Method for correcting anesthetic therapy

FIELD: medicine, anesthesiology, intensive therapy, surgery.

SUBSTANCE: the present innovation is suggested to correct anesthetic therapy in postoperational period. One should apply a modified visual-analog scale of pain on which patient should mark independently his (her) pain feelings by fixing them on vertical sections of the above-mentioned scale of pain every 2 h during the day, then doctor should plot an algogram of daily fluctuations of patient's pain feelings to analyze them for estimating the strength of pain feelings and adequacy of analgetic therapy conducted; and by taking into account the data obtained to conduct correction anesthetic program next day. The present innovation enables to adequately evaluate patient's pain feelings in postoperational period for subsequent performing adequate preventive analgetic therapy of pain syndrome, that, in its turn, enables to prevent pathological postoperational syndromocomplex.

EFFECT: higher efficiency of correction.

2 cl, 3 dwg, 1 ex

 

The invention relates to medicine, namely to anesthesiology, intensive care and surgery, i.e. when it is necessary to evaluate the intensity of pain activity after surgery.

The relevance of this method lies in the fact that inadequate assessment of pain patients may lead to inadequate postoperative analgesia. It is known that from 33 to 75% of patients complain of moderate to severe pain in the postoperative period (Ferrante P.M., VadeBoncouer T.R. 1998). Foreign multicenter studies have determined the status of postoperative pain relief catastrophic, because the adequacy of analgesia, subjective assessments of patients did not exceed 50% (Owen H., McMillan V. and D. Rogowski Postoperative pain therapy: a survey of patients' expectations and their experiences. // Pain. - 1990. - V.41. - P.303-309).

Over the last decade marked a steady increase in the frequency of complex extended and simultaneous operations, in particular, on the organs of abdominal cavity. Most of the patients who have undergone surgery, have expressed comorbidities from internal organs. This requires special anesthesiology-resuscitation approach to the management of these patients, including assessing the adequacy of relief of pain component in the postoperative period.

You know, QTableView feelings are at the root of the development of postoperative pathological complex of syndromes. Acute pain increases the rigidity of the muscles of the anterior abdominal wall and chest, leading to decreased tidal volume, vital capacity, functional residual capacity and alveolar ventilation. The consequence is the collapse of the alveoli, hypoxemia and decreased oxygenation of the blood (Liu S, Carpenter R, Neal J. Epidural anesthesia and analgesia. Their role in postoperative outcome. // Anesthesiology. 1995. - V.82. - P.1474-1506). The difficulty of clearing amid pain syndrome violates the evacuation of bronchial secretion, which contributes to the development of pulmonary infection.

The pain is accompanied by hyperactivity of the sympathetic nervous system, causing tachycardia, hypertension, and increased peripheral vascular resistance. Sympathetic activation also causes post-operative hypercoagulation and increases the risk of blood clots. Against this background, in patients with a high likelihood of a sharp increase in the demand of oxygen with the development of acute myocardial infarction (Breivik H. Postoperative pain management. // Bailliere''s Clinical Anaesthesiology. -1995. - V.9. - P.403-585).

Activation of the autonomic nervous system on the background of the pain syndrome reduces peristaltic activity and may cause postoperative paresis.

Intense pain is one of the factors the implementation of the catabolic hormonal response to injury: the water retention and sodium increase before the AI ADH and aldosterone, and hyperglycemia due to hypersecretion of cortisol and adrenaline (Kehlet h, Dahl JB Postoperative pain. // World J.Surg. 1993. V.17. P.215-219), increases negative nitrogen due to inactivity, lack of appetite and disrupt the normal power mode; deterioration of immune status and increased frequency of septic complications of inadequate relief of postoperative pain, especially in patients at high risk (Yeagcr M, Glass D, Neff R, Brick Johnsen f. Epidural anaesthesia and analgesia in high risk surgical patjents. // Anesthesiology. - 1988. - V.73. - P.729-736).

The result of inadequate pain relief is the formation of chronic postoperative neuropathic pain syndromes (Kalso E, Perttunen K, Kaasinen S. Pain after thoracic surgery. // Acta Anaesth. Scand. 1992. V.36. P.96-100).

By definition of the American organization for the study of pain (IASP Pain Terminology) pain is an unpleasant sensory or emotional experience that occurs during or with the threat of tissue damage, or described in terms of such damage. Note: Pain is always subjective. Each person perceives and applies this word through their own individual experience with injuries, previous (Classification of Chronic Pain, Second Edition, IASP Task Force on Taxonomy, edited by H. Merskey and N. Bogduk, IASP Press, Seattle, © 1994, pp. 209-214).

Thus, the complexity of the problem in the assessment of pain is that there is no exact physiological Il the clinical signs for measuring pain. The ideal tool for measuring pain should be assessed as its very presence, and dynamics over time (But Kendall; Julie Spence; Murphy Michael F..Review of pain measurement tools. Ann. Emergency Med. 1996. No. 4. S-432).

Pain is a subjective sensation, depending on the individual threshold of comprehension. Pain is a multidimensional phenomenon, including nociception, the feeling, the experience of pain and pain behavior (Hunfeld J.A.M.; Passchier J. Pain and assessment of pain in children. Eng. the honey. W. 1997 No. 7. S-424).

The severity of pain can be assessed subjectively by the patients in mind. There are no adequate methods for assessing the severity of the pain other people in patients with loss of consciousness (Memran N.; Steib, A.; Esteve, M.; Servin F.; Vulser C.; C. Lassalle; Pipien I.; Cousin M.T. Prise en charge de la douleur postoperatoire chez le sujet age. Sem. hop. Paris. 1998. P.700-708. Vol.15-16). Nociceptive impulses, regardless of their power, to become a pain then, and only then, when the Central nervous system upon receipt of this information recognizes it as "the way of pain" (O.V. Petrov et al. Information theory of pain. 2nd Congress of biophysicists Russia, M., 23-27 Aug., 1999. M., 1999. So 2, page 436). More subtle mechanisms for the assessment and control of pain can be correlated with the subjective evaluation of pain. (Danilov A.B.; Danilov ALB; Wayne A. M. Nociceptive flexor reflex: a method of studying brain mechanisms of pain control. J. neurol. and psychiatry. 1996. No. 1. S-111).

Traces of the tion, development and study of methods of measuring pain, her strength, the time span of subjective visual analogue methods is an important issue for modern anesthesiology, intensive care, surgery and other related specialties involved in the treatment and management of postoperative patients.

One of the analogs of the present invention is the method described in the source Fedorov VV, et al: Evaluation of discomfort and pain after laparoscopic surgery. Mater. VI international. proc. surgeon.-gepatol. CIS "current. Probl. chirurgic. gepatol.", Kiev, 4-6 Nov., 1998. The annals of the surgeon, gepatol. 1998. No. 3. S, in which patients who had, in particular, laparoscopic surgery was offered with the help of a questionnaire to assess their condition after surgery on a 5-point system in fixed hours after the operation.

Using this method allows patients to subjectively assess their pain after the operation.

However, the above method only captures the pain of patients after surgery, but does not provide the appropriate correction of analgesic therapy.

Also known another method in which the effectiveness of treatment and the intensity of the pain syndrome was determined by the verbal scale of ratings: 0 - no pain, 1 - slight pain, 2 - moderate, 3 - severe, 4 - very well what ü strong (G.A. Novikov and other Chronic pain and quality of life of cancer patients. Grew up with. the honey. log. 1997. No. 2, p.32-36).

The use of this method is limited only verbal rating pain patients undergoing surgery for cancer.

Closest to the claimed method is similar, taken as a prototype, described in the source Michael Ferrante. Postoperative pain. TRANS. with ang. M.: Medicine, 1998, page 119. This source using the visual analogue scale of pain, which is a straight line length 10 cm, the ends of which correspond to extreme degrees of intensity of pain ("no pain" on one end, "unbearable pain" at the other), (see figure 1).

This prototype was not possible to assess pain in a long time and is a criterion only for the moment; not allows users to build a graphic image dynamics painful activity for the day, which, in turn, complicates the assessment of pain, and to build a program of adequate postoperative analgesia, which can prevent, rather than cure the pain.

The aim of the present invention is an adequate assessment of pain on a visual analogue method in patients after surgery.

Technical result is and who directed the present invention, is an adequate assessment of the patient's pain visual ananlogue method in posleoperatsionnom period to conduct adequate preventive therapy pain syndrome.

To achieve the stated technical result we have developed a modified visual analogue scale (MVAS) (see figure 2), on which the patient says their pain at this point in time, every two hours, which he fixes at vertical intervals of pre-prepared forms MWESB. These mark the patient marks on the vertical sections of the form MWESB in the form of points, corresponding, in his view, the intensity of pain, considering that the beginning of the segment, i.e. the lower part indicates the absence of pain (absolute or “0” in pain), and the end of the segment, i.e. the upper portion - maximum pain (or unbearable pain). At night the patient describes his experience during waking hours. This analysis of pain should be performed within seven days after the operation.

Based on these grades, the doctor draw echogram, i.e. a curve of the intensity of pain (CIB), which is a graphical representation of the patient's pain over the past day and shows the adequacy or inadequacy of ongoing analgesic therapy during this period.

On the basis of allogamy correction of analgesic therapy. Which consists in the substitution of one analgesic to another, or in combination analgesics, or increase the dose of the drug or increasing multiplicity of an administered drug, or for additional analgesia by other means, such as regional methods of pain relief.

Implementation of the proposed method is illustrated by the following clinical examples.

Example 1. Patient K., aged 63, weight 75 kg, was admitted to the SE SSC of Coloproctology with the diagnosis of Cancer nizhneamudarinskogo division of the rectum with the transition to the anal canal T3The N”, which was performed abdomino-perineal extirpation of the rectum with the formation of smooth muscle cuff, pelvic colonic reservoir with taking them in the cavity of the pelvis, extended orthopadische-pelvic and lateral lymphadenectomy.

After surgery the patient is routinely enrolled in an intensive care unit (PETE), where he was held obezbolivaushee therapy in the form of morphine 1% - 2.0 V/m according to testimony.

The next (2nd) day after the operation the patient was asked to mark their pain on a scale MWESB according creatures of the claimed method. Analgesic therapy was assigned to the patient in the form/m injection PR is medola 1% - 2,0 scheme: 12-18-24-6 hours.

On the basis of the data obtained in the past 2 day's doctor was drawn algoritma or CIB, from which it followed that the patient was experiencing maximum pain during the period from 13 h to 24 h, therefore, held obezbolivaushee therapy was inadequate in this period (see figs). In this period, the ward doctor was appointed an additional Ketorolac dose of 2.0 ml/m in 18 h and 20 h On the basis of the analysis of allogamy received for the second day, that pain in this period of time demanded strengthening schemes analgesic therapy introduction Ketorolac, which was considered in the drafting of the programme of analgesia for 3-day postoperative period.

On the 3rd day after the operation the patient was also asked to mark their pain on a scale MWESB according creatures of the claimed method, and then was drawn KIB (see figb). Analgesic therapy was assigned to the patient, taking into account changes in CIB for the 2nd day in the form of I/m injection of morphine 1% - 2,0 scheme: 12-18-24-6 hours, at 13 : 00 and 21-00 was appointed as an additional injection of Ketorolac 2.0 ml/m On the basis of analysis of the CIB for the past 3 days it is seen that most algogennah period was less pronounced intensity, which gave occasion to store the schema for pain on the 4th day that PAC is UNT moved smoothly - without obvious pain. This fact gave the opportunity to carry out correction circuit anesthesia for 5-th day.

On the 5th day after the operation the patient was also asked to mark their pain on a scale MWESB according creatures of the claimed method, and then was drawn KIB (see figv). Analgesic therapy was assigned to the patient, taking into account changes in CIB for the 3rd day and the nature of the subjective sensations of the 4th day. And was presented in the form of I/m injection of morphine 1% - 2,0 scheme at 18 : 00 and 24-00, while at 12.00 and 6-00 injection of morphine has been replaced by the injection of Ketorolac 2.0 ml/m On the basis of allogamy for the 5th day there is an increase in pain during the period from 15.00 to 17.00, and therefore the ward doctor in this period there was an additional injection baralgina 5.0 ml/m, which was controlled adequately strengthening pain component. On the sixth day the scheme of the fifth postoperative day, it was decided to keep that provided adequate analgesic support for the patient.

On the 7th day after the operation the patient was also asked to mark their pain on a scale MWESB according creatures of the claimed method and drew KIB (see Figg). Analgesic therapy was assigned to the patient, taking into account changes in CIB for the previous days and was presented in the form/m injection only To the of torraca 2.0 ml/m in the diagram at 10 : 00, 17-00, 24-00. Assessment CIB on the seventh day showed that pain is virtually unpleasant subjective sensations of the patient, and therefore therapy proposed to continue the same dose and the same ratio until complete relief of pain.

Thus, the claimed method allows to adequately assess pain in patients in the postoperative period and to adjust analgesic therapy so that the patient did not experience intense discomfort associated with painful sensations. In this case, correction of ongoing analgesic therapy makes it possible to avoid increasing the narcotic potential of the postoperative period, i.e. to reduce the dose, frequency narcotic analgesics, to expand the indications for use of non-narcotic analgesics; to expand the indications for use of regional methods of anesthesia and other official methods aimed at the relief of pain in the postoperative period. This method allows also to reduce the number of postoperative complications related to the problem of inadequate pain management in the postoperative period.

The claimed method can be recommended for an adequate assessment of pain in clinical practice.

1. The correction method of analgesic therapy in patients in the first days after the operator the main intervention, includes assessment of pain using a visual analogue scale of pain, characterized in that use a modified visual analogue scale of pain, consisting of a horizontal straight line segment to which the restored vertical segments of straight lines at equal intervals corresponding to 2 hours; the patient says their pain, locking them into the vertical intervals of the scale for every 2 h during the day, then the doctor draws echogram daily fluctuations of the patient's pain; conducts their analysis in terms of strength, pain and the adequacy of ongoing analgesic therapy and taking into account the received data is used for the correction program of pain the next day.

2. The method according to claim 1, characterized in that at night the patient fixes his pain only during wakefulness.

3. The method according to claim 1, characterized in that echogram draw for the next seven days after the operation.



 

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FIELD: medicine, anesthesiology, intensive therapy, surgery.

SUBSTANCE: the present innovation is suggested to correct anesthetic therapy in postoperational period. One should apply a modified visual-analog scale of pain on which patient should mark independently his (her) pain feelings by fixing them on vertical sections of the above-mentioned scale of pain every 2 h during the day, then doctor should plot an algogram of daily fluctuations of patient's pain feelings to analyze them for estimating the strength of pain feelings and adequacy of analgetic therapy conducted; and by taking into account the data obtained to conduct correction anesthetic program next day. The present innovation enables to adequately evaluate patient's pain feelings in postoperational period for subsequent performing adequate preventive analgetic therapy of pain syndrome, that, in its turn, enables to prevent pathological postoperational syndromocomplex.

EFFECT: higher efficiency of correction.

2 cl, 3 dwg, 1 ex

FIELD: medicine, thoracic surgery, anesthesiology.

SUBSTANCE: as non-narcotic medicinal preparation one should apply heparin to be introduced intratracheally at the dosage of 300-500 IU/kg, moreover, heparin should be introduced during the first 30 min after the operation is over. The present innovation enables to create prolonged anesthetizing effect in combination with prophylaxis of postoperational thrombohemorrhagic complications due to heparin capacity to be kept in the body due to its accumulation by mast cells at blockade of their fermentative activity followed by its gradual release into the blood.

EFFECT: higher efficiency.

1 cl, 1 ex, 3 tbl

FIELD: medicine; physiotherapy.

SUBSTANCE: device can be used for treating osteochondrosis, muscular injuries and other diseases. Device for anesthetization during sleep has contact detectors connected with current pulse sequence oscillator, which is connected with control unit. Device additionally has band-pass amplifier, square detector and integrator. Control input of control unit is connected with output of comparator which has output connected with output of band-pass amplifier through integrator and square detector. Band-pass filter is adjusted to frequency of alpha rhythm of brain's potentials. Input of band-pass amplifier is connected with devices for receiving those potentials. Physiotherapeutic devices are turned on under influence of alpha rhythms of brain on the threshold of awakening.

EFFECT: improved efficiency of influence due to automatic switching-on.

1 dwg

FIELD: medicine, fitotherapy.

SUBSTANCE: claimed method includes administering of medicative herb powder for 5 days daily from 11 o'clock with 2 h interval. The first composition contains horsetail sprouts, hawthorn flours or fruits, bluebottle, chicory, cowberry leaves, green tea leaves, elecampane, tutsan, hyssop roots and/or leaves, and/or inflorescence. The second composition contains cranberry leaves, nettle leaves, maize stigma, burdock roots, coltstoof leaves and rootstocks, carrot seeds, blowball leaves and inflorescence. The third composition contains buckthorn, parsley, tansy flowers, goosegrass leaves. The forth composition contains sagebrash, motherwort, camomile, milfoil grass, senna leaves. The fifth composition contains milfoil grass, senna leaves, blueberry leaves, cinnamon rose fruits. Then 50-100 g of oily balsam prepared g of refined vegetable oil and 14 g of power of 5 plant composition is administered. In evening of fifth day mixture from juice of 3 lemons, 5 grapefruits, 2 oranges and garlic head, glass of squash cranberry and parsley is diluted with silica water up to 3 l, filtered and administered during the sixth day in amount of 100 g after 30 min. During 7th and 8th days flax seed tea is administered 9-10 times in amount of 100 g after 30 min.

EFFECT: improved method for body healing.

8 cl, 5 ex, 1 tbl

FIELD: medicine.

SUBSTANCE: method involves determining functional organism state on basis of pulse and acupuncture diagnosing data. Patient takes tranquilizers, antidepressants, neuroleptics, homeopathic drugs of sedative and spasmolytic activity. Autotraining, rational, hyposuggestive, family and sexual psychotherapy treatment is applied. Superficial multi-needle acupuncture, transcutaneous electric neurostimulation, point- and deep massage is applied to cervical collar zone, back, lumbosacral and gluteal zone alternated with deep abdominal massage and point massage of anterior chest wall. Scalp is massaged. Acupuncture, heat- and infrared light puncture is applied to auricular and corporal points. Point set selection depends on headache localization. Gallbladder, small intestine, urinary bladder, pancreas, stomach, large intestine, triple heater meridians, anterior and posterior middle meridians. Color and music therapy is applied.

EFFECT: enhanced effectiveness of treatment.

FIELD: medicine.

SUBSTANCE: invention refers to medicine, specifically to vertebrology and can be applied within complex therapy of severe compressive-vascular syndromes of vertebral column. It provides complete muscular relaxation of whole body by eans of intravenous anaesthesia, prescribed depending on the way patient feels, his age and clinical state - sodium hyopental or seduxen, or calipsol, or gamma hydroxy-butanoic acid. After loss of consciousness and complete relaxation, concerned vertebral parts are single-step corrected by single-step traction-pulse action on vertebral column followed by temporary fixation of concerned parts. After pain syndrome is lowered or decreased within one day after manipulation magnet-laser-light therapy is applied. Method provides sparing and safe effect on vertebral column owing to ideal relaxation of whole muscular system that makes it possible to perform single-step correction of all the vertebral parts at multisystem and combined injuries of vertebral-motor segment, reduction of treatment period, removal of pain dominant and reflex pathologic statico-dinamic stereotype in central nervous system and cerebral cortex.

EFFECT: sparing and safe effect on vertebral column, reduction of treatment period.

3 cl, 1 ex

FIELD: medicine; psychiatry.

SUBSTANCE: tranquilizers, antidepressants, homeopathic agents of sedative and antidepressant action. Autogenic training, rational, hypnosuggestive family and sexual psychotherapy are applied. Surface multi-needle acupuncture, transdermal electric stimulation of nerves, pressure point and deep massage of cervicocollar area, back, lumbosacral and gluteal region, abdomen and anterior chest are applied. Acupuncture, thermal and infrared light puncture to auricular and corporeal median points of heart, lungs, pericardium, liver, pancreatic gland, small and large intestine, triple heater, gallbladder, anterior and posterior median meridians is performed considering modifications detected by pulse and acupuncture diagnostics. Corporeal points are magnet laser punctured. Colour and musical therapy are applied.

EFFECT: reduced therapy time and prolonged remission.

2 ex

FIELD: medicine.

SUBSTANCE: invention relates to psychiatry. At the beginning of session rational non-directive psychotherapeutical action is performed. Then main and additional corporal and auricular biologically active points (BAP) are subjected to exposure to extremely-high-frequency electromagnetic radiation of non-heat intensity (EHF-radiation). Further resonance therapy is carried out by recording information from BAP on irradiator, which represents Gann diode, switched to EHF-therapy apparatus, which after that is fixed on BAP P1. Duration of one treatment session is 60-90 minutes; course of treatment consists of 3-7 sessions.

EFFECT: increase of duration of remission when treating dependence on negative factors.

5 ex, 5 cl

FIELD: medicine.

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SUBSTANCE: invention concerns medicine, particularly surgical ophthalmology, and can be applied in anesthetic support of scleroplasty operation for 9 to 14 years old children. Method involves administration of local anesthetic immediately before operation by triple instilling of visityl and alcaine mix in 1:1 ratio over 5 minutes to the eye to be under surgery. Mix of 0.5% seduxen solution and fentanyl solution mix is injected intravenously during surgical intervention. Each drug in the mix is taken in half amount of calculated dosage corresponding to age and weight of patient.

EFFECT: adequate anesthesia and sedation without loss of consciousness during surgical intervention, prolonged post-operation anesthesia due pre-operation administration of visityl and alcaine mix at definite ratio.

2 tbl

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