Аcute renal failure in patients with implanted LVAD in the early postoperative period

AKI is one of the major complications in the cardiac surgery group of patients in the world. In patients with LVAD in the short postoperative period, the situation with such a complication as AKI is associated with the state of hemodynamics and fluctuations in the parameters of the hemostasis system. The purpose of this scientific work is to analyze the state of the blood coagulation system and its response to therapy and complications in the early postoperative period in fifty patients with implanted devices for mechanical support of the left ventricle, left ventricle assist device, LVAD, in the Silesian Heart Disease, Poland. Patients were divided into two groups, a control group receiving classical anticoagulation targeted therapy (ATT), which included the most controlled monotherapy with heparin, after reaching the target values of APTT, the addition and transition to monotherapy with warfarin until reaching the target INR and ASA, and the main, research group, who received an alternative ATT consisting of the previous one with the addition of P2Y12-receptor blockers and Xa-factors. The results showed that the control group of patients with classical anticoagulant targeted therapy had greater mortality associated with AKI than the patients of the study group, and it was also demonstrated that the initially longer duration of surgery and intraoperative polyuria gave a greater percentage of AKI in the postoperative period. The work was carried out within the framework of a bilateral agreement on scientific cooperation between the Department of Anesthesiology & Intensive Care at the National Medical Academy of Post-Graduate Education Named After P.L. Shupyk and the Silesian Center for Heart Diseases (Poland). This article is part of the analysis of the work on the analysis of the blood coagulation system in patients after implantation of the left ventricular mechanical circulatory support system with the analysis of such postoperative complication as acute kidney failure

Comparison of the methods of the correction of the venous thromboembolism in bariatric surgery using the low-frequency thromboelastography: our experience

Introduction. In the world of obesity and its complications annually dies about 2.8 million people. Obesity is an independent factor of the risk of venous thromboembolism (VTE), as it interferes with the internal and external pathways of coagulation, as well as in anticoagulant mechanisms, which leads to a hypercoagulation state. Reducing excess body weight in patients with morbid obesity by bariatric surgery is becoming increasingly popular, as barium therapy is an effective means of treating obesity and related concomitant diseases. Advantages of bariatric surgery are undeniable, as well as risks. Despite many blood coagulation studies, cases of thromboembolism in such patients are becoming more frequent, especially during surgical interventions and in the postoperative period, given that the operation is a trigger factor in the development of thromboembolism. Materials and methods. A hemostasis system was studied in 63 patients with BMI> 35 kg / m2. All patients were divided into 3 groups. 1 group (n=20) - patients who received combined therapy: Enoxaparin sodium 0.1% 0.2 ml / kg 2 times a day every 12 hours and Pentoxifylline 100 mg 2 times a day every 12 hours; The 2nd group (n= 17) - patients treated with: Enoxaparin sodium 0.1% 0.2 ml / kg 2 times daily for every 12 hours; Group 3 (control): 26 people with obesity, BMI> 35, not subject to bariatric surgery. The study of the hemostasis system was carried out using low-frequency piezoelectric thromboelastography (LPTEG) immediately after hospitalization and on 1,3,5 days after bariatry. The following blood coagulation constants were checked: Contact Coagulation Intensity; intensity of coagulation drive; maximum bunch density; Fibrinolytic activity is the index of retraction and lysis of the clot. Results. In patients of group 1 (anticoagulants + antiplatelet agents) the risk of thrombotic complications is lower, since this therapy has reduced the value at all stages of hemocoagulation to the reference values; Patients in group 2 (anticoagulants), despite the normalization of the coagulation unit, had an increase in the values of aggregation and fibrinolysis, relative to the norm, which means the risk of thrombotic complications remains high. Conclusions. The instrumental method of NPTEG allowed to adequately estimate the system of hemocoagulation in dynamics in patients with morbid obesity, with BMI ≥ 35 kg / m2; This category of patients has shown a high risk of VTE; It has been proved that for an adequate prevention of VTE in obese patients undergoing bariatric surgery, the combination of anticoagulants and antiplatelet agents is more effective than monotherapy with anticoagulants

The state of hemostasis in pregnant women with hydramnion

Purpose. To determine the state of various stages of hemostasis in pregnant women with hydramnion as a risk factor for premature detachment of the placenta. Results. There was investigated the state of hemostasis in pregnant women with hydramnion by low piezoelectric thromboelastography (LPTEG) and standard coagulogram. According to the LPTEG results this group of women was found to have increased plasma coagulation potential manifested in elevated constant thrombin activity (TAC) by 76.8%, the intensity of coagulation drive (ICD) by 74.9%, maximum clot density (MA) by 16.8%, shortening of coagulation time (T3) by 7.8% and inhibition of fibrinolysis manifested by decrease in retraction intensity and clot lysis (RICL) by 67.7% (p<0.05). Conclusions. The state of hemostasis in pregnant women with hydramnion is characterized by increased plasma coagulation and inhibition of fibrinolysis potential that are factors of preparing the woman’s body for the upcoming birth to control and minimize blood loss

Features of the hemostasis system state in patients with pulmonary tuberculosis detected by the method of low-frequency vibration piezoelectric hemocoagulography

Objective: to estimate the state of the hemostasis system in patients with tuberculosis by the method of LPHC. Methods: the state of the hemostasis system in patients with tuberculosis was evaluated with the aid of the analyzer of the blood rheological properties ARP - 01 “Mednord” as well as by the use of a standard complex of laboratory coagulation tests. The indices characterizing the initial stages of the blood coagulation, the intensity of thrombin formation and fibrin polymerization was evaluated by the LPHC method as well as the indices, which characterize the intensity of the clot retraction and fibrinolytic activity. Results: the comparative analysis of the state of the hemostasis system with the use of a standard coagulogram and LPHC express method in patients with tuberculosis revealed the presence of the processes of the moderate hyper-coagulation shift and suppression of fibrinolysis in them. Conclusion: the comparative estimation of the state of the hemostasis system in patients with tubercular infection with the aid of the method of low-frequency vibration piezoelectric hemocoagulography and standard coagulation tests revealed unidirectionality of the processes. The determination of changes in the components of the regulation of aggregation of the blood condition (RABC) system by the LPHC method allows to diagnose the development of complications in the blood coagulation system in patients with tuberculosis without manifestations of the corresponding clinical symptoms

Complications of peripheral nerve blocks

Проведен обзор всех вероятных осложнений проводниковой анестезии, представлен глубокий и всесторонний анализ их причин, рассматриваются клинические и физиологические проявления, диагностика, а также методы профилактики и лечения. В качестве примеров приводятся конкретные клинические случаиThe work includes the overview of potential nerve block complications, represents comprehensive and deep analysis of possible reasons. Clinical and physiological manifestations of each complication are considered as well as its diagnostics and methods of prophylaxis and treatment. The work includes clinical case descriptions to show practical application of theoretical statements. Keywords: neural block, complication of neural block, local anesthetics

Периоперационный менеджмент абдоминальной гистерэктомии: новые подходы и обзор литературы

Абдоминальная гистерэктомия (АГ) является однй из наиболее распространенных операций, выполняемых при злокачественных, а также доброкачественных опухолях органов женской репродуктивной системы. Эффективный периоперационный менеджмент зависит от сотрудничества между хирургами, анестезиологами, гемостазиологами и службами управления болью лечебного учреждения и представляет собой сочетание упреждающей аналгезии, общей и региональной анестезии, изучения и регулирования функционального состояния системы гемостаза.Abdominal hysterectomy (AH) is one of the most common surgeries performed for malignant as well as benign indications. Effective perioperative managementdepends on the cooperation between the surgeons, anesthetists, hemostasiologists and the hospital’s pain management service, and is a combination of preemptive analgesia, general and regional anesthesia, studying and regulation of the functional state of the hemostasis system. The objective of this work is to present the currently available therapeutic strategies for the treatment of posthysterectomy pain and trombotic complications in the light of our experience and the literature review