[Combined use of local anesthetic with clonidine in cases of tooth extraction].

The technique of local anesthesia by lidocain in combination with clonidine (clofelinum) as vasoconstrictor in the dose of 1 microg/kg was compared with local anesthesia by novocain in combination with adrenaline (1:200 000) or by lidocain without vasoconstrictor or by articain in combination with adrenaline (0.012 mg/ml). Lidocain use led to expressed tachycardia and considerable increase of cardiac oufput in moderate hypertension reactions. Adrenaline addition in anesthetic solution increases general peripheral resistance and all parameters of arterial pressure with simultaneous rise of heart contractions. Adrenaline substitution as local vasoconstrictor for clofelinum decreases sympathetic tension during operation, prevents hypertensive reactions as the result of general peripheral resistance decrease, stabilizes heart rhythm and basic indices of central hemodynamics, that testifies to its (technique) adequacy.

[Combined premedication at adenectomy in children]. / Kombinirovannaia premedikatsiia pri adenotomii u detei.

Adenoid vegetation is a frequent pathology in children, and adenotomy (AT) is the only method of its treatment. The problem of anesthesia at AT has always remained an acute one: the risk of general anesthesia exceeds manifold the risk of intervention itself. At the same time, the local anesthesia is not always an method, therefore, the authors put the goal to improve it through potentiating. A total of 180 children, aged 3 to 14, were divided into several groups; anesthesia at AT was implemented according to the below described methods and with regard for the age-related doses of preparations: Group 1--a 2% lydocain solution administered endonasally (e/n); Group 2--lydocain plus diazepam solution administered e/n; Group 3--same preparations and 50% metamizol solution administered e/n; Group 4--lydocain, metamizol e/n, and diazepam administered transbuccally, i.e. chewing gum; Group 5--a 4% articain solution and metamizol e/n plus diazepam administered transbuccally; Group 6--the same technique after a preliminary administration of lydocain; Group 7--clonidine, administered transbuccally, was added. The adequacy of anesthesia was evaluated by using the parameters of the vegetative nervous system and hemodynamics. It was demonstrated that the administration of lydocain alone leads to a sharp activation of the sympathoadrenal system; metamizol and diazepam, especially when administered transbuccally, contribute to an enhanced efficiency of anesthesia, while the endonasal administration of articain and metamizol, after a preliminary introduction of lydocain, combined with the transbuccal administration of diazepam and clonidine is the most optimal variant, however, this method can not be acknowledged as an ideal one and needs further improvement.

[A method for potentiation of local anesthesia for tooth removal and pulp extirpation]. / Sposob potentsiirovaniia mestnoi anestezii pri udalenii zuba i ékstirpatsii pul'py.

Local anesthesia can be considered adequate in 22% cases, which is explained by the absence of inhibitory effect on allogens, persistence of psychoemotional tension, and effector reactions. Therefore it is recommended to potentiate local anesthesia by a drug complex including analgesic ketrodole, tranquilizer diazepam, and alpha-adrenoagonist clofelin, used transbuccally 8-10 min before anesthesia. This pretreatment 3-fold increased the adequacy of local anesthesia for tooth removal and pulp extirpation.

[General status of patients before dental treatment]. / Obshchee sostoianie bol'nykh pered lecheniem u stomatologa.

Arterial pressure (AP), heart rate, and stress index (estimated by ECG) were measured in 20 patients several minutes before dental treatment. Systolic AP was normal in 56% patients (mainly elderly), diastolic was normal in 50.5% and increased in 36% (particularly so in elderly patients). Heart rats was normal in 33% patients, the rest had bradycardia (6%) or tachycardia (61%); the latter condition was more typical of young patients and was paralleled by high systolic AP. 10.5% patients had normal stress index and in 87.5% it was increased, indicating extreme stress of the sympathoadrenal system. All 4 parameters were normal in 3.5% patients, half of whom were youths aged under 20 years. 10.5% examinees had three normal parameters, 32.5% had two normal parameters, and 37.5% had one normal parameters; 16% examinees had all parameters beyond the threshold values. The authors point to the double hazard of such a state (possible complications and decreased pain sensitivity) and emphasize the need in preventive measures to correct the general status of patients.

[Adequate analgesic sedation: an alternative to general anesthesia in ambulatory settings]. / Adekvatnaia analgosedatsiia--al'ternativa obshchemu obezbolivaniiu v ambulatornykh usloviiakh..

A tendency to treatment in an outpatient setting implies development and more often use to outpatient anesthesias. Improving of general anesthesia is to be supplemented by wider use of analgosedation, which causes less vital complications. Intravenous and noninvasive methods of analgosedation are described, their adequacy is evaluated, and indications for their use are defined.

[Potentiation of local anesthesia in endonasal surgery]. / Potentsirovanie mestnoi anestezii pri éndonazal'nykh operatsiiakh.

An original method of buccal administration of the drugs (by means of chewing gum) was tried in 30 patients aged 18-33 years. The drugs (ketrodol--0.5 mg/kg, diazepam--0.15 mg/kg, clofelin--1 microg/kg) were used to potentiate local anesthesia in operation--submucosal resection of the nasal septum under novocain solution anesthesia. Control 15 patients were operated under local anesthesia with morphine premedication (dose 10 mg). Adequacy of anesthesia was assessed by parameters of central and peripheral hemodynamics. Local anesthesia with morphine significantly activated sympathoadrenal system. Hyperdynamia was secured at the expense of accelerated cardiac rhythm with relatively low myocardial performance. Premedication with the chewing gum allowed to avoid pressor responses to the trauma in moderate hyperdynamia with adequate cardiac performance and minimal shifts in myocardial contractility.