[Regional anesthesia: combined spinal epidural anesthesia].

The review deals with the promising method of regional anesthesia--combined epidural anesthesia. It gives indications for anesthesia, the specific features of its technical performance, and possible complications.

[Adequacy of combined spinal and epidural anesthesia during upper-abdominal operations].

The paper provides a comparative evaluation of the protective effects of combined spinal epidural anesthesia with artificial ventilation (AV) (n=86) versus combined general anesthesia with AV (n=53) from the surgical stress response at abdominal surgery. The surgical stress was estimated by the activities of the sympathoadrenal system, the hypothalamo-pituitary-adrenocortical system, the serum complement system, and lipid peroxidation, and by the blood level of glucose. The findings suggest that the combined spinal epidural anesthesia with AV has a more valid protective activity against poor surgery-associated neurohumoral, hemodynamic, and immunological changes.

[Complications of accelerated opioid detoxification].

All accelerated opioid detoxifications under anesthesia, which were performed at our district hospital during 3 years (1999 to 2002), have been retrospectively analyzed. A total of 48 detoxifications were made in 43 patients. Three serious complications were recorded. In the first case, there was incomplete detoxification using naltrexone. The naloxone test was negative. After recovery from anesthesia, the patient developed a severe withdrawal syndrome that required repeated detoxification. In the second case, the patient developed bedsores at the site of the sacrum and scapulae after 7-hour detoxification. Reddening and edema disappeared on day 3 without treatment. In the third case, there was insufficient artificial ventilation due to inspiratory valvular defect. Capnography was not applied. The symptoms of hypercapnia, such hypertension, hyperemia, sweating, were regarded as the symptoms of abstinence so anesthesia was intensified. Valvular defect was detected when the patient developed hypoxia. All the patients were discharged from hospital in a satisfactory condition.

Morphofunctional changes in spinal cord neurons after epidural lidocaine.

Morphofunctional and histoenzymological changes in spinal cord neurons of mongrel dogs were studied after epidural administration of isobaric 2% lidocaine solution. Control animals received epidural 0.9% sodium chloride. The results obtained from these studies provide evidence for the absence of pathological structural-metabolic changes in nerve tissue after treatment with lidocaine. The occurrence of certain morphofunctional rearrangements in spinal cord neurons were typical of animals of both the experimental and control groups. The changes recorded varied within the limits of physiological variation and provided evidence predominantly of the functional response of these nerve tissue structures to epidural injections of both sodium chloride and lidocaine.

[Evaluation of the local neurotoxicity of lidocaine following epidural administration]. / Otsenka mestnoi neirotoksichnosti lidokaina pri épidural'nom vvedenii.

The morphological and histoenzymological changes in spinal neuron and in the spinal ganglia of outbred dogs were analyzed in the epidural administration of 2% solution of lydocaine. The results showed a lack of pathological or structural-and-metabolic changes in the nervous tissue. The morpho-functional reshaping occurring in the spinal cord cells and in the spinal ganglia was in line with that when the 0.9% solution of sodium chloride was in use. The registered changes ranging within the physiological deviations' limits witnessed to a functional reaction of the studied nervous-tissue structures to epidural drugs' injections.

[Use of epidural analgesia for the arresting of pronounced lumbar pains]. / Primenenie épidural'noi anal'gezii dlia kupirovaniia vyrazhennykh bolei v poiasnitse.

A combination of local anesthetics (2% lydokaine solution, 2 mg/kg; 0.5% bupivakaine solution, 0.4 mg/kg or 0.75% ropivakaine solution, 0.55 mg/kg), promedol (20 mg) and corticosteroids (125 mg hydrocortisone or 80 mg kenalog) was epidurally administered in 78 patients to arrest the pronounced root pain syndrome of the lumbar-sacral localization provoked by intervertebral disk hernias. The most prolonged analgesic effect was registered in groups, whose patients received bupivakaine or ropivakaine, which prevented the onset of pain before the antiinflammatory effect of corticosteroids started. The patient must be informed well in advance about the possibility of a momentary relapse of pains and about the intensification (at the same time moment) of pharmacotherapy prescribed by neuropathologist.

[Morpho-functional changes of the spinal cord neurons after epidural administration of lidocaine]. / Morfofunktsional'nye izmeneniia v neironakh spinnogo mozga posle epidural'nogo vvedeniia lidokaina.

The analysis of morphological and histoezymological changes of spinal cord neurons has been performed in outbred dogs following epidural infusion of isobaric 2% lidocaine solution. In the control group the animals received epidural infusion of 0.9% saline. The results obtained indicate the absence of pathological structural and metabolic changes in the nervous tissue after lidocaine application. Certain signs of morpho-functional reorganization were noted in spinal cord neurons of animals in both experimental and control groups. The registered changes were found to vary within the physiological fluctuation limits and are rather indicative of the functional reaction of the studied structures of the nervous tissue to the epidural injections of either saline and lidocaine.

Effect of epidural infusion of isobaric 2% lidocaine on spinal cord ganglionic neurons.

We analyzed morphological and histoenzymologic changes in spinal cord ganglionic neurons of mongrel dogs caused by epidural infusion of isobaric 2% lidocaine. Lidocaine produced no pathological structural and metabolic alterations in the nervous tissue. Both epidural infusion of 0.9% NaCl and lidocaine produced some morphofunctional rearrangements in spinal ganglionic neurons. These alterations were within the limits of physiological norm and probably attested to functional response of the examined nerve tissue structures to epidural infusion.

Effect of epidural injection of prosidol with clonidine on the state of spinal cord and spinal ganglion.

Morphological and histoenzymatic changes in cells of the spinal cord and spinal ganglia after epidural injection of a combination of prosidol with clonidine were studied on dogs. No pathological structural and metabolic changes in the nervous tissue were found after combined treatment with the test drugs. Higher activity of nucleic acids and alkaline phosphatase in spinal neurons and spinal ganglion in experimental animals in comparison with those in controls indicates intensification of protein synthesis and active transport in the endothelium of nerve tissue capillaries, which is a favorable factor.

[Analysis of morphological changes in the spinal cord and ganglia of dogs after epidural administration of prosidol, clopheline and prosidol-clopheline combination]. / Analiz morfologicheskikh izmenenii spinnogo mozga i spinno-mozgovogo gangliia sobak posle épidural'nogo vvedeniia prosidola, klofelina i kombinatsii proosidola s klofelinom.

Experiments were carried out on 22 mongrel dogs (12-20 kg). Group 1 consisted of 5 dogs to which prosidol in a dose of 0.65 mg/kg was injected epidurally; group 2, 5 dogs, clofelin (6.5 micrograms/kg) epidurally; group 3, 5 dogs, prosidol (0.65 mg/kg) + clofelin (6.5 micrograms/kg) epidurally. Control groups were as follows: 1) 5 intact dogs; 2) 2 dogs epidurally injected with 0.9% normal saline. Analysis of the spinal cord and ganglia in control groups showed no dystrophic changes in neurons. After epidural injections of prosidol, clofelin, or both only solitary cells with degenerative changes were detected or none at all. Nissle granules were evenly distributed in the cytoplasm of anterior and posterior spinal horn neurons in all control and experimental animals. The majority of ganglious cells in control and experiment had the nucleus and nucleolus. Hence, morphological analysis showed that epidural injection of prosidol, clofelin, and a combination of both caused no degenerative or necrobiotic changes in the anterior and posterior spinal horn neurons and in ganglious cells of spinal ganglia.

[Enzymatic activity in spinal cord neurons after epidural administration of clopheline in dogs]. / Aktivnost' fermentov v neironakh tkani spinnogo mozga posle épidural'nogo vvedeniia klofelina u sobak.

Time course of the major enzymes (SDH, LDH, GPDHcyt, GPDHmit, AP) and protein synthesis (DNA, RNA) in spinal neurons and spinal ganglia after epidural injection of clofelin were studied in an acute experiment on dogs. No physiological or neurological disorders or depriming effect of clofelin on the major enzymatic systems and protein synthesis in nervous tissue of dogs were detected. Increased activity of AP in the spinal white and gray matter is worthy of note, which indicates intensification of active transport in spinal capillary epithelium after epidural injection of clofelin.

[Morphological and histochemical changes in the spinal cord after epidural administration of prosidol in dogs]. / Morfologicheskie i gistokhimicheskie izmeneniia v spinnom mozge posle épidural'nogo vvedeniia prosidola u sobak.

Morphological, histochemical, and histoenzymatic changes in the nervous tissue of the spine and spinal ganglia after epidural injection of narcotic analgetic prosidol were studied in acute experiment on 12 mongrel dogs. No negative effect of prosidol on neuronal structure and nervous tissue microcirculatory bed were observed in experimental vs. control animals. The type of changes and their direction in various compartments of the nervous system (spine and spinal ganglia) were similar in control and experimental animals.

[Concept of epidural and associated combined spinal-epidural anesthesia concerning prevention of a neurodystrophic component of intra- and postoperative complications in patients subjected to thoracic and abdominal surgery]. / Kontseptsiia épidural'noi i sochetannoi kombinirovannoi spinal'no-épidural'noi anestezii o preduprezhdenii neirodistroficheskogo komponenta intra- i posleoperatsionnykh oslozhnenii u bol'nykh, podvergnutykh torakal'nym i abdominal'nym operatsiiam.

The stimulation of reflexogenic zones and interoreceptors in experiments and in patients during operations on the heart, lungs and organs of the gastrointestinal tract induces hyperactivation of the sympatho-adrenal system and associated with it neurogenic dystrophic alterations of the internal organs (markedly decreased level of noradrenaline, destruction of the cell ultrastructure, mitochondria in particular) and energy metabolism. The use of high epidural anesthesia as the main component of narcosis in operations on the heart (mitral commissurotomy) and on the lung prevents the development of intra- and postoperative complications, the above mentioned dystrophic alterations in particular. Similar protecting effects in the abdominal operations are obtained when using associated combined spinal-epidural anesthesia.

High-frequency jet ventilation in endolaryngeal surgery.

STUDY OBJECTIVE: To describe the clinical experience with high-frequency jet ventilation (HFJV) of the lungs during endolaryngeal surgery and its effect on acid-base balance and capillary PO2 (PcO2), PCO2, central hemodynamics, and tracheobronchial mucous membrane. DESIGN: Evaluation of different modalities of HFJV. SETTING: Operating rooms and otolaryngology intensive care unit in a medical institute. PATIENTS: 218 patients undergoing elective endolaryngeal surgery. INTERVENTIONS: Patients receive HFJV through catheters with an inner diameter of 1.4 to 1.8 mm. Catheters were introduced orotracheally, nasotracheally, percutaneously, or through a fenestrated tracheostomy tube. Minute volume was based on body weight times 0.2, corrected for acid-base balance. MEASUREMENTS AND MAIN RESULTS: Intraoperative cardiac output, airway pressure, changes in tracheobronchial mucosa, and acid-base balance were monitored. HFJV changed central hemodynamics slightly and preserved gas exchange: PcCO2 remained within normal limits, while PcO2 increased. Use of thin catheters enhanced largyneal exposure and surgical manipulation. Percutaneous catheterization permitted resumption of HFJV in the event of laryngeal edema and inadequate spontaneous respiration after surgery. CONCLUSION: HFJV leads to optimal conditions for endolaryngeal surgery, reverses constant outflow of the respiratory gas mixture, prevents aspiration of tissue products and blood, and removes smoke from the operative site when using laser surgery.

[New possibilities of the use of central adreno-positive preparations in anesthesiology]. / Novye vozmozhnosti primeneniia tsentral'nykh adrenopozitivnykh preparatov v anesteziologii.

New clinical findings demonstrate a high efficacy of clofelin (100-200 mcg epidurally) as a nonopiate analgesic at the pre-, intra-, and postoperative stages of anesthesiologic care. Prospects of using clofelin in combination with morphine are discussed, as is the use of guanfacine as an agent for prolonged analgesia in the postoperative period.