Assuntos
Coma/tratamento farmacológico , Traumatismos Craniocerebrais/tratamento farmacológico , Dopaminérgicos/uso terapêutico , Ketamina/uso terapêutico , Fármacos Neuroprotetores/uso terapêutico , Feminino , Humanos , Ketamina/farmacocinética , Masculino , Neopterina/líquido cefalorraquidiano , Tensoativos/análise , Síndrome , Traumatismos do Sistema Nervoso/tratamento farmacológicoRESUMO
In 34 patients the abstinence syndrome was treated by hypothermia (HT) with the EEG monitoring. HT was carried out under the general propofol-fentanil anesthesia. HT was achieved in the "Hirana" bath. The temperature was increased gradually by 1 degree C per 5 minutes up to 44 degrees C. EEG was recorded before anesthesia, as well as during and after the procedure. On the initial EEG alpha- and beta-rhythms were predominant. Under the anesthesia both alpha-rhythm frequency and amplitude were enhanced, spikes and wave discharges appeared. Under HT (t = 40-42 degrees C) low voltage and wave slowing were recorded. In the range t degree--42.5-43.4 degrees C EEG registered the appearance of clinically significant "biological break point", which was followed by neuropeptide destruction. At t degree--43-44 degrees C acute suppression and, then, electrocerebral silence were observed in a majority of patients. At the end of the procedure (t = 39 degrees C) EEG returned to the initial recording.
Assuntos
Eletroencefalografia , Temperatura Alta/uso terapêutico , Banho a Vapor , Síndrome de Abstinência a Substâncias/terapia , Anestesia Geral , Anestesia Intravenosa , Fentanila/administração & dosagem , Humanos , Monitorização Fisiológica , Propofol/administração & dosagem , Síndrome de Abstinência a Substâncias/fisiopatologiaRESUMO
The role of neutrophil leukocytes in the development of the polyorgan failure syndrome during an unfavorable course of destructive pancreatitis is discussed. The examinations of 52 patients demonstrated a high correlation of neutrophil functional activity tests (nitroblue tetrazolium reduction test and leukocyte-platelet aggregation) and disorders of microcirculation and hepatorenal involvement (detected clinically and by laboratory tests). The "critical mass" of leukocytosis has been estimated: at least 18 . 10(9)/liter, at which the risk of polyorgan failure appreciably increases. The authors discuss the advisability of selective cytopheresis in a complex of intensive care for critical states involving endogenous poisoning and leukocytosis.
Assuntos
Insuficiência de Múltiplos Órgãos/etiologia , Pancreatite/complicações , Doença Aguda , Adulto , Feminino , Humanos , Leucocitose/sangue , Leucocitose/complicações , Leucocitose/fisiopatologia , Masculino , Pessoa de Meia-Idade , Insuficiência de Múltiplos Órgãos/sangue , Insuficiência de Múltiplos Órgãos/fisiopatologia , Pancreatite/sangue , Pancreatite/fisiopatologia , Fatores de Risco , Índice de Gravidade de Doença , Fatores de TempoAssuntos
Hipotermia Induzida , Insuficiência da Valva Mitral/cirurgia , Troca Gasosa Pulmonar , Equilíbrio Ácido-Base , Adulto , Anestesia Geral , Fibrilação Atrial/etiologia , Fibrilação Atrial/fisiopatologia , Feminino , Próteses Valvulares Cardíacas , Hemodinâmica , Humanos , Hipotermia Induzida/métodos , Masculino , Pessoa de Meia-Idade , Valva Mitral , Insuficiência da Valva Mitral/complicações , Insuficiência da Valva Mitral/fisiopatologiaRESUMO
A method of bivalvular prosthesis of the heart without a perfusion is described. Operations were performed on 6 patients. One patient died. In 5 patients the aortomitral prosthesis was fulfilled, in one patient a mitral-tricuspid prosthesis was created. The article describes the technique of the operation and analyzes some anesthesiological aspects of maintaining a continuous occlusion of main vessels.