ПРИМЕНЕНИЕ ДЕКСМЕДЕТОМИДИНА В КАЧЕСТВЕ БАЗОВОГО СРЕДСТВА ДЛЯ АНЕСТЕЗИОЛОГИЧЕСКОГО ОБЕСПЕЧЕНИЯ РАДИОХИРУРГИЧЕСКОГО ЛЕЧЕНИЯ У РЕБЕНКА

This clinical case demonstrates specific features of anesthetic management during radiosurgery in pediatric patients considering the limited access to them during continuous manipulations with pharmacological sedation. Considering the age of the child, dexmedetomidine, the drug from the group of agonists of α2-adrenergic receptors, was used as the main agent. It was used since it could be administred by the noninvasive way for premedication and intravenously in a form of infusion to provide the necessary depth of sedation with preservation of spontaneous breathing and minimization of uncontrolled motions of the patient.Настоящее клиническое наблюдение демонстрирует особенности анестезиологического обеспечения радиохирургического лечения педиатрических пациентов в условиях ограниченного доступа к ним во время длительных процедур с использованием фармакологической седации. Ввиду возрастных особенностей ребенка в качестве базового средства использован дексмедетомидин ‒ препарат из группы центральных α2-адреноагонистов. Его применили благодаря возможности использовать неинвазивно для премедикации и внутривенно в виде инфузии для поддержания необходимой глубины седации с сохраненным самостоятельным дыханием, а также для минимизации самопроизвольных движений пациента

ПРОБЛЕМА ПОСЛЕОПЕРАЦИОННОЙ ТОШНОТЫ И РВОТЫ У НЕЙРОХИРУРГИЧЕСКИХ БОЛЬНЫХ

The review presents the most recent data on the causes, frequency, risk factors, prevention methods, and principles of management of post-operative nausea and vomiting. The special attention is paid to specific aspects of this type of adverse reactions to anesthesia in the neurosurgical practice. The review concludes that it is still necessary to search for better methods of prevention and management of post-operative nausea and vomiting in the group of neurosurgical patients considering the specific risk factors. В обзоре приведены актуальные данные о причинах, частоте встречаемости, факторах риска, методах профилактики и принципах терапии послеоперационной тошноты и рвоты. Особое внимание уделено специфическим аспектам проявления этого типа анестезиологических осложнений в нейрохирургической практике. Сделан вывод о сохраняющейся актуальности поиска путей улучшения профилактики и терапии послеоперационной тошноты и рвоты в группе нейрохирургических пациентов с учетом специфических факторов риска.

СИНДРОМ ОСТРОЙ ПОЛИУРИИ, ИНДУЦИРОВАННЫЙ ДЕКСМЕДЕТОМИДИНОМ, ПРИ ПРОВЕДЕНИИ СПИНАЛЬНОГО НЕЙРОХИРУРГИЧЕСКОГО ВМЕШАТЕЛЬСТВА (клиническое наблюдение)

Dexmedetomidine is a high-selective α2-agonist, which is used as an anesthetic component, and it is expected to induce polyuria. Initially, it was mainly used for sedation in emergency wards, and further this medicine got widespread use in anesthesiology. The major positive effect of dexmedetomidine is related to its central sympatholytic action and suppression of the activity of sympathetic nervous system. This medicine also provides a favorable hemodynamic profile. However, it has a number of certain disadvantages. The present clinical study reports development of acute polyuria syndrome due to the administration of dexmedetomidine during spinal neurosurgery.Дексмедетомидин − высокоселективный α2-агонист, который используется как компонент анестезии и, как предполагается, индуцирует полиурический синдром. Изначально его основной сферой применения являлась седация в отделениях интенсивной терапии, в дальнейшем препарат получил распространение и в анестезиологии. Основные положительные эффекты дексмедетомидина связаны с его центральным симпатолитическим действием и подавлением активности симпатической нервной системы. Также препарат обеспечивает благоприятный гемодинамический профиль. Однако дексмедетомидин имеет и ряд определенных недостатков. В данном клиническом наблюдении сообщается о развитии синдрома острой полиурии на введение дексмедетомидина при проведении спинального нейрохирургического вмешательства

Global patient outcomes after elective surgery: prospective cohort study in 27 low-, middle- and high-income countries.

BACKGROUND: As global initiatives increase patient access to surgical treatments, there remains a need to understand the adverse effects of surgery and define appropriate levels of perioperative care. METHODS: We designed a prospective international 7-day cohort study of outcomes following elective adult inpatient surgery in 27 countries. The primary outcome was in-hospital complications. Secondary outcomes were death following a complication (failure to rescue) and death in hospital. Process measures were admission to critical care immediately after surgery or to treat a complication and duration of hospital stay. A single definition of critical care was used for all countries. RESULTS: A total of 474 hospitals in 19 high-, 7 middle- and 1 low-income country were included in the primary analysis. Data included 44 814 patients with a median hospital stay of 4 (range 2-7) days. A total of 7508 patients (16.8%) developed one or more postoperative complication and 207 died (0.5%). The overall mortality among patients who developed complications was 2.8%. Mortality following complications ranged from 2.4% for pulmonary embolism to 43.9% for cardiac arrest. A total of 4360 (9.7%) patients were admitted to a critical care unit as routine immediately after surgery, of whom 2198 (50.4%) developed a complication, with 105 (2.4%) deaths. A total of 1233 patients (16.4%) were admitted to a critical care unit to treat complications, with 119 (9.7%) deaths. Despite lower baseline risk, outcomes were similar in low- and middle-income compared with high-income countries. CONCLUSIONS: Poor patient outcomes are common after inpatient surgery. Global initiatives to increase access to surgical treatments should also address the need for safe perioperative care. STUDY REGISTRATION: ISRCTN5181700

THE PROBLEM OF POST-OPERATIVE NAUSEA AND VOMITING IN THE PATIENTS UNDERGOING NEUROSURGERY

The review presents the most recent data on the causes, frequency, risk factors, prevention methods, and principles of management of post-operative nausea and vomiting. The special attention is paid to specific aspects of this type of adverse reactions to anesthesia in the neurosurgical practice. The review concludes that it is still necessary to search for better methods of prevention and management of post-operative nausea and vomiting in the group of neurosurgical patients considering the specific risk factors

THE URGENCY OF THE PROBLEM OF RESIDUAL NEUROMUSCULAR BLOCK AFTER SINGLE INTRAOPERATIVE RELAXANT ADMINISTRATION IN NEUROSURGICAL PATIENTS: PRELIMINARY DATA

Under the present-day conditions, it is necessary to allow for rapid postoperative awakening in each neurosurgical patient, which is impossible under residual neuromuscular block. The paper gives the preliminary data of a prospective observational study of the frequency of residual neuromuscular block after single intraoperative administration of a moderate- or long-acting myorelaxant. When the myorelaxants are used once according to the standard procedure (in the absence of TOF monitoring and pharmacological elimination of the action of myorelaxants), the rate of residual myorelaxation in neurosurgical patients has been found to be unacceptably high and to hinder their rapid awakening and neurological assessment. The administration of pipecuronium gives rise to residual block in all cases. That of rocuronium makes it possible to reduce the rate of residual myorelaxation, but not to eliminate it completely. Residual block can be preserved 2–4.5 hours after single administration of rocuronium or pipecuronium

ACUTE POLYUMERIA SYNDROME INDUCED BY DEXMEDETOMIDINE DURING SPINAL NEUROSURGERY (clinical observation)

Dexmedetomidine is a high-selective α2-agonist, which is used as an anesthetic component, and it is expected to induce polyuria. Initially, it was mainly used for sedation in emergency wards, and further this medicine got widespread use in anesthesiology. The major positive effect of dexmedetomidine is related to its central sympatholytic action and suppression of the activity of sympathetic nervous system. This medicine also provides a favorable hemodynamic profile. However, it has a number of certain disadvantages. The present clinical study reports development of acute polyuria syndrome due to the administration of dexmedetomidine during spinal neurosurgery

DYNAMICS OF COGNITIVE FUNCTION OF PATIENTS WITH DEFECTS OF THE SKULL AFTER RECONSTRUCTIVE SURGERY

Due to  the  high social significance of traumatic  brain injury and its consequences,  dynamics of cognitive functions  at  the  background  of the reduction of reconstructive and plastic surgery is of interest to researchers in the world, but this topic is not sufficiently studied. A large number of patients with bone defects of the skull due to a traumatic  brain injury and skull defects after surgery for tumors, and as a consequence of possible cognitive deficits of these patients  makes it necessary to study and assess the possibility of its compensation  as a result of reconstructive  plastic surgery of the skull. Material and methods. In our study, we examined 54 patients  (12 women and 42 men) in surgical treatment neurotrauma department (reconstructive  surgery) after traumatic  brain injury or skull defect after surgical removal of tumors. The average age of patients  is33,09 years. All patients  were examined by a psychologist before surgery, and on the first, third, and seventh-eighth day after the surgery. MoCA, FAB, Schulte tables, HADS, Spielberger-Hanin anxiety test, a set of stimulus materials for neuropsychological diagnosis, all patients were asked to subjectively evaluate their appearance:  until defect acquisition prior to surgery after treatment (see questionnaire  by Sinbukhova E.[8]), also was used projective drawing method, where patients were asked to perform a series of drawings on the given topics. In our study to reduce the high level of situational and personal anxiety of the patients they had Art-therapy sessions with a psychologist before surgery and from the second day after it. The purpose of research is to study the changes in cognitive function, level of depression, anxiety of patients  with postoperative bone defects of the skull after a reconstructive-plastic surgery. Keywords cognitive function, depression, anxiety, reconstructive  surgery. Results On the 3 days after surgery, a statistically significant increase was observed in the evaluation acording MoCA (preoperative mean value — 22 points, 3 days after the operation  — 24 points, p = 0,0002033). Before сheck out (MoCA) significant improvement  in cognitive function was confirmed. Depression, personal and situational  anxiety was significantly reduced by the time сheck out. By the time of сheck out the emotional  state  of the patients showed significant improvement  of emotional  state  level to the level prior to the defect acquisition. Subjective evaluation of appearance  by the time of сheck out of patients showed a significant recovery of subjective apearance evaluation of the level prior to the defect acquisition. Conclusion. The obtained data revealed a statistically significant increase of early postoperative cognitive function of the background of reconstructive-plastic surgery. Statistically significant results of the reduction  of depression, situational  and personal anxiety, improvement  of the emotional  state  of patients after surgery, at the background of daily Art-therapy (projective drawing) sessions with a psychologis

Preop endovascular embolization in juvenile nasal angiofibroma management

Introduction. Juvenile nasal angiofibroma (JNA) is an aggressively expanding fibro-vascular benign tumor, which occurs in male adolescents. Surgical management of JNA is considered as one of the most difficult in rhinology, because it very often has accompanied with profuse, streaming bleeding. Endovascular embolization has successfully used for reducing the operative blood loss since 2000th. Nevertheless, there is no consensus in the literature about its expediently using because of complications, which may occur.Objective is to evaluate the effectiveness of selective angiography and endovascular embolization in reducing bleeding when removal of JNA of different stages.Materials and methods. In the N.N. Burdenko National Medical Research Center of Neurosurgery 134 patients with JNA had been treated surgically.Results. 110 patients with JNA, who underwent embolization, managed to perform total, subtotal or partial devascularization of the tumor. Total devascularization was achieved in JNA blood supply variant only from the external carotid artery (ECA) system from 1 or 2 sides  (in primary patients or in patients who had not previously been embolized) (n = 39); subtotal devascularization, if the blood supply was carried out from the ECA system, internal carotid artery (ICA) on the 1 side (n = 52) and partial, if there was blood supply from the ECA and significant from the ICA system from 2 sides (in patients with relapse after previous embolization with microspirals or the ECA ligations from 1 or 2 sides, as well as with giant JNA (n = 19). Since the vast majority of patients admitted to our clinic were previously operated on, and JNA blood supply in relapses was more pronounced, we performed the comparison of the degree of tumor devascularization depending on its blood supply in primary patients and patients with relapse. It turned out, as could be expected, that with the primary JNA often managed  to execute a total devascularization than with JNA with continued increase, the difference was statistically significant (p = 0.009).Conclusion. It accurately proved that embolization decreases intraoperative blood loss and reduce surgical risks even in later stages JNAs  (r = –0,51, p <10–7). Ligation of ECA as well as proximal occlusion of its branches leads to rapid reconstruction blood supply from ICA and inability of its embolization if recurrence of JNA occurs