ОЦЕНКА РИСКА ОСЛОЖНЕНИЙ ВО ВРЕМЯ ВВОДНОЙ АНЕСТЕЗИИ У ПАЦИЕНТОВ С МАССИВНЫМИ ОПУХОЛЯМИ СРЕДОСТЕНИЯ

Anesthetic management of surgery in patients with large mediastinal mass remains a topical issue of thoracic anesthesiology, since such patients often develop superior mediastinal compression (SMC) which results in a high risk of hemodynamic and respiratory disorders during induction. The degree of compression does not always depend on the mass size, and the prediction of SMC progression during induction becomes a challenge.The method to evaluate the degree of mediastinal compression through the functional orthoclinostatic test was developed – the patient is to be placed in Fowler position for 45 degrees in order to follow changes in the cardiac index.It was found out that the patients with SMC detected during the test (increased cardiac index in Fowler position) had their arterial blood pressure reduced after induction, and the number of critical incidents was statistically significantly higher. The test proved to be a non-invasive and safe method of pre-operative prediction of the risk of SMC development and progression during induction.Анестезиологическое обеспечение оперативных вмешательств у пациентов с массивными опухолями средостения остается актуальной проблемой торакальной анестезиологии, поскольку у больных данной категории заболевание часто осложняется синдромом медиастинальной компрессии (СМК), что приводит к высокому риску гемодинамических и дыхательных нарушений во время вводной анестезии. Степень компрессии не всегда зависит от размеров опухоли, поэтому прогнозирование усугубления СМК во время вводной анестезии остается сложной задачей.Разработали способ оценки степени компрессии средостения методом функциональной ортоклиностатической пробы ‒ перевод пациента в положение Фовлера с наклоном в 45% с определением динамики сердечного индекса.Полученные результаты показали, что у больных с выявленным во время пробы СМК (увеличение сердечного индекса в положении Фовлера) в большей степени происходило снижение артериального давления после вводной анестезии, также было статистически значимо выше количество критических инцидентов. Проба показала себя как неинвазивный и безопасный метод предоперационного прогнозирования риска развития и прогрессирования СМК во время вводной анестезии

Блокада грудных нервов как компонент мультимодальной анальгезии при операциях по поводу рака молочной железы

Objective: to evaluate the efficacy and safety of adding pectoral nerve block to anesthesia regimen in radical mastectomy.Subjects and methods. 65 female patients underwent unilateral radical mastectomy under general anesthesia. All patients enrolled into the study were divided into two groups. Group 1 included patients (the main one, n = 33) who had PEC block and general anesthesia; Group 2 (the control one, n = 32) had general anesthesia only.Results. The group of patients with PEC block versus the Control Group, demonstrated a lower score of the visual analogue scale at all stages of the study. The intra-operative fentanyl consumption was statistically significantly lower in Group 1 versus the Control Group (290.91 ± 67.84 and 393.75 ± 66.90 μg, respectively, p < 0.033). The consumption of opioid analgesics during the 1st day in the Main Group was 2-fold lower compared to the Control Group – 30.91 ± 12.34 and 63.75 ± 9.42 mg, respectively (p < 0.026). In Group 1, the time till the first analgesia with promedol made 309.55 ± 56.59 minutes.Conclusions. Pectoral nerves block combined with general anesthesia provides effective analgesia during breast surgery with axillary lymph node dissection.Цель исследования: оценить эффективность и безопасность включения блокады грудных нервов в схему обезболивания при радикальной мастэктомии.Материал и методы: 65 пациенткам выполнена односторонняя радикальная мастэктомия под общей анестезией. Все пациентки, включенные в исследование, разделены на две группы. В 1-ю группу включены пациентки (основная, n = 33), которым проведены PEC block и общая анестезия; во 2-й группе (контрольная, n = 32) проведена только общая анестезия.Результаты. В группе пациентов с PEC block в сравнении с контрольной группой выявлен более низкий показатель по визуально-аналоговой шкале на всех этапах исследования. Интраоперационная потребность в фентаниле статистически значимо была меньше в 1-й группе по сравнению с контрольной (290,91 ± 67,84 и 393,75 ± 66,90 мкг соответственно, p < 0,033). Потребность в опиоидных анальгетиках в 1-е сут в основной группе была в 2 раза меньше, чем в контрольной ‒ 30,91±12,34 и 63,75 ± 9,42 мг соответственно (p < 0,026). Время до первого обезболивания промедолом в 1-й группе составило 309,55 ± 56,59 мин.Выводы. Блокада грудных нервов в комбинации с общей анестезией обеспечивает эффективную анальгезию при операции на молочной железе с подмышечной лимфодиссекцией

ASSESSING THE RISK OF COMPLICATIONS DURING INDUCTION IN THE PATIENTS WITH LARGE MEDIASTINAL MASS

Anesthetic management of surgery in patients with large mediastinal mass remains a topical issue of thoracic anesthesiology, since such patients often develop superior mediastinal compression (SMC) which results in a high risk of hemodynamic and respiratory disorders during induction. The degree of compression does not always depend on the mass size, and the prediction of SMC progression during induction becomes a challenge.The method to evaluate the degree of mediastinal compression through the functional orthoclinostatic test was developed – the patient is to be placed in Fowler position for 45 degrees in order to follow changes in the cardiac index.It was found out that the patients with SMC detected during the test (increased cardiac index in Fowler position) had their arterial blood pressure reduced after induction, and the number of critical incidents was statistically significantly higher. The test proved to be a non-invasive and safe method of pre-operative prediction of the risk of SMC development and progression during induction

HIGH-INTENSITY FOCUSED ULTRASOUND ABLATION OF PATIENTS WITH LOCALLY ADVANCED PROSTATE CANCER

<p>In this study the results of retrospective analysis of treatment of 311 patients in Samara Oncology Center in 2008–2011 with locally advanced prostate cancer are presented. According to the received treatment patients were divided into 3 groups: 103 underwent HIFU, 101 patients had a course of EBRT, 107 patients received only hormone therapy (HT). Overall survival in patients with locally advanced prostate cancer after HIFU therapy was 86.2 %, after EBRT and HT – 66.3% and 18.1 %, respectively. These data indicate a high clinical efficacy of ultrasound ablation.</p><p> </p

Pectoral nerves block as a component of multimodal analgesia in breast cancer surgery

Objective: to evaluate the efficacy and safety of adding pectoral nerve block to anesthesia regimen in radical mastectomy.Subjects and methods. 65 female patients underwent unilateral radical mastectomy under general anesthesia. All patients enrolled into the study were divided into two groups. Group 1 included patients (the main one, n = 33) who had PEC block and general anesthesia; Group 2 (the control one, n = 32) had general anesthesia only.Results. The group of patients with PEC block versus the Control Group, demonstrated a lower score of the visual analogue scale at all stages of the study. The intra-operative fentanyl consumption was statistically significantly lower in Group 1 versus the Control Group (290.91 ± 67.84 and 393.75 ± 66.90 μg, respectively, p &lt; 0.033). The consumption of opioid analgesics during the 1st day in the Main Group was 2-fold lower compared to the Control Group – 30.91 ± 12.34 and 63.75 ± 9.42 mg, respectively (p &lt; 0.026). In Group 1, the time till the first analgesia with promedol made 309.55 ± 56.59 minutes.Conclusions. Pectoral nerves block combined with general anesthesia provides effective analgesia during breast surgery with axillary lymph node dissection