Perioperaciina Medicina en-US <p><a href="" rel="license"><img src="" alt="Creative Commons License"></a><br>This work is licensed under a <a href="" rel="license">Creative Commons Attribution 4.0 International License</a></p> (Oleksandr Marchuk) (Viktor Vitkovskyi) Wed, 16 May 2018 00:00:00 +0300 OJS 60 To the issues of history and formalization of the concept of anesthesia <p>Anesthesiology as a science has passed a long way of development. The empirical period begins with the moment when people realize that they can reduce pain and get rid of it. Real prerequisites for the development of effective methods of anesthesia began to take shape at the end of the 18th century. It conditioned the emergence of a second (pre-scientific) period of development of anesthesiology. The active use of anesthesia in surgery led to special training for anesthesia. Improved methods of general anesthesia, developed methods for replacing and managing the functions of vital organs and the organism as a whole, scientific discoveries and systematization of the results of scientific research formed the basis for the formation of anesthesiology and intensive therapy as a separate scientific and practical discipline.</p> <p>The concept of “anesthesia” was introduced in the scientific professional language – a physiologically based, combined and multicomponent, selectively directed and balanced set of therapeutic and prophylactic measures aimed at optimizing the algorithm for performing physiological functions of the human body during the perioperative period of the surgical method of treatment or in the procedure followed by the formation and development of the phenomenon of pain. Its components:</p> <p>1) modulation of the psychoemotional state;</p> <p>2) modulation of the neurovegetative state;</p> <p>3) analgesia;</p> <p>4) anesthesia;</p> <p>5) miorelaxation.</p> V. I. Poberezhny, A. S. Logvinov, D. V. Dmytriiev ##submission.copyrightStatement## Wed, 16 May 2018 00:00:00 +0300 Review of respiratory therapies in patients with spinal muscular atrophy <p>The purpose of this article was to systematize available literary data and to provide general recommendations for respiratory therapy in patients with spinal muscular atrophy. Spinal muscular atrophy (SMA) is a severe neuromuscular disease with autosomal recessive inheritance with degeneration of alpha motor neurons in the anterior horns of the spinal cord, leading to progressive proximal muscle weakness and paralysis. SMN 1–2 genes potentially encode identical proteins, although most of the transcripts of the SMN1 genes are halfsized, whereas most transcripts of the SMN2 genes do not contain the seventh exon. Therefore, the SMN2 gene is only partially functional, and a low-level SMN protein is produced in SMA patients. Moreover, the number of copies of the SMN2 can not be considered an exact predictive factor for any particular patient. The main causes of mortality and deterioration in the quality of life are the development of secondary respiratory failure.</p> <p>Type 1 (a, b, c) is the heaviest: early onset and lack of motor abilities, usually patients with a disease of this type survive no more than 2 years.</p> <p>Type 2 – an intermediate type characterized by a later onset, the patient may take a sedentary position, survival may reach the adult height.</p> <p>Type 3 is the softest form that manifests itself at the age of 1 year, the patient can walk and stand. The forecast is more favorable.</p> <p>Type 4 “adult form” manifests itself at the age from 10 to 20 or from 20 to 30 years and has a favorable outlook.</p> <p>The main causes of respiratory failure in patients with neuromuscular diseases are weakness of the respiratory muscles, unproductive cough and sleep disturbances. The weakness of the respiratory muscles, defined as the inability of resting respiratory muscles in the state of rest to create a normal level of pressure and air flow velocity when entering and exhaling, is common. Patients with neuromuscular diseases are susceptible to sleep disruption, especially in the REM sleep phase, with the most frequent form of this disorder being hypoventilation. Over time, hypoventilation in a dream can become more prolonged, resulting in the development of a severe form of hypoxia, an increase in the level of carbon dioxide in the blood and the suppression of the activity of the respiratory center. Thus, as a result of the review of literary data, a strategy of respiratory support in patients with CMA was proposed.</p> V. Yu. Artemenko, E. V. Plotna ##submission.copyrightStatement## Wed, 16 May 2018 00:00:00 +0300 Influence of immunological nutrition on treatment of patients with oncological profile <p>In the reviewed article, we consider epidemiological and laboratory data that confirm the protective effects of biologically active nutrients in our diet for various diseases. Along with various factors such as alcohol, smoking, nutrition plays a vital role in influencing the patient’s immune response by transforming cells or by preventing, or acceleration of malignancy. Many data suggest that immunoactive nutrients control inflammatory and precancerous reactions in immune cells. Immunoprophylaxis is usually associated with modulation of the immune response when inflamed, thereby improving clinical outcomes. Different nutrients, including glutamine, arginine, vitamins, minerals and long-chain fatty acids, are important components of immunological nutrition. Clinical studies associated with these substances show different results with minimal effect. However, some studies have shown that these nutrients may have immunomodulatory effects that can reduce the risk of developing cancer. Pre-clinical studies claim that most of these nutrients have a positive effect in the complex treatment of cancer patients. In this article, we will consider the effect of the above nutrients on the immune system in patients of oncologic profile.</p> <p>Recent evidences suggest that immunological nutrition plays an important role in the development of cancer and its progression. Data from animal studies have clearly shown that the use of immunomodulatory nutrients isolated from food, by launching a cascade of immunological reactions, can detect and eliminate the tumor. Although the technology has evolved to such an extent that we can study each individual cytokine or function of the immune cell, it is difficult to demonstrate the powerful role of the immune system in preventing or treating cancer due to the complexity of the tumor cell or heterogeneity in different patients' populations. However, the study sheds light on interactions in immune responses and cancer development, prevention and therapeutic strategies that involve modulation through biologically active agents.</p> M. O. Katrichenko, I. I. Lisnyi ##submission.copyrightStatement## Wed, 16 May 2018 00:00:00 +0300 Propofol in modern multicomponent general anesthesia <p>This article examines the use of propofrol in the perioperative period. It is known that one of the main principles of modern anesthesiology is to ensure maximum safety of the patient during and after anesthesia. As the knowledge about the mechanisms of pain and anesthesia increases, the development and improvement of methods of general anesthesia continues. General anesthesia should provide rapid and pleasant induction, predictable loss of consciousness, stability of vital functions, minimal side effects, rapid and smooth recovery of protective reflexes and psychomotor functions. In connection with the introduction of new anesthetics with improved properties, a discussion continues in the publications about the choosing of the hypnotic component of general anesthesia.</p> <p>Thus, the article stipulates that the use of propofol in daily practice of an anesthesiologist improves the quality of anesthetic care in general and increases the safety of patients.</p> <p>When propofol is used, where medium fatty chain triglycerides (MST) and long chain triglycerides (LST) are used as the fat emulsion solvent, pain manifestations upon administration of the drug are reduced, that is valuable for comfortable anesthesia. Propofol LCT/MST has a lesser effect on blood lipid levels in liver transplantation, it helps to reduce the incidence of thrombophlebitis after administration and to reduce the negative effect on lipid metabolism in patients with a severe initial disturbance (despite the relatively small amounts of fat emulsion administered during anesthesia). The significance of this factor increases with the duration of anesthesia.</p> E. Yu. Sorokina ##submission.copyrightStatement## Wed, 16 May 2018 00:00:00 +0300 Effect of L-arginine on the resolution rate of postoperative ileus in patients with urgent abdominal pathology <p><strong>Background.</strong> Postoperative ileus is widespread in the postoperative period and occurs not only after extended operations on the abdominal cavity, retroperitoneal cavity, but also after minor surgical interventions, including laparoscopic operations [1, 2]. The aim of this study is to increase the effectiveness of intensive care after urgent abdominal surgeries by developing a drug correction for bowel motility disorders based on studying of the motor and evacuator function of the gastrointestinal tract, inflammatory markers, hemodynamic parameters and electrolyte blood composition.</p> <p><strong>Materials and methods.</strong> 51 patients were examined, who underwent urgent surgical interventions with laparotomy access for infringed hernias, acute intestinal obstruction, perforation of duodenal ulcers. Depending on the variant of drug correction of postoperative intestinal motility disorder, patients were divided into 2 groups. The first (control) group (n = 27). In the postoperative period, the pharmacological correction of the motor-evacuator function of the gastrointestinal tract was performed by combining a solution of 0,5% metoclopramide and neostigmine bromide. The second (main) group (n = 24). In the postoperative period, the pharmacological correction of the motor-evacuator function of the gastrointestinal tract was performed by combining 0.5% metoclopramide solution and L-arginine (Tivortin, Yuriya-Farm, Ukraine). Motorevacuation disorders of the gastrointestinal tract (the frequency of development of bloating, nausea, vomiting, delay in the escape of gases, an independent moving of gases, measurement of intra-abdominal pressure), parameters of hemodynamics, the level of systolic, diastolic, mean arterial pressure, cardiac index, stroke volume, total peripheral vascular resistance, heart rate, minute volume of blood circulation and left ventricular power, markers of inflammation (leukocyte count, fibrinogen, IL-lα, TNFα, IL-10, calculation of leukocyte intoxication index, the study of electrolytes of blood serum (Na+, K+, Ca2+, Cl- ) were studied before and after 1st, 3rd and 7th days after the operation.</p> <p><strong>Results.</strong> The use of L-arginine leads to a decrease in the phenomena of peripheral vasospasm, which, improving the microcirculation of the intestinal wall leads to a faster recovery of the motor-evacuation function of the gastrointestinal tract. With standard prokinetic therapy (combination of metoclopramide with neostigmine bromide), the number of patients with elevated intra-abdominal pressure increases in 92,1%, оn the second day after surgery, the number of patients with elevated intra-abdominal pressure exceeds the norm in 100%. The resumption of intestinal motility 3 days after the operation is accompanied by the normalization of intra-abdominal pressure in 55% of patients. Against the backdrop of the use of L-arginine with metoclopramide on day 1 after the operation, the number of patients with an increase in intra-abdominal pressure does not exceed 50%. 37,5% of them have elevated intra-abdominal pressure, 8,3% have abdominal hypertension of the 1st degree. On the second day of the observation, intraabdominal pressure in 41,7% patients normalized, abdominal hypertension of 1 degree was noted in 16,7%. of them. On the 3rd day after surgery, intra-abdominal pressure corresponded to the norm in 79,2% of patients, abdominal hypertension of 1st degree was registered in 8,3% of patients.</p> <p><strong>Сonclusions.</strong> The use of a combination of metoclopramide with L-arginine reduces the stress on the myocardium, activates - anti-inflammatory link of the cytokine system, accelerates the normalization of intra-abdominal pressure, increases the rate of self-evacuation, independent defecation, and reduces the patients’ stay in the intensive care, which makes it possible to recommend it as the most optimal remedy for resuming motor activity intestines after urgent operations in abdominal surgery.</p> L. V. Novitskaya-Usenko, O. N. Kligunenko, S. G. Dyomin, O. V. Zaharchuk, A. I. Lavrova ##submission.copyrightStatement## Wed, 16 May 2018 00:00:00 +0300 Intensive therapy in patients with scar strictures of the esophagus <p>The proposed medical tactics and intensive therapy of scar strictures of the esophagus we represent in this article. The causes of their occurrence: burns in the esophagus, surgical interventions on the esophagus, reflux esophagitis, and malignant genesis – esophageal cancer. A considerable part of patients with scar strictures of the esophagus is hospitalized at later stages of the stricture: with 4th and 5th degrees of obstruction. This leads to increasing of the number of exhausted patients and neglected cases, that contributes to increasing of levels of postoperative lethality and complications.</p> <p>The sults of surgical treatment of 116 patients with esophageal strictures at the period of 2003–2017 were analyzed. We used a logistic regression method to determine the risk factors for postoperative complications. It was established that the risk increases significantly with the presence of technical difficulties during operation, diabetes mellitus, blood plasma albumin levels less than 25 g/l, complete obstruction of the esophagus. The proposed program of treatment of patients with scar strictures of the esophagus reliably reduces the risk of postoperative complications. The diagnostic algorithm, the program of treatment of patients with preoperative infusion therapy and parenteral nutrition with “all in one” system were applied in patients of the main group. Due to the treatment program and intensive therapy, the number of postoperative complications has decreased from 27,27% to 12,0%, and mortality – from 6,06% to 2,0%.</p> V. O. Shaprynskyi, Y. V. Shaprynskyi, V. F. Kryvetskyi, Mustafa Bassam Hussein ##submission.copyrightStatement## Wed, 16 May 2018 00:00:00 +0300 Practical aspects of use of emergency sonography for differential diagnosis of critical respiratory incidents (Blue-protocol “Bedside Lung Ultrasound in Emergency”) <p>This article contains rather motivating than teaching information. It is a synthesis of analysis of authoritative global scientific publications and personal experience. The modern approaches to diagnosis of critical respiratory incidents using ultrasound, superficial theoretical review of the core of the method and our own experiences regarding effective protocol of sonographic lung assessment are presented here. Several interesting clinical cases emphasize the advantages of routine use of diagnostic ultrasound in patients with critical uncompensated respiratory disaster as well as in sub-compensated and compensated patients.</p> <p>The main principles of bedside lung ultrasound in emergency that should encourage wider implementation and use of this method by doctors of different specialties are: “Lung ultrasound is very easy to perform using simple equipment”, and “BLUE-protocol is a simple protocol that allows quick (&lt; 3 min) diagnosis of the cause of respiratory failure”.</p> <p>Lung sonographic assessment allows not only to determine quickly the cause of critical respiratory failure and counteract it starting the etiotropic treatment as soon as possible, but also visualize the dynamics of pathological changes in response to therapy, thus allowing us to evaluate its effectiveness properly.</p> <p>The use of ultrasound in diagnosing enables more adequate decision making regarding the need of interventional therapy. It also leads to setting the right diagnosis faster, improving the quality of medical care, shortening the length of stay of patients in ICU, decreasing the total cost of the treatment.</p> <p>Identification and analysis of the amount of sonographic signs “B-lines – lung rockets” provides an opportunity to measure the volume/amount of interstitial lung fluid properly and track this marker/indicator in dynamics in response to the treatment.</p> <p>The unified method of protocolized assessment should be used within one medical facility in order to boost effectiveness and make evaluation and dynamic evaluation of pathological changes more objective by the same one or different medical specialists.</p> <p>Diagnostic ultrasound has a very low cost and there is no radiation exposure to patients which allows performing as many examinations as needed, without limitations.</p> O. O. Valenko, O. O. Volkov, A. S. Bessarab ##submission.copyrightStatement## Wed, 16 May 2018 00:00:00 +0300 A case of multiple spontaneous hepatic ruptures and literature review <p>Liver rupture most commonly occurs because of a blunt abdominal trauma. We present a case of peliosis hepatis in a postpartum patient who developed hemoperitoneum due to spontaneous hepatic rupture from this rare liver condition. Physicians should be aware of this rare condition in patients with non-traumatic liver rupture and with hemoperitoneum. Peliosis hepatis is most often asymptomatic and incidentally found during autopsy. It comes to the surgeon’s attention just after the spontaneous rupture of the lesion, resulting in a massive hemoperitoneum. Peliosis hepatis should always be considered in the differential diagnosis of sudden intraperitoneal hemorrhage, especially when the cause of hepatic rupture is unknown.</p> N. V. Tytarenko, O. V. Sergiychuk ##submission.copyrightStatement## Wed, 16 May 2018 00:00:00 +0300 An anesthesiologist’s view of problems in HIV-positive patients <p>Currently, HIV infection is becoming epidemic. More than 42% of HIV-infected people in the world are women of childbearing age. With the onset of antiretroviral therapy, chemoprophylaxis during pregnancy, and planned cesarean section, the risk of perinatal HIV transmission decreases to 1–2%. However, various side effects such as anemia, neutropenia, thrombocytopenia, fatty liver dystrophy, toxic hepatitis, acute pancreatitis, increased serum transaminases, changes in biochemical parameters of liver function, impaired glucose tolerance, and hypocoagulation may occur in the context of antiretroviral therapy. This poses to the anesthesiologist a number of new tasks to ensure patient safety during the perioperative period.</p> E. V. Grigimalsky, A. I. Garga, A. V. Tarasov, I. N. Dovgiy, N. N. Budnyk ##submission.copyrightStatement## Wed, 16 May 2018 00:00:00 +0300 Mathematical modeling for prediction of complicated acute appendicitis in children <p>Endogenous intoxication, which accompanies the complicated course of acute appendicitis in children, is one of the serious conditions, which are the main cause of complications in the postoperative period. Diverse clinical observations done by clinicians suggest that despite the use of modern technologies in operating equipment, anesthetic support, the number of complications in the postoperative period has no tendency to decrease, and the main cause of lethal outcomes with appendicular peritonitis is lightning development of severe degree of endotoxicosis, which develops as a result of resorbing toxic substances formed of many components, including pathogenic microflora and destruction metabolism.</p> <p><strong>Purpose.</strong> Creation of a mathematical model for prediction of complicated acute appendicitis in children using the functions of regression analysis of EXCEL spreadsheet by approximating experimental data.</p> <p><strong>Materials and methods.</strong> In the work, there is information about 59 patients with acute appendicitis treated at the clinic of pediatric surgery at the National Pirogov Memorial Medical University. The data on patients were divided into two groups: patients with not complicated course of pathology – 24 patients, and patients with complicated course of acute appendicitis – 35 children. The control group served the data of 37 healthy children. In each of the three groups, the following parameters were studied: gender, age, bed day, duration of the disease, presence of symptoms of peritoneal irritation, the nature of exudate in the abdominal cavity, the number of red blood cells, hemoglobin, leukocytosis, quantitative characteristics of white blood formula, ESR, cellogenic endogenous intoxication: leukocyte index of intoxication and hematological index of intoxication. All the data were determined directly at the time of hospitalization of a patient to the hospital.</p> <p><strong>Results. Discussion.</strong> Based on multiple correlation x = f (x1 , x2 ) a two-factor mathematical model of probability of the complicated course of acute appendicitis in children was created. According to the obtained results of the study of the system of three equations with three unknowns, it was established that if the indicator of the form of the disease is y = 2.67 and above, when, in numerical terms, the result falls into the zone of complicated flow of acute appendicitis and completely coincides with data analysis of the three groups of patients.</p> <p><strong>Conclusions.</strong> The components that determine the uncomplicated course of acute appendicitis in children, according to the developed two-factor model, include LII and GPI, which exceed the values intoxication of certain intervals studied at the time of hospitalization. The analyzed indices were determined by the degree of severity of the pathological process, duration of disease, virulence of microflora and age of patients against the background of the formed endogenous intoxication syndrome.</p> V. S. Konoplitsky, V. V. Motygin, A. G. Yakimenko, D. V. Dmytriiev, T. I. Mikhalchuk ##submission.copyrightStatement## Wed, 16 May 2018 00:00:00 +0300