Agent for removing post-narcosis depression

FIELD: medicine, pharmacy.

SUBSTANCE: invention proposes an agent for removing the post-narcosis depression after combined anesthetic assistances with applying sedative and narcotic preparations. As such agent the preparation "Reamberin" is used based on succinic acid that is a natural metabolite in human body. The preparation provides reducing time for adequate spontaneous breathing and awaking time by 1.5-fold and the absence of complications and negative adverse responses.

EFFECT: valuable properties of agent.

4 dwg, 3 ex

 

The present invention relates to medicine, namely pediatric anesthesiology and intensive care, and is intended for use in intensive care, anesthesiology, surgery, interventional radiology diagnostic and treatment centers.

It is known that to eliminate anesthesia depression caused by opioid analgesics, is used naloxone (Morgan Jedward - ml, Maged S. Mikhail's Clinical anesthesiology. M "Binom", SPb. Nevsky dialect", I. 1, 1998, str-269).

It is also known that in order to eliminate the aftereffects of the drugs of the benzodiazepine series is used ANEXT (Molchanov I. Rational use of benzodiazepines and their antagonist of flumazenil (anexate) in anesthesia practice //journal of intensive care, collection "Actual issues of General anesthesia and sedation", 1998, p.23-25).

However, the known methods are extremely narrow (naloxone when using opioid analgesics, ANEXT when using benzodiazepines), which makes their application difficult. Moreover, these funds are inaccessible due to their relative high cost.

The aim of the invention is a means for removal of post anesthesia depression, devoid of the aforementioned drawbacks.

This goal is achieved by the fact that as a means to reduce the Oia anesthesia depression drug use "Reamberin".

Infusion solution "Reamberin 1,5%" - preparation of domestic production. Intended for use in adults and children as antihypoxic and detoxifying agent in acute intoxications of various etiologies. At its core is succinic acid, which is a natural and important substrate processes of cellular metabolism in the human body. Unlike other drugs used to eliminate anesthesia depression, which are synthetic substances foreign to the body, Reamberin has no side effects, because it is a natural metabolite. In addition, it has a positive effect on all the body's cells (membrane, energosintezirute etc), promotes the formation of high energy compounds (Obolensky SV Reamberin - a new tool for infusion therapy in the practice of medicine critical States; guidelines, s-Petersburg, 2002, p.23).

To remove anesthesia depression medication Reamberin" has not previously been used.

Figure 1 shows the dynamics of cerebral oximetry patient K. figure 2 - graphs of cytochrome C oxidase and regional saturation of the patient K. figure 3 - graphic indicators of cerebral oximetry patient M figure 4 - graphs of cytochrome C oxidase and regional Satur is the patient M

The method is illustrated in the following clinical examples:

Example 1.

A female patient, 14 years of age, medical history, 4187, entered the operating room for performing the transposition of the flexors of the lower leg in the calf muscle.

In the preoperative period according to the data of laboratory and instrumental examinations of violations were found, the state match is satisfactory.

In terms of operating the child was recorded indicators of cerebral oximetry: total hemoglobin, oxyhemoglobin, deoxyhemoglobin, regional saturation, cytochrome C oxidase; electroencephalography; acid-base status; indicators of systemic hemodynamics: heart rate, blood pressure systolic blood pressure diastolic blood pressure mean; time from start of output from anesthesia to Wake evaluated by the following criteria: a conscious speech and movement for infants active motor response, cry, crying, eyes opening; the recovery time is adequate spontaneous breathing after artificial ventilation of the lungs, as measured by course-respiratory carbon dioxide concentration, the respiratory rate and tidal volume.

Conducted combined General anesthesia using fentanyl (6,05 mcg/kg/hour), sibazona (0,29 mg/kg), nimbexa (0,29 mg/kg) with probleemas artificial ventilation of the lungs.

Duration of anesthesia was 85 minutes. Surgery duration 55 minutes.

10 minutes before the end of the operation/in the jet was introduced solution "Reamberin in a dose of 2 ml/kg Again the drug was introduced in the same dose in 10 minutes after the first injection.

According to cerebral oximetry showed a slight increase in blood supply to the brain (increased total hemoglobin), a significant increase in regional saturation in periarticular brain by increasing the fraction of oxyhemoglobin and reduced fraction of deoxyhemoglobin (figure 1 on the x-axis markers marked the introduction of reamberine, y1the levels of total hemoglobin (tHb), oxyhemoglobin (O2b), deoxyhemoglobin (b) are expressed in optical absorption units μMsta-1on the y axis2data regional saturation (RSat), measured in percent). There was an increase of the level of metabolic activity, characterized by reduced levels of the oxidized form of cytochrome C oxidase (figure 2 on the y axis1data regional saturation (RSat), measured in percent on the y axis2indicators of cytochrome C oxidase (Cytaa3) measured in conventional optical units on the x-axis markers marked the introduction of reamberine). Changes electroencephalography was manifested by the increase in summary the th power of wave activity and changes in the wave spectrum, characterized by an increase in the percentage of alpha waves and decrease theta waves.

The estimated hemodynamic parameters did not undergo significant changes. According to the acid-base status was not noted any significant changes.

The recovery time is adequate spontaneous breathing (19 min) and the Wake-up time (22 min) after the first injection of the drug was on average 1.5 times less than in children, which this drug is not administered.

Example 2.

Patient M-a 3 year history 5318, entered the operating room for holding ventriculoarterial bypass.

In the preoperative period according to the data of laboratory and instrumental examinations of violations were found, the condition corresponded to moderate.

In terms of operating the child was recorded indicators of cerebral oximetry: total hemoglobin, oxyhemoglobin, deoxyhemoglobin, regional saturation, cytochrome C oxidase; electroencephalography; acid-base status; indicators of systemic hemodynamics: heart rate, blood pressure systolic blood pressure diastolic blood pressure mean; time from start of output from anesthesia to Wake evaluated by the following criteria: a conscious speech and movement, the babies - active motor response, cry, crying, eyes opening; the recovery time is adequate spontaneous breathing after artificial ventilation of the lungs, as measured by course-respiratory carbon dioxide concentration, respiration rate and tidal volume.

Conducted combined General anesthesia using fentanyl (4,68 mcg/kg/hour), Diprivan (10,8 mg/kg), nimbexa (0.4 mg/kg) with controlled artificial ventilation of the lungs.

Duration of anesthesia was 108 minutes. The duration of 62 minutes.

10 minutes before the end of the operation/in the jet was introduced solution "Reamberin of 1.5%in a dose of 2 ml/kg Again the drug was introduced in the same dose in 10 minutes after the first injection.

According to cerebral oximetry showed a slight increase in blood supply to the brain (increased total hemoglobin), a significant increase in regional saturation in periarticular brain by increasing the fraction of oxyhemoglobin and reduced fraction of deoxyhemoglobin (figure 3 on the x-axis markers marked the introduction of reamberine, y1the levels of total hemoglobin (tHb), oxyhemoglobin (O2b), deoxyhemoglobin (b) are expressed in optical absorption units μMcmA-1on the y axis2data regional saturation (RSat), measure the e in cent). Reducing the oxidized form of cytochrome C oxidase testified to increase the level of metabolic activity (figure 4 on the y axis1data regional saturation (RSat), measured in percent on the y axis2indicators of cytochrome C oxidase (Cytaa3) measured in conventional optical units on the x-axis markers marked the introduction of reamberine). Changes electroencephalography was manifested by the increase of the total capacity of wave activity to 20% and changes in the wave spectrum, characterized by an increase in the percentage of alpha and beta waves and decreasing theta waves.

The estimated hemodynamic parameters did not undergo significant changes. According to the acid-base status of significant changes was not.

The recovery time is adequate spontaneous breathing and extubation was 15 minutes after the first injection of reamberine of 1.5%. The Wake-up time of 16 minutes.

Example 3.

A female patient, 1year 1 month, history 2769. Operation - installation of drainage in the third ventricle of the brain, about the internal progressive hydrocephalus.

Anesthesia benefit was performed with the use of fentanyl (5 µg/kg/hour), Diprivan (2.5 mg/kg), nimbexa (0,175 mg/kg). The duration of anesthesia of 60 minutes duration 14 minutes For anesthesia was stable, without Oslo the clusters. During anesthesia was assessed indicators, similar to those described in example 1.

10 minutes before the end of the operation/in the jet was introduced solution "Reamberin of 1.5%in a dose of 2 ml/kg Again the drug was introduced in the same dose in 10 minutes after the first injection.

With the introduction of reamberine according to cerebral oximetry is set to increase regional saturation by 10% from the original and reducing the oxidized form of cytochrome C oxidase by 1.5-2%. Total hemoglobin in periarticular departments increased slightly. Changes in the wave spectrum of the electroencephalogram had the same character as that in example 2.

The recovery time is adequate spontaneous breathing and extubation was 14 minutes after the first injection of reamberine. The Wake-up time of 23 minutes.

Just at the moment the drug "Reamberin" eliminated depression in 37 children aged from 1 year to 14 years who had been treated with various surgical pathology. While none of the cases was not observed any adverse reactions to the drug.

Despite the popularity of this drug, used in intensive care, the very possibility of its application as a means to eliminate anesthesia depression was unknown to the anesthesiologists-resuscitators to the present reminisced obvious to the experts in this field.

We first developed the method of using an infusion solution, "Reamberin of 1.5%to eliminate anesthesia depression after General anesthesia in children.

The claimed method is used in children's city clinical hospital №13 of them. Noffilative and the Russian children's clinical hospital, Moscow, and is currently the method of choice for removing anesthesia depression.

The developed method has important socio-economic importance from the point of view of minimizing the use of expensive drugs to correct the action of anesthetics. The use of an infusion solution, "Reamberin 1,5%" does not cause complications and adverse reactions.

The tool is fully developed and ready to use in the departments of anesthesiology, intensive care, surgery, interventional radiology health care institutions. The drug is commercially available, is affordable and relatively cheap.

Use of the drug "Reamberin" as a means to eliminate anesthesia depression.



 

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