Method for supporting deep hypervolemic hemodilution

FIELD: medicine.

SUBSTANCE: method involves introducing catheter into epidural space and set at the level of Th 9 - Th 10. Then, 15 ml of 0.5% Marcain solution is introduced via the catheter, going on introducing it until sensory block of Th 7 - Th 5 is reached. Infusion therapy with 6% Refortan solution as basic hemodilution agent is concurrently started in the amount of 14 ml/kg but not exceeding 1000 ml. 0.9% sodium chloride solution is used in the amount of 28.5 ml/kg but not exceeding 2000 ml. Infusion volume is equal to 42.5 ml/kg not exceeding 3000 ml during the first hour of blockade development with infusion volume being supported at the level of 8 ml/kg in every operation hour.

EFFECT: avoided bloodstream overload.

 

The invention relates to medicine, namely to anesthesiology and intensive care, to kroesbergen technologies during the operation.

Operating hemorrhage still remains one of the most frequent and severe complications.

Transfusion of donor blood components not safe intervention, which is essentially the transplantation of foreign tissue, and is associated with risk of development of various post-transfusion reactions and complications of immune and non-immune nature, as well as infection of the recipient by the human immunodeficiency virus, hepatitis and other infections.

To minimize intraoperative blood loss is actual and not completely solved problem. Modern kroesbergen methods are different methods in different ways to reduce the amount of blood lost patients during the operation. The idea of reducing the actual amount lost during the operation of erythrocytes, platelets and plasma factors of hemostasis due to their pre-breeding is fairly simple. The most widely used in the clinic methods include gemodilucia (giperwolemicescoy and izovolemicescuu). Gemodilucia is diluzio all blood components with a reduction in unit volume.

As a counterpart, the author offers a way izovolemicescuu hemodilution (Ayubi, Get the and. Izovolemicescuu gemodilucia. - // Anesthesiology and resuscitation. - 1994. No. 3. - P.60-68). Izovolemicescuu gemodilucia - delucia all components of the blood components by simultaneous substitution of collected whole blood of the patient is equal to the volume of plasma substitute. When this blood volume (CBV) remains unchanged. As a result, in the course of surgery lost diluted blood, so there is less loss of vectors oxygen - red blood cells. Selected patient's own blood is mixed with heparin or citrate be stored at room temperature and is introduced if necessary the patient during surgery or in the postoperative period.

This method hemodilution has several disadvantages:

1. Fence autologous blood in the vessel and store it affects the physico-chemical properties of blood.

2. The use of preservatives (citrate) increases the risk of allergic reactions when you follow exposee banked blood and can cause citrate intoxication.

3. Deep izovolemicescuu hemodilution (Ht reduction to 0.25%) is theoretically possible, however, rarely been used in practice, because exfuze large blood volume (1000 ml) in a patient can lead to hemodynamic instability, with the fall in systemic arterial pressure.

4. Normal exfuze 40-800 ml of blood with a refund of this amount of colloids does not allow for deep hemodilution and accordingly has a low kroesbergen potential.

5. This method is not applicable in patients with low baseline hemoglobin level.

As a prototype, the author offers a way for hemodilution on the background of epidural anesthesia (Drobin D, Hahn RG. Time course of increased haemodilution in hypotension induced by extradural anaesthesia. Br J Anaesth. 1997 Jan; 78(1):111). In their work the authors studied the relationship between heart rate, blood pressure and gentilicia on the background of epidural anesthesia in patients with urological operations. Achieving a deep degree of hemodilution was not included in the objectives of the study authors, and hemodilution not considered as cervezeria technology. So the way hemodilution, described by the authors, has some serious shortcomings.

1. The authors have not used high thoracic epidural blockade, allowing to achieve a greater degree of increase in the volume of the vascular bed.

2. As an infusion solution used ringer's solution, which does not accumulate in the bloodstream and quickly leaves it, therefore, cannot be considered as hemodiluted, providing a deep and long hemodilution.

3. The amount entered by the authors of the ringer's solution is 15 ml/kg, which is insufficient for achieving a deep degree of hemodilution.

The author proposes a method of providing deep giperwolemicescoy hemodilution is as high epidural blockade. As the main problem when performing deep giperwolemicescoy hemodilution is a danger of overloading the vascular bed infusionum solution with the development of acute cardiovascular insufficiency, the author proposed for compensation arising hypervolemia to carry out a gradual increase in the volume of the vascular bed with high extension of epidural blockade.

Performing extended epidural blockade is necessary to increase the volume of the vascular bed, is as follows.

Carefully processed the skin around the puncture and the hands of the anesthesiologist-resuscitator. Is the puncture of the epidural space of the patient is in sitting position at the level of Th 9 - Th 10. For identification of the epidural space using the loss of resistance. Make sure the correct location of the puncture needle, through its lumen of the catheter. The catheter is pushed into the epidural space in the cranial direction to a depth of 4 see After which the puncture needle is carefully removed and the catheter is fitted along the spine and bring in the subclavian region, locking adhesive tape throughout. After catheterization of the epidural space type "test dose of local anesthetic (lidocaine 2% to 4.0 ml). Within 5 minutes of careful observation of patients on the subject of detecting signs of spinal block. In the absence of data for the development of spinal anesthesia is injected marcain. The author offers a 0.5% solution of marcaine as a local anesthetic, with the longest period. The initial dose was 15 ml, but not more than 20 ml of the Required level of sensory block - 5 Th. Emerging in the area of the blockade-induced sympathectomy vascular causes marked vasodilation, which allows active infusion therapy in two veins, one of which is Central.

For the first hour of closure, the patient receives an infusion therapy in volume 42, 5 ml/kg as the main dilutant used solution pentachrome - reportan in the amount of 14 ml/kg, but not more than 1000 ml as an auxiliary - 0.9% solution of sodium chloride in the amount of 28.5 ml/kg, but not more than 2000 ml For the first 30 minutes of the development of epidural blockade infoseries 500 ml of reportan and 500 ml of 0.9% sodium chloride solution. The rate of infusion solutions is determined by the parameters of Central hemodynamics (HR, BP, Central venous pressure). HELL is not maintained below 15% of normal for this patient level. For the second 30 minutes of closure Infoservice other doses of reportan and 0.9% solution of sodium chloride. Further infusion volume is maintained at the level of 8 ml/kg for each hour of operation.

Choice as the main gem is dilutant 6% solution of reportan based on that during his stay in the bloodstream coincides with the time steps of the input epidurally 0.5% solution of marcaine and is 5 hours. Deep giperwolemicescoy hemodilution on the background of high thoracic epidural blockade allows temporarily, in traumatic stage of the operation, to reduce the hematocrit of the patient to 0.25 and below that the degree of diluzio exceeds the data in the analog and the prototype.

Thus, during the operation, the patient loses the minimum number of red blood cells. The effect of epidural blockade and increased the volume of the vascular bed can prolongirovtsa periodic injection of local anesthetic marcaine.

During extended epidural anesthesia in a patient are monitored constantly hemodynamic parameters (blood pressure, heart rate, CVP) and the saturation of hemoglobin with oxygen (Sp O2).

The advantages offered by the author of how deep giperwolemicescoy hemodilution on the background of high thoracic epidural blockade in relation to the prototype are:

1. The possibility of achieving a greater increase in the volume of the vascular bed due to the high thoracic epidural blockade.

2. More pronounced degree of hemodilution. Due to the possibility infusion of a large volume of fluid is decreased hematocrit to 0.25 and below.

3. Using as a base the ate of dilutant solution reportan, which remains in the bloodstream and coincident in time with the input into the epidural space Marquina, provides reliable, long-term (at least 5 hours) hemodilution.

4. Use as an auxiliary dilutant 0.9% sodium chloride solution allows to avoid the risk of volume overload of the vascular bed, since the latter quickly leaves, and its excess is excreted by the kidneys.

The proposed method is deep giperwolemicescoy hemodilution used by the author in 18 patients during the reconstructive operations on the abdominal aorta and 4 patients with gynecologic operations (amputation and removing of the uterus).

Clinical example 1.

Patient K., 56, health card No. 12562, was admitted to the Department of cardiovascular surgery for surgical treatment with a diagnosis of Stratifying aneurysm of the abdominal aorta.

The patient's condition is moderate. Noted pain syndrome. Baseline hemodynamics (blood pressure 140/90 mm RT. Art., pulse rate 88 / min. Baseline Hb - 126 g/l, Ht - 0,39.

The patient in an emergency operation performed resection of the aneurysm with the bifurcation of the aorta-femoral prosthetics. Before surgery performed catheterization of the right subclavian vein and two cubital veins. Started infusion therapy. Patient in Polo is sitting drop were performed puncture and catheterization of the epidural space at the level of Th 11 - Th 10. After the test dose (2% lidocaine 80 mg) in the epidural space is entered 15 ml of 0.5% solution of marcaine. Received touch the level of blockade to Th 7 - Th 6. After 20 minutes as the development of epidural blockade BP - 120/80 mm RT. Art., heart rate of 80 per minute. For the first 30 minutes of the infusion was 500 ml of reportan and 500 ml of 0.9% sodium chloride solution. Then made induction in anesthesia (thiopental sodium - 300 mg, fentanyl 0.1 mg, ketamine 100 mg), the introduction of muscle relaxants (ListenOn 100 mg), the patient was transferred to AIVL machine RO-6 with parameters UP to 400 ml, MOD - 9 l/min, Fi O2 of 0.5. For the next 30 min introduced 500 ml of reportan and 1500 ml of 0.9% sodium chloride solution. Indicators Hb and Ht 1.5 hours were respectively 76 and 0.26 g/L. AD - 110/75 mm Hg Subsequent infusion therapy averaged 9-12 ml/kg/h Duration of surgical intervention - 4 hours. Total infusion volume per transaction - 5100 ml Average blood loss of 500 ml of urine Output during surgery - 1400 ml. After surgery indicators Hb and Ht, respectively 114 g/l and 0, 34. On the following day Hb - 119 g/l, Ht - 0,37.

The postoperative period was uneventful. After 12 days the patient was discharged in satisfactory condition home.

Clinical example 2.

Patient N., 58 years, medical card No. 12562, was admitted to the gynecological Department goose "OKB" with a diagnosis of uterine Fibroids large rapid growth on a scheduled surgical treatment.

The initial state is closer to satisfactory. HELL 150/90 mm Hg, heart rate of 76 per minute. Hb - 132 g/l, Ht - 0,41.

The patient was performed surgery: hysterectomy with appendages.

Before the operation produced catheterization two cubital veins. Started infusion therapy. The patient is in the sitting position were performed puncture and catheterization of the epidural space at the level of Th And 11 - Th 10. After the test dose (2% lidocaine 80 mg)in the epidural space is entered 15 ml of 0.5% solution of marcaine. Received touch the level of blockade to Th 6 - Th 5. After 20 minutes as the development of epidural blockade AD - 125/80 mm Hg, heart rate of 70 per minute. For the first 30 minutes of the infusion was 500 ml of reportan and 500 ml of 0.9% sodium chloride solution. Then made induction in anesthesia (thiopental sodium 400 mg, fentanyl 0.1 mg), the introduction of muscle relaxants (ListenOn 100 mg), the patient was transferred to AIVL machine RO-6 with parameters UP to 400 ml, MOD - 8.5 l/min, Fi O2 of 0.5. For the next 30 min introduced 500 ml of reportan and 1500 ml of 0.9% sodium chloride solution. Indicators Hb and Ht 1.5 hours were respectively 70 and 0.22 g/L. AD - 115/75 mm Hg Subsequent infusion therapy has averaged 10 ml/kg/h Duration of surgical intervention - 3 hours. Total infusion volume per transaction - 5400 ml Average blood loss of 600 ml of urine Output during surgery - 1100 ml Immediately after the operation indicators Hb and Ht was the respectively 110 g/l and 0, 30. On the following day Hb - 116 g/l, Ht - 0,36.

The postoperative period was uneventful. After 10 days the patient was discharged in satisfactory condition home.

The way to ensure giperwolemicescoy hemodilution, including epidural anesthesia, characterized in that through a catheter at the level of Th 9 - Th 10, inject 15 ml of 0.5%aqueous solution of marcaine and continue his introduction to achieve the level of sensory block Th 7 - Th 5, simultaneously begin infusion therapy 6%solution of reportan as the main hemodiluted in the amount of 14 ml/kg, but not more than 1000 ml, and 0.9%solution of sodium chloride in the amount of 28.5 ml/kg, but not more than 2000 ml in as a subsidiary dilutant, and for the first hour of closure infusion volume is 42.5 ml/kg, but not more than 3000 ml, with maintenance in the future volume infusion at the rate of 8 ml/kg for each hour of operation.



 

Same patents:

FIELD: medicine, surgery.

SUBSTANCE: one should perform Novocain blockade presacrally before operation and not less than one time after operation. Solution for blockade is being a 200 ml 0.25%-novocaine solution supplemented with 1.0 g antibiotic and 40 mg low-molecular heparin. The method enables to improve motor-evacuatory intestinal function, conduct microbiocenosis correction of small intestine, decrease the risk of the development of enterogenic purulent-septic complications, improve microcirculation and hemostasiological profile in mesenteric vessels of small intestine and its wall.

EFFECT: higher efficiency of therapy.

1 ex, 3 tbl

FIELD: medicine.

SUBSTANCE: method involves applying combined analgesia during the first postoperative day on the background of basic anesthesia with a non-steroid anti-inflammatory preparation. Lumbar plexus block is carried out via inguinal access with 0.1% Naropin solution completed with single-dose obturator nerve anesthesia using the same solution. Xephocam is advised as the non-steroid anti-inflammatory preparation.

EFFECT: enhanced effectiveness of treatment; stable analgesic results; small doses consumed.

2 cl

FIELD: medicine, ophthalmology.

SUBSTANCE: one should intramuscularly introduce Ketanov about 1 h before operation, not later, at the dosage of 0.4-0.45 mg/kg patient's body weight followed by local anesthetization as blockade of pterygopalatine ganglion and akinesia with 2%-lidocaine solution. The present innovation enables to prolong anesthetization in post-operational period that, in its turn, prevents iatrogenic complications, especially in senile patients.

EFFECT: higher efficiency.

FIELD: medicine, anesthesiology.

SUBSTANCE: it is necessary to perform skin puncture at lower cervical department being2 cm above sterno-clavicular joint where lateral tracheal wall is located restricted with trachea from median side and with general carotid artery - from lateral side. Moreover, before puncturing patient's skin one should pre-shift carotid artery towards lateral side due to pressing the neck in the region between carotid artery and trachea. The present innovation enables to prevent lesions of vascular-nervous bundle and infection of paratracheal fiber.

EFFECT: higher efficiency of anesthetization.

1 cl, 2 ex

FIELD: medicine, anesthesiology, surgery.

SUBSTANCE: in preoperational and early postoperational periods after planned and urgent operations one should intramuscularly inject adrenogangliolytics: benzohexonium 0.18 - 0.22 mg/kg, droperidol 0.078 - 0.083 mg/kg and obzidan 0.016 - 0.022 mg/kg thrice daily; moreover, the time for their introduction after operation depends upon the type of anesthetic preparation applied to carry out spinal anesthesia, that is: if one applied lidocaine as local anesthetic the above-mentioned adrenogangliolytics should be introduced 2 h after the end of operation, and if marcaine was applied as local anesthetic - 3 h after the end of operation. The innovation enables to prevent disorders of central and peripheral hemodynamics at carrying out spinal anesthesia in perioperational period.

EFFECT: higher efficiency.

FIELD: medicine, orthopedics, traumatology.

SUBSTANCE: one should perform blockades in crossing points of vertical line located along anterior surface of the inferior third of patient's shin at equal distance against median and lateral ankles and the line connecting supramalleolar areas, and, also, in crossing points of vertical line and horizontal one that connects the tops of ankles to improve the accuracy of injections made.

EFFECT: higher efficiency of conservative therapy.

1 dwg, 1 ex

FIELD: medicine, surgery, anesthesiology, traumatology, orthopedics.

SUBSTANCE: before operation one should perform premedication by prescribing individual dosages of tranquilizers and analgesics followed by subarachnoidal anesthesia by applying anesthetizing preparations being 2-3 segments higher against the site of operation, moreover, anesthetizing preparations should be introduced simultaneously into subarachnoidal space and the quantity of anesthetic introduced should not exceed 75% against the standard dosage. The present innovation provides reliable protection before operation and raise the development of tolerant impact of adaptation processes to higher power, improves the flow of postoperational period by preventing the development of postoperational pain syndrome, catabolic reaction and immunosuppression.

EFFECT: higher efficiency.

1 ex, 2 tbl

FIELD: medicine, anesthesiology.

SUBSTANCE: as the values of anesthesiological efficiency one should apply temperature alteration in area of local anesthetic's action and at decreased temperature by 0.6 C and more one should conclude upon efficiency of anesthesia; moreover, the temperature in area of anesthetic injection should be measured not earlier than 2 min after its injection. The present innovation enables to objectively evaluate the efficiency of infiltration anesthesia followed by its correction in the course of operative interference.

EFFECT: higher accuracy of detection.

1 cl, 2 ex

The invention relates to medicine, operative gynecology, anesthesiology and can be used for anesthesia in cosmetic surgery for vulva in women
The invention relates to medicine, obstetrics, and can be used for the treatment of discoordination labor

FIELD: medicine, anesthesiology.

SUBSTANCE: as the values of anesthesiological efficiency one should apply temperature alteration in area of local anesthetic's action and at decreased temperature by 0.6 C and more one should conclude upon efficiency of anesthesia; moreover, the temperature in area of anesthetic injection should be measured not earlier than 2 min after its injection. The present innovation enables to objectively evaluate the efficiency of infiltration anesthesia followed by its correction in the course of operative interference.

EFFECT: higher accuracy of detection.

1 cl, 2 ex

FIELD: medicine, surgery, anesthesiology, traumatology, orthopedics.

SUBSTANCE: before operation one should perform premedication by prescribing individual dosages of tranquilizers and analgesics followed by subarachnoidal anesthesia by applying anesthetizing preparations being 2-3 segments higher against the site of operation, moreover, anesthetizing preparations should be introduced simultaneously into subarachnoidal space and the quantity of anesthetic introduced should not exceed 75% against the standard dosage. The present innovation provides reliable protection before operation and raise the development of tolerant impact of adaptation processes to higher power, improves the flow of postoperational period by preventing the development of postoperational pain syndrome, catabolic reaction and immunosuppression.

EFFECT: higher efficiency.

1 ex, 2 tbl

FIELD: medicine, orthopedics, traumatology.

SUBSTANCE: one should perform blockades in crossing points of vertical line located along anterior surface of the inferior third of patient's shin at equal distance against median and lateral ankles and the line connecting supramalleolar areas, and, also, in crossing points of vertical line and horizontal one that connects the tops of ankles to improve the accuracy of injections made.

EFFECT: higher efficiency of conservative therapy.

1 dwg, 1 ex

FIELD: medicine, anesthesiology, surgery.

SUBSTANCE: in preoperational and early postoperational periods after planned and urgent operations one should intramuscularly inject adrenogangliolytics: benzohexonium 0.18 - 0.22 mg/kg, droperidol 0.078 - 0.083 mg/kg and obzidan 0.016 - 0.022 mg/kg thrice daily; moreover, the time for their introduction after operation depends upon the type of anesthetic preparation applied to carry out spinal anesthesia, that is: if one applied lidocaine as local anesthetic the above-mentioned adrenogangliolytics should be introduced 2 h after the end of operation, and if marcaine was applied as local anesthetic - 3 h after the end of operation. The innovation enables to prevent disorders of central and peripheral hemodynamics at carrying out spinal anesthesia in perioperational period.

EFFECT: higher efficiency.

FIELD: medicine, anesthesiology.

SUBSTANCE: it is necessary to perform skin puncture at lower cervical department being2 cm above sterno-clavicular joint where lateral tracheal wall is located restricted with trachea from median side and with general carotid artery - from lateral side. Moreover, before puncturing patient's skin one should pre-shift carotid artery towards lateral side due to pressing the neck in the region between carotid artery and trachea. The present innovation enables to prevent lesions of vascular-nervous bundle and infection of paratracheal fiber.

EFFECT: higher efficiency of anesthetization.

1 cl, 2 ex

FIELD: medicine, ophthalmology.

SUBSTANCE: one should intramuscularly introduce Ketanov about 1 h before operation, not later, at the dosage of 0.4-0.45 mg/kg patient's body weight followed by local anesthetization as blockade of pterygopalatine ganglion and akinesia with 2%-lidocaine solution. The present innovation enables to prolong anesthetization in post-operational period that, in its turn, prevents iatrogenic complications, especially in senile patients.

EFFECT: higher efficiency.

FIELD: medicine.

SUBSTANCE: method involves applying combined analgesia during the first postoperative day on the background of basic anesthesia with a non-steroid anti-inflammatory preparation. Lumbar plexus block is carried out via inguinal access with 0.1% Naropin solution completed with single-dose obturator nerve anesthesia using the same solution. Xephocam is advised as the non-steroid anti-inflammatory preparation.

EFFECT: enhanced effectiveness of treatment; stable analgesic results; small doses consumed.

2 cl

FIELD: medicine, surgery.

SUBSTANCE: one should perform Novocain blockade presacrally before operation and not less than one time after operation. Solution for blockade is being a 200 ml 0.25%-novocaine solution supplemented with 1.0 g antibiotic and 40 mg low-molecular heparin. The method enables to improve motor-evacuatory intestinal function, conduct microbiocenosis correction of small intestine, decrease the risk of the development of enterogenic purulent-septic complications, improve microcirculation and hemostasiological profile in mesenteric vessels of small intestine and its wall.

EFFECT: higher efficiency of therapy.

1 ex, 3 tbl

FIELD: medicine.

SUBSTANCE: method involves introducing catheter into epidural space and set at the level of Th 9 - Th 10. Then, 15 ml of 0.5% Marcain solution is introduced via the catheter, going on introducing it until sensory block of Th 7 - Th 5 is reached. Infusion therapy with 6% Refortan solution as basic hemodilution agent is concurrently started in the amount of 14 ml/kg but not exceeding 1000 ml. 0.9% sodium chloride solution is used in the amount of 28.5 ml/kg but not exceeding 2000 ml. Infusion volume is equal to 42.5 ml/kg not exceeding 3000 ml during the first hour of blockade development with infusion volume being supported at the level of 8 ml/kg in every operation hour.

EFFECT: avoided bloodstream overload.

FIELD: medicine, anesthesiology.

SUBSTANCE: before endotracheal narcosis it is necessary to carry out conduction anesthesia of sciatic nerve and, also, obturator, external cutaneous and femoral nerves due to one puncture in by the certain technique (Winnie's method) and while carrying out endotracheal narcosis one should inject narcotic analgesic preparation once directly before intubation. The present innovation enables to achieve adequate analgesia and decrease the risk of post-operational complications due to decreasing the number of applied analgesic preparations that enables to apply it in the most severe category of patients at accompanying serious diseases.

EFFECT: higher efficiency of anesthesia.

2 cl, 1 ex

Up!