A prospective observational study of the change in regional cerebral oxygen saturation during cesarean delivery in women receiving phenylephrine prophylaxis for spinal hypotension.

BACKGROUND: Spinal hypotension causes decreased regional cerebral oxygen saturation (ScO2) in women undergoing cesarean delivery. In this study we aimed to measure the change in ScO2 using near infrared spectroscopy in women receiving a prophylactic phenylephrine infusion during cesarean delivery under spinal anesthesia. METHODS: This was a prospective, observational cohort study. Fifty-three women had ScO2 measurements at the following time points: preoperatively, in the supine position with 30° of left lateral tilt; one and five minutes after spinal anesthesia; at the time of skin incision; immediately after delivery; one minute after commencing the oxytocin infusion; at completion of surgery, and one hour after surgery. Spinal anesthesia and a prophylactic phenylephrine infusion were administered according to a standard treatment protocol. Statistical analysis used the Wilcoxon Signed Rank test with Bonferroni's correction for multiple comparisons. RESULTS: Blood pressure was maintained within 20% of baseline throughout surgery. The baseline mean (range) ScO2 was 61.5% (54.0-66.3%). It decreased significantly at all subsequent measurement points. The maximum decrease was five minutes after spinal anesthesia. Thirty-four (64.2%) of the parturients exhibited ScO2 values <20% of baseline, or a decrease to below an absolute value of 50%. There was no significant correlation between systolic blood pressure and mean ScO2. CONCLUSION: Spinal anesthesia with phenylephrine infusion during cesarean delivery is associated with a significant decrease in ScO2 levels, maximal five minutes later. Further studies are required to establish the clinical significance of this finding.

[Results of usage of temporary prosthetics in cases of combat injuries of extremities].

The comparative analyzes of the results of usage of temporary prosthetics (TP) of injured main arteries during the war in Afghanistan (1979-1989) and counter-terrorist operations in the Northern Caucasus (1994-1996, 1999-2002) has been carried out. The development of new models of temporary prosthetics of vessels has been experimentally substantiated. In Afghanistan the two-staged usage of TP was made along with the amputation of extremities in 35,1% of cases and in the Northern Caucasus - in 15,0%. The reason for that was the considerable reduction of terms of evacuation of wounded. The average terms of presence of TP in the arteries in Afghanistan were 26,2+/-4,0 hours and in the Northern Caucasus - 18,1+/-3,4 hours. During a series of experiments on comparative testing of efficiency of three types of TP it was determined that prosthetics made of armored silicone (10,1+/-0,6 hours)and, especially made of enlarged micropored polytetraftoraethylen (11,5 +/-0,6 hours) are thrombosed slower comparing to polyclorvinil tube from the blood transfusion system (7,9+/-0,7 hours).

[Surgical strategy for combined gun-shot wounds of extremities with injuries of main arteries].

An investigation of materials of treatment of 130 wounded with combined wounds (CW) of extremity blood vessels during war in Afghanistan and in counter-terrorist operations in the Northern Caucasus has shown that the specific feature of surgical treatment of wounds of the extremity arteries associated with severe wounds of other localizations consists in limited possibilities to save the extremities. The scale MESS of a severity of extremity wounds was improved. It allowed a reliable prognosis for wounded with gunshot injuries of the arteries concerning necessary amputation (97%) or a possibility to save the extremity (100%). A strategy of surgical treatment of CW of the extremity arteries is proposed on the basis of an estimation of the general severity of the trauma, the V.A. Kornilov classification of the severity of acute ischemia and a FS-MESS scale of extremity injuries.