Anesthesiological Support Research Articles

Estimation of the Adaptive Capacities of the Cardiovascular System in Pregnant Females by Active Orthostatic Test

The investigation was undertaken to study the adaptive capacities of the cardiovascular system (CVS) in physiological full-term pregnancy, by using the active orthostatic test (AOT) and to analyze cardiac rhythm variability (CRV). The study covered 49 low-risk group females during 38—39-week physiological pregnancy, who had indications for planned surgery -cesarean section. Before surgery, during an anesthesiological examination, all the pregnant females performed AOT during which ECG was continuously recorded. For CRV estimation, 5-min ECG fragments recorded in the standing and lying positions. AOT could reveal a normal orthostatic response (NOR) in 37 pregnant females, postural orthostatic tachycardia (POT) in 8 and orthostatic hypotension in 4. No relationship was found between the clinical characteristics and the types of responses to AOT. At the same time, comparison of CVS demonstrated that the baseline enhanced activity of the sympathetic portion of the autonomic nervous system was typical of females with POT as compared with females showing a NOR. Thus, estimation of CRV parameters in pregnant females permits predetermination of adaptive CVS capacities, which is important to be taken into account in choosing an anesthesiological support and modes of hemodynamic correction when cesarean section is performed.

Deep Sedation with Propofol for Upper Gastrointestinal Endoscopy in Children, Administered by Specially Trained Pediatricians: a Prospective Case Series with Emphasis on Side Effects

The need to administer procedural sedation to children has increased in recent years, as has experience in this field among nonanesthesiologists. Using propofol makes it easier to achieve sufficiently deep sedation. There is a considerable literature on the administration of propofol by nonanesthesiologists for gastroscopy in adults, but very few data are available on this issue in children. The aim of the present study was to assess the safety and efficacy of procedural sedation with propofol for gastroscopy in a pediatric ward with trained personnel and monitoring facilities. A training protocol was developed to educate nurses and residents. Children requiring gastroscopy were included in the study prospectively and underwent procedural sedation with propofol administered by nonanesthesiologists. A total of 811 upper gastrointestinal endoscopies were carried out with procedural sedation. Sedation was achieved in all procedures, and all but three (0.4%) were conducted successfully. None of the patients required intubation. Stridor with signs of upper airway obstruction occurred in 14 of the 811 procedures (1.7%). Laryngoscopy was required to manage difficulties in introducing the gastroscope in 16 of the 811 procedures (2.0%). Major desaturation requiring a short course of ventilation occurred in six procedures (0.7%), and transient desaturation that resolved spontaneously occurred in 97 of the procedures (12%). Administration of propofol by nonanesthesiologists for gastroscopy examinations in children was successful in this study, but was associated with a small risk of potentially severe complications. Although the residents were generally able to administer procedural sedation alone, constant and immediate availability of anesthesiological support continues to be mandatory.

Anesthesiologic Provision of Osteosynthesis of the Neck of the Femur in Geriatric Patients

The purpose of the study was to evaluate the clinical efficiency of femoral 3 in 1 block using the solution of a local anesthetic in combination with an opioid versus central regional (spinal) anesthesia during operation involving osteosynthesis of the neck of the femur with cannulated screws in geriatric patients. Osteosynthesis of the neck of the femur with cannulated screws proposed by the Osteosynthesis Association (OA) was performed in 90 patients (33 males and 57 females) aged 65 to 90 (71.0±5.026) years. Two procedures were used for the anesthe-siological provision of the operation. The osteosynthesis was made in 65 patients under central regional (spinal) anesthesia (Group 1) and in 25 patients under femoral 3 in 1 block employing the solution of a local anesthetic in combination with an opioid (Group 2). Both groups were matched by age, gender, anthropometric data, and the pattern of concomitant diseases. Analysis of the findings revealed that in 40% of cases, operations made under spinal anesthesia (Group 1) used adrenomimetics: ephedrine, 0.2—0.4 mg/kg, or dopamine, 3—5 ^g^kg/min; the total infusion volume was 2254±162 ml. Colloid agents (polyglucin, 6% infucol, or 6% refortan solutions) were given to 23 (36%) of the 65 patients. The reduction in mean blood pressure was 26.3% of the baseline. Group 2 did not require the use of colloidal and/or adrenomimetics. The mean intraoperative infusion volume was 1146±109.3 ml. During surgery, hemodynamics remained stable in all the patients. All Group 1 patients operated on under spinal anesthesia experienced postoperative pain whose relief required the use of nonsteroidal anti-inflammatory drugs (ketorol, ketonal, baralgin) and opioids (promedole, omnopon), 44% of cases requiring multiple administration of narcotic analgesics within the first and second postoperative days. Analysis of the postoperative period indicated a good analgesia in the patients operated on under femoral 3 in 1 block with local anesthetic solution in combination with an opioid. At a rest, all Group 2 patients did not observe no painful sensations at the site of surgery. Thus, femoral 3 in 1 block with 40 ml of 0.25% marcaine and 10 mg of morphine hydrochloride is an effective and safe anesthesiological support in geriatric patients during operations involving the osteosynthesis with OA cannulated screws. Perineutal administration of 10 mg of morphine hydrochloride provides a good postoperative analgesia, which is an important factor in preventing cardiorespiratory complications in patients to be surgically treated.

Endoscopic management of the liver transplant patient

Endoscopic management of the liver transplant patient