Anesthesia by electro acupuncture in neurosurgery

Given the fact that in neuroanesthesia the choice of anesthetic substances must take into account the effect they have over the cerebral substance, we felt that using as few drugs as possible eliminates their shortcomings, improving the intraoperative conditions as well as the outcome of the surgical intervention. For this purpose, we have used anesthesia through electro acupunctural stimulation associated to hypnosis, drug relaxation under controlled breathing on a group of 12 patients, from which 10 patients had undergone brain surgery and 2 patients had undergone surgery for herniated disc. The outcomes showed the better effect of this method than that of the classical, the patients showing excellent intraoperative hemodynamic stability, relaxed brain, without the need to use depleted substances, rapid awakening with a much better postoperative analgesia

De-installation of the multi-organic dysfunction syndrome by associating the mitochondrial microcirculatory recruitment with multiple organ support therapy in extracorporeal life support organization

World Academy of Medical Sciences (WAMS), Netherland, Fundeni Institute, Bucharest, Romania, Institute of Scientific Research in the field of Mother and Child Health Care, Republic of Moldova, State University of Medicine and Pharmacy “Nicolae Testemitanu”, Republic of Moldova, State Medical University of Samara, The Russian Federation, Aretaieion University Hospital, Athens, Medical School, National, and Kapodistrian The University of Athens, Greece, Odesa National Medicine University, Ukraine, Private Hospital Medical Institution “Via - Intosana”, Republic of Moldova, Medicine University of Buenos Aires, Argentina, Al VI-lea Congres Național de Obstetrică și Ginecologie cu participare internațională, 13-15 septembrie 2018, Chișinău, Republica MoldovaIntroduction: The installation of macro-circulation centralization in MODS triggering in critical obstetric states caused by intravascular coagulation, HELLP, shock, SIRS, septicemia, CARS, embolism of the pulmonary artery, cerebral and other, – microcirculation will also be seriously damaged, as the reduction in blood flow perfusion affects the venous return to eliminate the waste of cellular metabolism, where a marker of tissue hypoxia is the increase in carbon dioxide. Objective: The mitochondrial microcirculatory recruitment with multiple organ support therapy in extracorporeal life support. Material and methods: This is a retrospective study over 35 years, in a lot of critical situations in obstetrics. Results: This disorder generates microcirculatory - mitochondrial distress syndrome, mitochondrial energy collapse, which can be recovered by microcirculation – mitochondrial recruitment to optimize systemic perfusion pressure (SPP), in turn, dependent on mean blood pressure and capillary resistance. Microcirculation - mitochondrial recruitment decentralizes macrocirculation benefits microcirculation in the capillary-cell metabolic area. In cases of manifestation respiratory-pulmonary CO2 ↑ (ARDS), confirmed ↓ PaO2/FiO2 ↓300 to Acute Respiratory Distress Syndrome (Berlin definition, 2012), thus also aggravates the microcirculatory-mitochondrial distress syndrome, mitochondrial collapse and the recruitment of the microcirculatory-mitochondrial is supplemented with multi-organ support therapy (MOST). 1. Alveolar recruitment through respiratory support in specific ventilation modes, predominantly APRV, with permissive hypercapnia at a normal pH. 2) MOST - extracorporeal with technical support. Extracorporeal Life Support Organization – ELSO. 3) Modeling of extra-vascular pulmonary fluid; 4) Th4 - Th5 thoracic epidural block. Conclusion: The absence of decreasing of the pCO2 tissue hypoxia marker at the A-V difference after microcirculatory - mitochondrial recruitment, rejects the necrosis /apoptosis, cellular hypo-(an)ergic and proves the mitochondrial eu-energetic metabolic remodeling with the elimination of the hypo (an) ergic mitochondria performed by clearance lysosomal (mitophagy), thus demonstrating eu-ergic mitochondria with the normalization of mitochondrial uniporter-Ca ++ and mitochondrial permeability pore transition, which productively inactivate the toxic forms of oxygen and nitrogen.Rezumat. Instalarea centralizării macro-circulaţiei în declanşarea MODS în stări critice de obstetrică cauzate de coagularea intravasculară, HELLP, şoc, SIRS, septicemie, CARS, embolie a arterei pulmonare, cerebrală şi altele; - microcirculaţia va fi de asemenea grav afectată, iar perfuzia fluxului sanguin afectează revenirea venoasă pentru a elimina deşeurile de metabolism celular, unde un marker al hipoxiei tisulare este creşterea dioxidului de carbon, la diferenţa A-V. Această tulburare generează sindromul detresei microcirculator – mitocondriale (MMDs), colapsul energetic mitocondrial, care poate fi de-instalat (recuperat) prin recrutarea microcirculator - mitocondrială odată cu optimizarea presiunii de perfuzie sistemică, în dependenţă de tensiunea arterială medie şi rezistenţa capilară. Recrutarea microcirculator - mitocondrială descentralizează macrocirculaţia şi ameliorează microcrculaţia în spaţiul metabolic capilar-celulă. În cazurile de manifestare a ↑CO2-dependent respirator-pulmonar, confirmat ↓ PaO2 / FiO2 ↓ 300 pentru ARDS, sindromul de detresă respiratorie acută (definiţia de la Berlin, 2012), agravează de asemenea, şi sindromul detresei microcirculator-mitocondriale, colapsul mitocondrial iar recrutarea microcirculator - mitocondrială este suplimentată cu terapia de sprijin multi-organ (MOST). 1. Recrutarea alveolară prin suport respirator în moduri de ventilaţie specifice preponderent APRV, cu hipercapnie permisivă la un pH normal. 2) MOST - extracorporal cu suport tehnic în managmentul vital prin sprijin extracorporeal - ELSO. 3) modelarea fluidului pulmonar extra-vascular; 4) Blocul epidural T4-Th5 toracic. Reducerea markerului hipoxiei tisulare pCO2 la diferenţa A-V după recuperarea microcirculator - mitocondrială, respinge necroza / apoptoza, hipo-(an)ergicul celular şi dovedeşte remodelarea metabolică eu-energetică mitocondrială prin eliminarea hipo (an) mitocondriilor ergice efectuate prin clearance-ul lizozomal (mitofagie), demonstrând astfel mitocondriile eu-ergice cu normalizarea tranziţiei porilor permeabilităţii mitocondriale şi canalului uniporter-Ca ++ , care inactivează productiv formele toxice de oxigen şi azot

Role of pCO2 (AV gap) of Multi Organ Dysfunction Syndrome

Recruitment of Microcirculatory-Mitochondrial (RMM) reduces Microcirculatory-Mitochondrial Distress Syndrome (MMDs), and Syndrome of Multi-Organ Dysfunction (MODs), by accelerated speed of delivery and return of blood flow which directly leads to a decrease in tissue hypoxia marker pCO2 (AV gap) and respectively with ↓ many other Endogenous Toxic Substances (ETS). In cases of pulmonary damage with ↑ pCO2 & ↓ Oxygenation Index PaO2/FiO2 ↓ 300 the development of Acute Respiratory Distress Syndrome (ARDs), MMDs are also aggravated at ↑ with pCO2 AV gap. RMM also needs additional support of Multiple Organ Therapies-Multi-Organ Supportive Therapy (MOST), Alveolar Recruitment, Extracorporeal Life Support Organization (ELSO), Modeling of the Index of Extravascular Lung Fluid, EVLWI, Th4- Th5 Thoracic Epidural Block, Active detoxification methods. The absence of decreasing of the pCO2 tissue hypoxia marker at the pCO2 AV gap ↓ 5.0 mmHg, after RMM proves the mitochondrial eu-energetic metabolic remodeling with the elimination of the hypo(an)ergic mitochondria performed by lysosomal clearance (mitophagy) makes the predominance eu-ergic mitochondria with the normalization of mitochondrial Ca++-uniporter-channel and mitochondrial permeability pore transition which productively inactivate the toxic forms of oxygen and nitrogen

The recruitment of microcirculatory-mitochondrial of critical obstetric situations in the complex multi-organ support therapy reduces pCO2 (AV gap) and the development of the syndrome of acute multi-organ dysfunction

Aretrospective analysis of the 35-year absence of maternal mortality in critical obstetrics, in different countries, was due to the timely decentralization of macro-circulation, detoxification and analgesia. Macro-circulation was decentralized once the systemic perfusion pressure has been established; which is the difference between the mean blood pressure and the pressure of the capillary resistance, and what contribute to by decreasing the tissue hypoxia marker pCO2 (pCO2 AV gap >6 mm Hg) due to micro-circulatory-mitochondrial recruitment, through improved microcirculation at the level of the capillary-cell metabolic area: metabolic capillary – cells – mitochondria; with ameliorate of the venous return compliance and reduction (pCO2 AV gap <6 mm Hg), and respectively, diminishes of the microcirculatory-mitochondrial distress syndrome (MMDs), and stopping expansion syndrome of acute multi-organ dysfunction