Prolonged Paresis Research Articles

Features of the diagnosis and treatment of patients with postoperative peritonitis

Annotation. The aim of the work is to improve the diagnosis and treatment of patients with postoperative peritonitis. The work is based on an analysis of the treatment results of 98 patients who were in the clinic from 2010 to 2019, of which 47 (48%) were admitted to the hospital with a peritonitis clinic, and 51 (52%) had a prolonged bowel paresis in the postoperative period. The diagnosis was established on the basis of data from an objective examination, laboratory parameters and radiation research methods — radiography of the abdominal organs and ultrasound. Based on the analysis of clinical material, it was found that for patients with primary peritonitis, more pronounced clinical symptoms are more characteristic. Postoperative peritonitis in its clinical manifestations proceeds under the mask of a protracted intestinal paresis. Due to the ultrasound criteria of 51 patients with postoperative paresis, 32 (63%) prolonged paresis were allowed conservatively, which avoided unnecessary repeated surgical interventions. In 19 (37%), the causes of postoperative complications were diagnosed and relaparotomy was performed in a timely manner to these patients. Postoperative mortality was 5.1%.

Differential diagnostics and treatment of post-operative dynamic ileus

Annotation. Diagnostics and treatment of patients with long-term existing intestinal paresis in post-operative period with the frequency from 3.5 to 75% is an actual problem of abdominal surgery. Functional violations of intestinal motility demanding conservative therapy can be in one of case the cause of prolonged paresis, in other case – complications of surgery itself or pathologic state appearing independently but demanding relaparotomy. The objective criteria of differential diagnostics of prolonged paresis and dynamic ileus as a consequence of complications demanding surgery are absent by now. Aim of the study — identification and determination of reliable diagnostic criteria of differential diagnostics of “prolonged paresis” and other complications demanding surgery in the way of relaparotomy. 52 patients of the main group with dynamic ileus and its causes confirmed by ultrasound were included into the study; 50 patients with diagnosed dynamic ileus by combination of clinical and radiological methods of study were included into the comparison group. The study demonstrated that ultrasound method is most significant in differential diagnostics of dynamic ileus and its causes. Radiological study is uninformative in early post-operative period as it is done in horizontal position and the abdomen in these terms contains free gas (relaparotomy, presence of drainages). The use of the suggested method in the main group allowed determination of the causes of prolonged paresis and indications for relaparotomy: in 9 (17.2%) patients BO was found on the 3-4th day, post-operative peritonitis — in 3 (5.7%) cases, interstitial abscess — in 1 (1.9%). In 38 (73%) cases dynamic ileus was resolved conservatively. In the comparison group BO was found in 8 (16%) patients on the 7th day, post-operative peritonitis — in 4 (8%) cases, in 5 (10%) cases of the comparison group relaparotomy was done in vain. Thus ultrasound method is the main diagnostic method in early post-operative period in patients with prolonged paresis with the help of which differential diagnostics of mechanical and dynamic ileus can be done and indications for relaparotomy in the given category of patients can be determined. Decrease of post-operative mortality from 6 to 0% was the result of ultrasound method.

MUSCLE DYSFUNCTION IN THE INTENSIVE CARE UNIT

Muscle weakness, particularly impairment of the respiratory muscles, is a frequent abnormality in ICU patients. This is more relevant in some clinical situations--for example, in weaning patients from mechanical ventilation. Intensive care procedures that are designed to "rest" respiratory muscles, such as mechanical ventilation, may also contribute to impaired muscle function. Pharmacologic administration of glucocorticoids, several antibiotics, NMB agents, and so on has the potential to cause untoward effects. The development of myopathy and prolonged paresis has been increasingly recognized after prolonged use of these drugs in the ICU. Pathophysiologic changes in the nerve, muscle, or neuromuscular junction associated with the patient's underlying condition may also play a role in the development of impaired function. The assessment of muscle function is difficult and inaccurate. The techniques developed have a poor predictive value because of the difficulty in making the measurements in uncooperative patients and the lack of standardization. Furthermore, it is likely that some voluntary maneuvers underestimate muscle strength. Invasive procedures such as phrenic nerve stimulation or EMG recording are also of limited value.

Prolonged weakness after the withdrawal of atracurium.

Prolonged weakness after the use of neuromuscular blocking agents is an increasingly recognized iatrogenic complication of critical care. Vecuronium and pancuronium have been associated with this syndrome, but few cases of atracurium-associated prolonged paresis have heretofore been reported. Many practitioners have thus chosen to use atracurium instead of longer-acting neuromuscular blockers when muscle relaxation is required in the supportive management of critically ill patients. We here report a case of prolonged paresis after the administration of atracurium.

A Case of Prolonged Paresis following GaIIamine on Reoperation Patient

A Case of Prolonged Paresis following GaIIamine on Reoperation Patient

The Muscle Relaxants and Renal Excretion

Neuromuscular transmission was observed in 11 patients undergoing operation while in terminal renal failure. In 6 patientsd-tubocurarine was used to produce abdominal relaxation and prolonged paresis was not encountered. In 5 patients in whom gallamine was used, there was evidence of persistent paresis in three instances. Possible differences between the metabolism ofd-tubocurarine and gallamine are discussed. The recommendation is made that gallamine is contraindicated in the presence of poor renal function. There does not appear to be any evidence thatd-tubocurarine is contraindicated in such cases.