maintenance. Neither lactic acidosis nor prolonged muscle relaxation occurred in the perioperative period. At the end of surgery, flumazenil was administered to antagonize sedation, which rapidly resulted in consciousness. Conclusions Remimazolam administration and reversal with flumazenil were successfully used for general anesthesia in a patient with mitochondrial disease.

Pelvic-floor relaxation techniques using biofeedback – more effective therapy for chronic prostatitis/chronic pelvic pain syndrome

2020 ◽  
Vol 13 (6) ◽  
pp. 454-459
Author(s):  
Manish Pandey ◽  
Vaibhav Shrivastava ◽  
Vijay Patidar ◽  
Sabby Dias ◽  
Sameer Trivedi
Keyword(s):  
Pelvic Floor ◽  
Pelvic Pain ◽  
Chronic Prostatitis ◽  
Pelvic Floor Muscle ◽  
Muscle Relaxation ◽  
Chronic Pelvic Pain Syndrome ◽  
Pain Syndrome ◽  
Pelvic Pain Syndrome ◽  
Group A ◽  
Group B

Objective: Chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS) is characterized by pelvic pain and voiding symptoms, the management of which is challenging. The present study was designed to assess the efficacy of biofeedback and pelvic-floor relaxation treatment for CP/CPPS. Methods: A total of 84 patients diagnosed with CP/CPPS were randomly assigned to one of the two groups: conventional therapy (group A) and pelvic-floor muscle relaxation and biofeedback (group B). The Biofeedback and Electrical Stimulation apparatus was used for pelvic-floor muscle electrical stimulation and relaxation with biofeedback. National Institutes of Health Chronic Prostatitis Symptom Index (NIH-CPSI) scores were evaluated at the start of therapy, after 3 months of treatment and at 6 months (3 months after last treatment received). Results: At 3 months, patients in both groups had a significant decrease (improvement in symptoms) in NIH-CPSI scoring. However, at 6 months, only 19 (47.5%) patients in group A maintained a fall in NIH-CPSI score >6 compared with 37 (94.8%) patients in group B ( p<0.05). At 6 months, there was significant decrease in NIH-CPSI score in group B, whereas in group A, scores had increased (worsening of symptoms). Conclusions: Pelvic-floor muscle relaxation and biofeedback training is a safe and effective treatment for CP/CPPS with sustained efficacy.

scholarly journals Prevention of pain syndrome and immediate postoperative complications in the surgical treatment of chronic hemorrhoids

2020 ◽  
pp. 68-71
Author(s):  
V. N. Ishchenko ◽  
A. E. Krasnobaev ◽  
A. A. Grigoryuk
Keyword(s):  
Surgical Treatment ◽  
Postoperative Complications ◽  
Urinary Retention ◽  
Acute Urinary Retention ◽  
Surgical Intervention ◽  
Pain Syndrome ◽  
Modified Technique ◽  
Postoperative Urinary Retention ◽  
Clinical Comparison ◽  
Suggested Technique

Objective: To assess the efficacy of hemorrhoidectomy with Milligan-Morgan technique in the author’s modification.Methods: Results of surgical treatment of 558 patients aged 21–72 years with complicated hemorrhoids of III–IV stage were analyzed. The group of clinical comparison (207 patients) was operated according to standard scheme, the main group (351 patients) – according to author’s technology with modified technique for treating the hemorrhoid bolus using betamethasone.Results: When using the author’s technique, a more significant decrease in postoperative pain syndrome severity was achieved: injection analgesics were not required already in a day, and after 6 days the pain syndrome was stopped in all cases. Only three patients (0.9%) demonstrated an acute urinary retention up to two days. The group of clinical comparison maintained a longterm (up to three months) pain syndrome; postoperative urinary retention was registered in 38 cases (18.4%); 9 patients (4.3%) developed blood loss in the area of surgical intervention.Conclusions: Suggested technique of surgical treatment for hemorrhoids is quite effective, simple and can be implemented in any surgical inpatient facility. 

scholarly journals Multimodal anesthesia and analgesia at the stages of the perioperative period in children with abdominal surgical pathology

2021 ◽  
Vol 24 (1) ◽  
pp. 27-31
Author(s):  
Elmira A. Satvaldieva ◽  
Otabek Ya. Fayziev ◽  
Anvar S. Yusupov
Keyword(s):  
General Anesthesia ◽  
Postoperative Period ◽  
Surgical Intervention ◽  
Anesthetic Management ◽  
Perioperative Period ◽  
Postoperative Recovery ◽  
Surgical Pathology ◽  
Abdominal Organ ◽  
Epidural Blockade ◽  
Abdominal Operations

Aim of the study was assess both the effectiveness and safety of anesthetic management and optimizing postoperative anesthesia under conditions of multimodal anesthesia and analgesia during abdominal operations in children. Patients and methods. The authors examined 58 children aged 1 to 17 years with abdominal operations (malformations, diseases, and abdominal organ injuries). To ensure anesthetic protection, patients underwent combined general anesthesia with propofol and fentanil (induction) with inhalation of sevoflurane + propofol intra venous (maintenance) in combination with epidural blockade with bupivacaine. Results. According to surgical intervention, the arrangement of perioperative analgesic protection provided a favorable correction of the hemodynamic status of patients, a decrease in inhalation anesthetic, promoted a smooth course of the postoperative period, a long painless period, an excellent psychoemotional background, and rapid postoperative recovery.

scholarly journals Acute Lower Gastrointestinal Bleeding: Part II

2001 ◽  
Vol 15 (8) ◽  
pp. 517-521 ◽  
Author(s):  
Robert Enns
Keyword(s):  
Gastrointestinal Bleeding ◽  
Surgical Intervention ◽  
Lower Gastrointestinal Bleeding ◽  
Lower Gastrointestinal Hemorrhage ◽  
Nuclear Scintigraphy ◽  
Diagnostic Strategies ◽  
Advantages And Disadvantages ◽  
Therapeutic Value ◽  
The Face ◽  
Acute Lower Gastrointestinal Hemorrhage

Diagnostic strategies for lower gastrointestinal bleeding include nuclear scintigraphy, mesenteric angiography and endoscopic evaluation of the lower gastrointestinal tract. Each method has inherent advantages and disadvantages. Nuclear scintigraphy is simple and noninvasive, but high rates of false localization have led most clinicians to insist on confirmation of the bleeding site by another method before considering surgical intervention. Angiography is very specific, but is invasive and not as sensitive as nuclear scintigraphy. Colonoscopy is sensitive and specific, and can offer therapeutic value but can be technically challenging in the face of acute lower gastrointestinal hemorrhage. These strategies and the evidence behind them are discussed.

Efficacy of selective agonist V2 vasopressin receptor, 1-dezamino-8-D-arginine-vasopressin, in the treatment of pain in patients with degenerative-dystrophic diseases of the spine

2016 ◽  
Vol 14 (3) ◽  
pp. 58-65
Author(s):  
Svetlana G. Belokoskova ◽  
Sergei G. Tsikunov
Keyword(s):  
Arginine Vasopressin ◽  
Vertebral Column ◽  
Depressive Disorders ◽  
Pain Syndrome ◽  
Control Group ◽  
Reduction Of Pain ◽  
Therapy Of Pain ◽  
V2 Vasopressin Receptor ◽  
Leading Symptom ◽  
The Impact

Pain is the leading symptom with degenerative-dystrophic diseases of the vertebral column. Now for the treatment of vertebral pain using pharmacological and non-pharmacological treatments. However, in some cases, the application of these techniques is contraindicated or ineffective. In this regard, relevant search for new methods of therapy of pain syndrome. It is known that arginine-vasopressin (AVP), along with the hormonal effects shows properties of neuromodulator. The experiment shows that AVP showed analgetic properties. AVP reduced the severity of pain in patients with renal colic, with migraine, pains due to cancer [24, 36, 37]. There is not data on the impact of AVP on vertebrogenic pain syndrome. In this context, the aim of the research was to assess the effectiveness of the agonist V2-receptors, 1-dezamino-8-D-arginine-vasopressin, DDAVP, in correction of pain syndrome in patients with degenerative-dystrophic diseases of the vertebral column. Treatment received 23 patients. DDAVP is injected intranasal drip in a daily dose of 1•10 -7 g. The control group consisted of 10 patients with vertebral pain who received traditional therapy. Therapeutic effect of DDAVP was in 87 % of cases. Pain decreased after 2.5-3 hours from the beginning of treatment in patients with moderate and mild pain. Along with reduction of pain regressed fatigue-depressive disorders. Thus, it was shown that the DDAVP was effective and safe in the treatment of vertebral pain.

Complex regional pain syndrome following lateral lumbar interbody fusion

2013 ◽  
Vol 19 (4) ◽  
pp. 502-506 ◽  
Author(s):  
Simon Morr ◽  
Adam S. Kanter
Keyword(s):  
Complex Regional Pain Syndrome ◽  
Interbody Fusion ◽  
Surgical Techniques ◽  
Pain Syndrome ◽  
Fine Tuning ◽  
Review Of The Literature ◽  
Anatomical Structures ◽  
Transpsoas Approach ◽  
Surgical Corridor ◽  
Lumbar Spinal

The minimally destructive lateral transpsoas approach to the spine has been used in the treatment of various lumbar spinal pathologies. Approach-specific complications have been reported due to the unique surgical corridor and lateral anatomical structures. The authors report a case of complex regional pain syndrome (CRPS) following interbody cage placement utilizing the lateral lumbar transpsoas approach. A review of the literature is discussed. Further clarification of the mechanism of CRPS and its treatments remains crucial for the fine-tuning of novel surgical techniques and complication avoidance during the development of these techniques.

scholarly journals Use of Metaphyseal Sleeves in Revision Knee Arthroplasty

2017 ◽  
Vol 24 (2) ◽  
pp. 5-10
Author(s):  
M. V Girkalo ◽  
I. A Norkin
Keyword(s):  
Knee Arthroplasty ◽  
Surgical Intervention ◽  
Pain Syndrome ◽  
Type I ◽  
Type Ii ◽  
Short Term ◽  
Type Iii ◽  
Revision Knee Arthroplasty ◽  
Total Knee

Purpose. To study the short-term results of revision knee arthroplasty performed using metaphyseal sleeves. Patients and methods. During the period from 2013 to 2015 the total number of 40 patients was operated on. Type I femoral defects (by AORI classification) were diagnosed in 11 (27.5%), type II - in 26 (65.0%), type III - in 3 (7.5%) cases. Type I tibial defects were diagnosed in 2 (5.0%), type IIa - in 24 (65.0%), type IIb - in 11 (27.0%) and type III - in 3 (7.54%) cases. Metaphyseal femoral sleeves were used in 8 and metaphyseal tibial sleeve - in 40 patients. Results. Follow up period made up from 12 to 43 (mean 32.8) months. Excellent and good results by KSS scale were achieved in 30 (75.0%) of patients, by functional KSS scale - in 24 (60.0%) patients. Mean point by Knee Society Total Knee Arthroplasty Roentgenographic Evaluation scale in patients with femoral and tibial metaphyseal sleeves made up 2.35 versus 0.375 that confirmed the absence of progressive bone resorption. No one case of aseptic instability of the revision implant was observed. Repeated surgical intervention due to reinfection and knee joint contracture with pain syndrome was performed in 2 (5.0%) patients. Conclusion. The obtained data enable to recommend the use of metaphyseal sleeves for revision knee arthroplasty in patients with tibial and femoral defects of types II and III by AORI classification.

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