Method for combined general anaesthesia in combination with deep and superficial cervical plexus blockade in carotide endaterectomy or internal carotid artery resection after pathological deformation thereof

FIELD: medicine.

SUBSTANCE: invention refers to medicine, namely to anaesthesiology, and may be used as an anaesthesia care of a surgical intervention for carotid endaterectomy or internal carotid artery resection after pathological deformation thereof. That is ensured by general anaesthesia in a combination with deep and superficial cervical plexus blockade. Pre-medication is used the day before the operation and on the operative day in the morning. Diazepam is introduced intramuscularly 30 minutes before the operation in a combination with phentanyl; the introduction is followed by ECG monitoring and heart rate count, plethysmography with arterial blood saturation, non-invasive blood pressure measurement and neuromonitring according to a bispectral index or entropy. Catheterisation of patient's peripheral or central vein is followed by an infusion therapy, an ionotropic therapy, a cardiotropic therapy, peripheral resistance maintenance. If heart rate is no more than 80 beats per minute, the anaesthesia is induced to reach an anaesthetic depth according to the bispectral index or entropy within 40-60 units. Analgesia is provided by the intravenous introduction of 0.005% phentanyl; myoplegia is ensured by the intravenous introduction of a myorelaxant. After tracheal intubation, the patient is transferred to forced volumentic artificial pulmonary ventilation with the CO2 level within 35-45 mm Hg according to capnography. The anaesthesia is maintained by supplying an inhalation anaesthetic to the steam level of 0.8-1.0 MAK 0.8-0.9 litre of the air and oxygen flow containing 50% oxygen with controlling the inhalation anaesthetic volume by the level of the anaesthetic depth according to the bispectral index or entropy. That is followed by deep cervical plexus blockade. A tubercle of the VI cervical vertebra (a carotid tubercle) and a mastoid process are localised; thereafter a line connecting the above reference points is drawn on skin. The second line is drawn 1 cm below the first one in parallel. To verify an injection point of a local anaesthetic, the spines of IV, III, II cervical vertebras being at 1.5 cm from each other are palpated, and the reference point is the VI cervical vertebra. The needle is inserted perpendicularly to the skin and slightly in the caudal direction to reach the spines. The anaesthetic is introduced in a dose of 5-7 ml in each point C4, C3, C2. Another 5-7 ml of the anaesthetic is introduced in a point found in an apex of the mastoid process. The superficial cervical plexus blockade requires introducing he fan-shaped introduction of the anaesthetic solution in a dose of 15 ml in a point found in the middle of a lateral crus of the nodding muscle under the above muscle, 4-5 ml in each direction from the same point; the first and following injections are performed at a depth of a usual intramuscular needle perpendicularly to nodding muscle.

EFFECT: method provides the adequate and safe anaesthesia ensured by avoiding linear blood velocity reduction in the medial cerebral artery during the surgical intervention, preventing intracranial pressure increase, reducing cerebral perfusion pressure in a combination with providing adequate protection against surgical invasion with maintaining stroke volume and arterial pressure.

4 cl, 3 ex

 

The invention relates to medicine, namely to method combined General anesthesia in combination with blockade of deep and superficial cervical plexus during carotid endarterectomy or resection of the internal carotid artery at its pathological deformation, and can be used in surgical and other hospitals.

There is a method of combined anesthesia for carotid endarterectomy, including deep blockade of the cervical plexus in combination with General anesthesia (see gentle D.A. Anesthetic management of carotid endarterectomy. The dissertation on competition of a scientific degree of candidate of medical Sciences, Novosibirsk, 2007).

However, the known method combined anaesthesia for carotid endarterectomy when its use has the following disadvantages:

- insufficient prevents reduction of the linear blood flow velocity in middle cerebral artery

not enough to prevent increased intracranial pressure,

- does not prevent the decrease in cerebral perfusion pressure,

- does not ensure the preservation of stroke volume of the heart and blood pressure.

The objective of the invention is to provide a method of combination of General anesthesia in combination with blockade of deep and superficial cervical plexus at artenay endarterectomy or resection of the internal carotid artery at its pathological deformation.

The technical result is to prevent run-time carotid endarterectomy or resection of the internal carotid artery at its pathological deformation of reducing the linear velocity of blood flow in the middle cerebral artery, prevent increased intracranial pressure, preventing reduction of cerebral perfusion pressure, while ensuring adequate protection from surgical aggression and maintaining stroke volume of the heart and blood pressure.

The technical result in the implementation of the invention is achieved by a method of a combination of General anesthesia in combination with blockade of deep and superficial cervical plexus during carotid endarterectomy or resection of the internal carotid artery at its pathological deformation, including deep blockade of the cervical plexus in conjunction with General anesthesia, while before the implementation of regional blockade deep and superficial cervical plexus are premedication, consisting of the patient before surgery per os tablet phenazepam in a dose of 0.0005-0.001 g and the morning of the operation for 30 minutes before operation introduction to the patient by intramuscular injection of diazepam in a dose of 10 mg in combination with drug analgesic fentanyl in a dose of 100 g and 30 min, after which operation the th begin to monitor the patient's ECG counting heart rate, pletismography with saturation of arterial blood, non-invasive blood pressure, and exercise neuromonitoring after application of the electrodes in the frontal region of the patient's most interesting indicators of the index or entropy, then after catheterization of peripheral or Central vein of a patient infusion therapy intravenous ringer's solution, or physiological solution of sodium chloride in 500 ml and begin to carry out inotropic therapy 200 mg of a solution of dopamine hydrochloride, dissolved in 40 ml of saline in a dose of 5 mcg/kg/min, cardioprotective therapy by intravenous injection of a 0.5% solution of nitroglycerin in an initial dose of 0.3 mcg/kg/min, maintaining the peripheral resistance vessels is carried out by intravenous injection of 10 mg solution mezatona dissolved in 50 ml of physiological solution with an initial infusion rate in a dose of 0.3 mcg/kg/min, then when the heart rate of 80 beats per minute start induction in anesthesia by intravenous injection of a solution of propofol at a dose of 0.5-1 mg/kg or thiopental sodium at the dose of 1.5-4 mg/kg, or inhalation of preparation to achieve the level of depth of anaesthesia according to the most interesting index or entropy within 40-60 units, and achieve analgesia by intravenous entered what I 0,005% solution of fentanyl in a dose of 5 g/kg, diplegia provide by intravenous nedepoliarizuth solution muscle relaxant nimbexa at a dose of 0.15 mg/kg or tracrium at a dose of 0.5-0.6 mg/kg or esmeron at a dose of 0.3 mg/kg in 90 to 100 seconds inkubiruut the trachea of the patient and transfer him to a forced artificial lung ventilation mode volume ventilation with the level of CO2within 35-45 mm Hg according to capnography, and maintenance of anesthesia are filing inhalation anesthetic preparation or isoflurane to the level of 0.8-1.0 MAC flow of 0.8-0.9 liters of oxygen-air mixture containing 50% oxygen, with control of the volume of the inhalation anesthetic supply the level of depth of anesthesia is the most interesting indicators of the index or entropy, then before performing regional anesthesia deep and superficial cervical plexus anatomical points of the cervical plexus of a patient with this as a first point of reference define the tubercle VI cervical vertebra (carotid tubercle), as the second reference point - the mastoid process of the temporal bone after which sterile marker or dye antiseptic spend on skin connecting these landmarks line, then spend the second line is 1 cm below and parallel to the first, and to verify the site of injection of local anesthetic is determined by palpation of the transverse processes 4, 3, 2 neck on Vankov, which are at a distance of 1.5 cm from each other, with the countdown starting from VI cervical vertebra, then perform regional anesthesia deep and superficial cervical plexus, and when the blockade deep cervical plexus to reduce the distance from skin to bone structures use the effect of the pressure of the finger, whereupon the needle on the syringe perpendicular to the skin and a few in a caudal direction until reaching the transverse process of constant performing suction of the sample due to the slight pull of the plunger of the syringe and in the absence of blood in the syringe with a clear sense of bone structures perform an injection of 0.5% solution of local anesthetic marcaine hydrochloride or naropin hydrochloride 5-7 ml in each point of C4With3With2and impose additional 5-7 ml of local anesthetic solution of marcaine hydrochloride or naropin hydrochloride at a point at the apex of the mastoid process, and then block the superficial cervical plexus from a point located at the middle of the lateral legs of sternocleidomastoid muscle (sternocleidomastoid muscle), the introduction of the local anesthetic solution of marcaine hydrochloride or naropin hydrochloride in the amount of 15 ml under specified muscle is fan-shaped, 4-5 ml in each direction from one point, and the first and subsequent inye the tion perform at a depth of intramuscular needle perpendicular to the sternocleidomastoid muscle. When this warning vagusnye effects conduct, in the absence of contraindications, the introduction of a 0.1% solution of atropine sulfate at a dose of 0.3-0.5 mg of the dye of antiseptic when defining anatomical landmarks of the cervical plexus using a sterile marker, or antiseptic - potassium iodide or brilliant green. When regional anesthesia deep and superficial cervical plexus injection use syringe of 10 ml, and the needle 22 G or standard intramuscular needle.

The method is as follows. Perform a premedication before surgery the introduction of the patient per os tablet phenazepam dose 0,0005-0,001, the Morning of the operation for 30 minutes before surgery diazepam intramuscularly at a dose of 10 mg in combination with a narcotic analgesic fentanyl in a dose of 100 g. After 30 min after sedation in the operating room start to monitor the patient's ECG counting heart rate, pletismography with saturation of arterial blood, non-invasive blood pressure, and exercise neuromonitoring after the imposition of electrodes in the frontal region of the patient with the definition and maintenance of the most interesting indicators of the index or entropy within 40-60 units. Then after catheterization of peripheral or Central vein of a patient, infuse the traditional therapy intravenous ringer's solution, or physiological solution of sodium chloride in a volume of 500 ml Begin to inotropic therapy introduction solution of dopamine hydrochloride in a dose of 200 mg, dissolved in 40 ml of physiological solution, in a dose of 5 mcg/kg/min Spend cardioprotective therapy intravenous 0.5% solution of nitroglycerin in an initial dose of 0.3 mcg/kg/min Maintenance of peripheral resistance vessels is carried out by intravenous injection of a solution mezatona at a dose of 10 mg diluted in 50 ml saline, at a dose of 0.3 mcg/kg/min Then when the heart rate of 80 beats per minute start induction in anesthesia by intravenous injection of propofol at a dose of 0.5 1 mg/kg or thiopental sodium at the dose of 1.5-4 mg/kg) or by inhalation moreover, to achieve the level of depth of anaesthesia according to the most interesting index or entropy within 40-60 units, and analgesia reach the introduction of 0.005% solution of fentanyl in a dose of 5 mcg/kg Warning vagusnye effects conduct, in the absence of contraindications, the introduction of a 0.1% solution of atropine sulfate at a dose of 0.3-0.5 mg of Peopleyou provide an introduction nedepoliarizuth solution muscle relaxant nimbexa at a dose of 0.15 mg/kg, or tracrium at a dose of 0.5-0.6 mg/kg or esmeron dose of 0.3 mg/kg in 90 to 100 seconds after administration of the muscle relaxant inkubiruut the trachea and translate the patient's forced artificial blower adjust is a pulmonary mode volume ventilation with the level of CO 2within 35-45 mm Hg according to capnography. Maintenance of anesthesia are filing inhalation anesthetic preparation or isoflurane to the level of 0.8-1.0 MAC flow of 0.8-0.9 liters of oxygen-air mixture containing 50% oxygen, with control of the volume of the inhalation anesthetic supply the level of depth of anesthesia is the most interesting indicators of the index or entropy. Then before performing regional anesthesia deep and superficial cervical plexus anatomical points of the cervical plexus of the patient. At the same time as the first point of reference define the tubercle VI cervical vertebra (carotid tubercle), as the second reference point - the mastoid process of the temporal bone, and sterile marker or dye antiseptic spend on skin connecting these landmarks line. At the same time as the dye antiseptic when defining anatomical landmarks of the cervical plexus use of potassium iodide or brilliant green. Then spend the second skin line 1 cm below and parallel to the first, and to verify the site of injection of local anesthetic is determined by palpation of the transverse processes 4, 3, 2 cervical vertebrae, which are at a distance of 1.5 cm from each other. While the countdown start from VI cervical vertebra. Then perform regional anesthesia deep and superficial cervical with whom Latini. Moreover, blockade of the deep cervical plexus to reduce the distance from skin to bone structures use the effect of the pressure of the finger, whereupon the needle on the syringe perpendicular to the skin and a few in a caudal direction until reaching the transverse process of constant performing suction of the sample due to the slight pull of the plunger of the syringe in the absence of blood in the syringe. When regional anesthesia deep and superficial cervical plexus injection use syringe of 10 ml, and the needle 22 G or standard intramuscular needle. With a clear sense of bone structures perform an injection of 0.5% solution of local anesthetic marcaine hydrochloride or naropin hydrochloride 5-7 ml in each point With4With3C2and impose additional 5-7 ml of local anesthetic solution of marcaine hydrochloride or naropin hydrochloride at a point at the apex of the mastoid process. Then block the superficial cervical plexus from a point located at the middle of the lateral legs of sternocleidomastoid muscle, the introduction of the local anesthetic solution of marcaine hydrochloride or naropin hydrochloride in the amount of 15 ml under specified muscle is fan-shaped, 4-5 ml in each direction from one point, and the first and subsequent injections are performed to a depth of obyknovennoi needle perpendicular. At the time of suturing the muscles and platysma neck inhalation anesthetic off, but the flow of the air-oxygen mixture remain at 0.8 l / min, while the MAC was at the level of 0.1, and most interesting index of 65 units At the beginning of the suturing of the skin, the flow of the air-oxygen mixture is increased to 8 l in 1 minutes of the Patient extabit after 1 min after surgery.

Among the significant characteristics of the proposed method combined General anesthesia in combination with blockade of deep and superficial cervical plexus during carotid endarterectomy or resection of the internal carotid artery at its pathological deformation, distinctive are:

- conduct before the implementation of regional blockade deep and superficial cervical plexus sedation before surgery the patient per os tablet phenazepam in a dose of 0.0005-0.001 g and the morning of the operation for 30 minutes before operation introduction intramuscular injection of diazepam in a dose of 10 mg in combination with a narcotic analgesic fentanyl in a dose of 100 mcg,

- carrying out 30 minutes after sedation in the operating room monitoring the ECG of a patient with counting heart rate, pletismography with saturation of arterial blood, non-invasive blood pressure, as well as the implementation of neuromonitoring after application of the electrodes on Lobo the region of the patient with the definition of the indicators most interesting index or entropy

- conducting after catheterization of peripheral or Central vein of a patient infusion therapy by intravenous ringer's solution, or physiological solution of sodium chloride in 500 ml

- launch of inotropic therapy by intravenous injection of 200 mg of a solution of dopamine hydrochloride, dissolved in 40 ml of physiological solution, in a dose of 5 mcg/kg/min,

- conducting cardioprotective therapy by intravenous injection of a 0.5% solution of nitroglycerin in an initial dose of 0.3 mcg/kg/min,

- maintaining peripheral resistance vessels carry out intravenous 10 mg solution mezatona dissolved in 50 ml of physiological solution, the initial dose of 0.3 mcg/kg/min,

- when heart rate less than 80 beats per minute induction in anesthesia by injection of a solution of propofol at a dose of 0.5-1 mg/kg or thiopental sodium at the dose of 1.5-4 mg/kg) or by inhalation moreover, to achieve the level of depth of anaesthesia according to the most interesting index or entropy within 40-60 units, and achieve analgesia intravenous 0.005% solution of fentanyl in a dose of 5 g/kg, diplegia provide intravenous nedepoliarizuth solution muscle relaxant nimbexa at a dose of 0.15 mg/kg or tracrium at a dose of 0.5-0.6 mg/kg or in esmeron a dose of 0.3 mg/kg,

through 90-100 seconds after administration of the muscle relaxant inkubiruut the trachea of the patient and transfer him to a forced artificial lung ventilation mode volume ventilation with the level of CO 2within 35-45 mm Hg according to capnography,

- implementation maintenance of anesthesia with inhalation anesthetic supply preparation or isoflurane to the level of 0.8-1.0 MAC flow of 0.8-0.9 liters of oxygen-air mixture containing 50% oxygen, with control of the volume of the inhalation anesthetic supply the level of depth of anesthesia is the most interesting indicators of the index or entropy

- definition prior to performing regional anesthesia deep and superficial cervical plexus anatomical landmarks of the cervical plexus of a patient with this as a first point of reference define bugorki VI cervical vertebra (carotid tubercle), as the second reference point - the mastoid process of the temporal bone, followed by a skin with a sterile marker or dye antiseptic connecting these landmarks line, then spend the second line is 1 cm below and parallel to the first,

- identification to verify the site of injection of local anesthetic by palpation of the transverse processes 4, 3, 2 cervical vertebrae, which are at a distance of 1.5 cm from each other, with the starting point from VI cervical vertebra,

- performing regional anesthesia deep and superficial cervical plexus, and when the blockade deep cervical plexus to reduce the distance from skin to bone structures use effect of pressure the I finger then the needle on the syringe perpendicular to the skin and a few in a caudal direction until reaching the transverse process of constant performing suction of the sample due to the slight pull of the plunger of the syringe and in the absence of blood in the syringe with a clear sense of bone structures perform an injection of 0.5% solution of local anesthetic marcaine hydrochloride or naropin hydrochloride 5-7 ml in each point With4With3C2and impose additional 5-7 ml of local anesthetic solution of marcaine hydrochloride or naropin hydrochloride at a point at the apex of the mastoid process,

- blocking superficial cervical plexus from a point located at the middle of the lateral legs of sternocleidomastoid muscle (sternocleidomastoid muscle), the introduction of the local anesthetic solution of marcaine hydrochloride or naropin hydrochloride in the amount of 15 ml under specified muscle is fan-shaped, 4-5 ml in each direction from one point, and the first and subsequent injections are performed to a depth of intramuscular needle perpendicular to the sternocleidomastoid muscle,

- conduct warning vagusnye effects, in the absence of contraindications, the introduction of a 0.1% solution of atropine sulfate at a dose of 0.3-0.5 mg,

- use as an antiseptic dye when determining anatomical PR is Antonov cervical plexus potassium iodide or brilliant green,

use in regional anesthesia deep and superficial cervical plexus injection syringe of 10 ml and needle 22 G or standard intramuscular needle.

Experimental studies of the proposed method combined General anesthesia in combination with blockade of deep and superficial cervical plexus during carotid endarterectomy or resection of the internal carotid artery at its pathological deformation showed its high efficiency. It was found that the proposed method is a combination of General anesthesia in combination with blockade of deep and superficial cervical plexus during carotid endarterectomy or resection of the internal carotid artery at its pathological deformation provides a reduction in the linear blood flow velocity in the middle cerebral artery, to prevent increased intracranial pressure. It was also prevented the decrease in cerebral perfusion pressure and at the same time provide adequate protection from surgical aggression with preservation of stroke volume of the heart and blood pressure.

Implementation of the proposed method combined General anesthesia in combination with blockade of deep and superficial cervical plexus during carotid endarterectomy or resection of the internal carotid artery pathological is its deformation is illustrated by the following clinical examples.

Example 1. Patient K., 72 years old, he entered the Institute of surgery named after A.A. Vishnevsky with the diagnosis of a Critical stenosis of the right ICA. SMS 3 tbsp. IRB, angina 2 FC. Hypertension stage 2 of 3 degrees high risk of cardiovascular complications. Diagnosed on the basis of anamnesis, inspection, auscultation, USDG and color duplex scanning of the carotid arteries.

The patient operation was performed carotid endarterectomy in conditions of combined General and regional anesthesia.

Complied with the premedication, which was to receive the patient before surgery per os tablet phenazepam in a dose of 0.0005, the Morning of the operation for 30 minutes before surgical intervention was intramuscularly injected 10 mg solution of diazepam in combination with a narcotic analgesic fentanyl in a dose of 100 g. After 30 min after sedation in the operating room began to monitor the ECG of a patient with counting heart rate, pletismography with saturation of arterial blood, non-invasive blood pressure, and have implemented neuromonitoring after application of the electrodes in the frontal region of the patient with the definition of the most interesting indicators of the index. Then after catheterization of peripheral vein of the patient spent infusion therapy intravenous ringer's solution is the volume of 500 ml Initiated inotropic therapy the introduction of 200 mg of a solution of dopamine hydrochloride, dissolved in 40 ml of physiological solution, in a dose of 5 mcg/kg/min Spent cardioprotective therapy intravenous 0.5% solution of nitroglycerin in an initial dose of 0.3 mcg/kg/min Maintenance of peripheral resistance vessels was carried out by intravenous injection of 10 mg solution mezatona dissolved in 50 ml of physiological solution, the initial dose of 0.3 mcg/kg/min Then when the heart rate of 80 beats per minute started induction in anesthesia by inhalation of the preparation to achieve the level of depth of anaesthesia according to the most interesting index or entropy within 40-60 units, and analgesia was achieved by intravenous injection of 0.005% solution of fentanyl in a dose of 5 mcg/kg Warning vagusnye effects was carried out by intravenous injection of a 0.1% solution of atropine sulfate at a dose of 0.5 mg of Peopleyou provided by intravenous nedepoliarizuth solution esmeron 0.3 mg/kg and 90 seconds after administration of the muscle relaxant was intubated the trachea of the patient and the patient was transferred to a forced artificial lung ventilation mode volume ventilation with the level of CO2within 40 mm Hg according to capnography. Maintenance of anesthesia was carried out by applying inhalation Annes who etika of preparation to the level of 0.8 MAC flow of 0.8 liters of oxygen-air mixture, containing 50% oxygen, with the control of the flow volume of inhalation anaesthetics on the level of depth of anesthesia as measured by the most interesting index. After the start of the combined General anesthesia the patient was given a horizontal position with her head turned in the direction opposite to the operated side. Then before performing regional anesthesia deep and superficial cervical plexus defined anatomical landmarks. At the same time as the first reference point defined tubercle VI cervical vertebra (carotid tubercle), as the second reference point chose the mastoid process of the temporal bone, after which a sterile marker held on the skin connecting these landmarks line. Then held on the second skin line 1 cm below and parallel to the first, and to verify the site of injection of local anesthetic is determined by palpation of the transverse processes 4, 3, 2 cervical vertebrae, which are at a distance of 1.5 cm from each other. When the countdown started from VI cervical vertebra of the patient. Then perform regional anesthesia deep and superficial cervical plexus. Moreover, blockade of the deep cervical plexus to reduce the distance from skin to bone structures, we used the effect of the pressure of the finger, and then introduced the needle on the syringe perpendicular to the skin and a few in a caudal direction until the reaches the transverse process of constant performing suction of the sample due to the slight pull of the plunger of the syringe, to ensure the absence of blood in the syringe. When regional anesthesia deep and superficial cervical plexus injection used a syringe with a volume of 10 ml and the needle 22 G. With a clear sense of bone structures complied with the injection of a 0.5% solution of local anesthetic naropin hydrochloride in 5 ml each point With4With3C2and additionally introduced 5 ml of local anesthetic naropin hydrochloride at a point at the apex of the mastoid process. Then blocked superficial cervical plexus from a point located at the middle of the lateral legs of sternocleidomastoid muscle of the patient, the introduction of the local anesthetic solution of naropin hydrochloride in the amount of 15 ml under specified muscle is fan-shaped, 4-5 ml in each direction from one point, and the first and subsequent injections were performed at a depth of intramuscular needle perpendicular to the specified muscles mandatory compliance with the suction of the sample. At the moment work in vegetationatmosphere region of the carotid artery (on the back surface passes the sympathetic trunk) there was an increase in heart rate from 64 to 82 beats per 1 minute and systolic blood pressure 130 to 165 mm Hg At the level of adequacy of anesthesia was confirmed most interesting data ind the KSA (48). In this regard, reduced the dose of the solution of inotropic drug dopamine hydrochloride with 5 mcg/kg/min to 2 mcg/kg/min, and the introduction of a solution of vasopressor mezatona was discontinued. When this dose of nitroglycerin was increased from 0.3 g/kg/min to 0.8 g/kg/min After changing the settings vasoactive infusion of funds, the heart rate was 67 beats per 1 min, and systolic blood pressure was determined at the level of 140 mm Hg When this data is the most interesting index remained the same 48%, which indicated an adequate level of anesthesia was confirmed that hemodynamic changes were associated with activation of the sympathetic innervation zone of the carotid artery. At the time of measurement of retrograde pressure, which indirectly indicates an adequate level of compensation of cerebral blood flow at the time of clamping of the carotid artery did not need the solution of vasopressor mezatona that standard General anesthesia is a necessary condition for the establishment of pharmacological hypertension. Further during anesthesia smooth. At the time of suturing the muscles and platysma neck inhalation anesthetic supply has stopped, but the flow of the air-oxygen mixture was kept at 0.8 l / min, while the MAC was at the level of 0.1, and most interesting index of 65 units At the beginning of the suturing skin the flow of air and oxygen the mixture was increased to 8 liters in 1 minute The patient was extubated after 1 min after surgery.

Neurological deficit no, blood pressure 130/70 mm Hg, heart rate of 62 1 min, pain no. After transferring the patient to the intensive care unit hemodynamic parameters remained stable and the pain was gone for 9 hours after surgery with stable hemodynamics and clear consciousness of the patient.

Achieved stability of linear blood flow velocity in the middle cerebral artery, prevented the increase in intracranial pressure, prevented the decrease in cerebral perfusion pressure and at the same time provide adequate protection from surgical aggression with preservation of stroke volume of the heart and blood pressure.

Example 2. Patient C., 64 years old, was admitted to the Institute of surgery named after A.A. Vishnevsky with the diagnosis of Stenosis of the left ICA. SMS 3 tbsp. CHD, ateroskleroticeski koronarokardioskleroze. Hypertension stage 2 of 3 degrees high risk of cardiovascular complications. Diagnosed on the basis of anamnesis, inspection, auscultation, the ultrasound imaging of the carotid arteries and color duplex scanning of the carotid arteries.

The patient performed surgery carotid endarterectomy in conditions of combined General and regional anesthesia.

In what was implemented pretreatment, which was taking before surgery patient per os tablet phenazepam at a dose of 0.001, the Morning of the operation for 30 minutes before surgery, the patient was injected intramuscularly diazepam (Relanium) at a dose of 10 mg in combination with a narcotic analgesic fentanyl in a dose of 100 g. After 30 min after sedation in the operating room began to monitor the patient's ECG counting heart rate, pletismography with saturation of arterial blood, non-invasive blood pressure, and have implemented neuromonitoring after application of the electrodes in the frontal region of the patient with the measurement of entropy. Then after catheterization of peripheral vein of the patient spent infusion therapy by intravenous administration of ringer's solution in a volume of 500 ml. Spent inotropic therapy by intravenous injection of 200 mg of a solution of dopamine hydrochloride, dissolved in 40 ml of physiological solution, in a dose of 5 mcg/kg/min Spent cardioprotective therapy by intravenous nitroglycerin solution in a dose of 0.3 mcg/kg/min Maintenance of peripheral resistance vessels was carried out by intravenous injection of 10 mg solution mezatona dissolved in 50 ml of physiological solution, the initial dose of 0.3 mcg/kg/min Then when the heart rate is not more than 80 beats per minute was started and the products in anesthesia by intravenous injection of a solution of propofol at a dose of 0.75 mg/kg to achieve the level of depth of anaesthesia according to the entropy within 50 units, moreover analgesia was achieved by intravenous injection of 0.005% solution of fentanyl in a dose of 5 mcg/kg Warning vagusnye effects have not performed because there were contraindications. Diplegia provided by intravenous nedepoliarizuth solution muscle relaxant nimbexa at a dose of 0.15 mg/kg in 100 seconds after the injection which, after 90 seconds, the trachea was intubated and transferred the patient to the forced artificial lung ventilation mode volume ventilation with the level of CO2within 35 mm Hg according to capnography. Maintenance of anesthesia was carried out by applying the inhalation anesthetic isoflurane to the level of 0.9 POPPY in the flow of 0.95 liters oxygen-air mixture containing 50% oxygen, ow control volume inhalation anesthetic according to the level of depth of anaesthesia in terms of entropy. After the start of combination of General anesthesia, the patient gave a horizontal position with her head turned in the direction opposite to the operated side. Then before performing regional anesthesia deep and superficial cervical plexus identified anatomical landmarks of the cervical plexus of the patient. At the same time as the first reference point defined tubercle VI cervical vertebra (carotid tubercle), as the second reference point is selected mastoid process of the temporal bone, and then painting the antiseptic - potassium iodide held on the skin connecting these landmarks line. Then held on the second skin line 1 cm below and parallel to the first, and to verify the site of injection of local anesthetic is determined by palpation of the transverse processes 4, 3, 2 cervical vertebrae of the patient, which are at a distance of 1.5 cm from each other. When the countdown started from VI cervical vertebra of the patient. Then perform regional anesthesia deep and superficial cervical plexus. Moreover, blockade of the deep cervical plexus to reduce the distance from skin to bone structures, we used the effect of the pressure of the finger, and then introduced the needle on the syringe perpendicular to the skin and a few in a caudal direction until reaching the transverse process of constant performing suction of the sample due to the slight pull of the plunger of the syringe to verify the absence of inflow of blood into the syringe. When regional anesthesia deep and superficial cervical plexus injection used a syringe with a volume of 10 ml and the needle 22 G. With a clear sense of bone structures complied with the injection of a 0.5% solution of local anesthetic marcaine hydrochloride (bupivacaine hydrochloride) in 7 ml each point With4With3With2and additionally introduced 7 ml of local anesthetic solution of marcaine hydrochloride (bupivacaine hydrochloride is) to the point located in the apex of the mastoid process. Then blocked superficial cervical plexus from a point located at the middle of the lateral legs of sternocleidomastoid muscle of the patient, the introduction of the local anesthetic solution of marcaine hydrochloride in the amount of 15 ml under specified muscle is fan-shaped, 4-5 ml in each direction from one point, and the first and subsequent injections were performed at a depth of intramuscular needle perpendicular to the sternocleidomastoid muscle with the obligatory fulfillment of the aspiration of the sample. Infiltration of tissues was carried out on 5 ml in each direction during reverse needle. After skin incision signs of reaction to painful stimulus, the patient was not determined, it was confirmed data entropy (52 units), which indicated an adequate level of anesthesia. At the moment work in vegetationatmosphere region of the carotid artery (on the back surface passes the sympathetic trunk) there was an increase in heart rate from 56 to 84 beats per 1 minute and systolic blood pressure from 140 to 170 mm Hg At the level of adequacy of anesthesia was confirmed data entropy (50 units). In this regard, reduced the dose of the solution of inotropic drug dopamine hydrochloride with 5 mcg/kg/min to 2 mcg/kg/min, and the introduction of a solution of vasopressor mezatona was discontinued. P is, and the dose of nitroglycerin increased from 0.3 g/kg/min to 1.0 mcg/kg/min After you change the settings vasoactive infusion of funds, the heart rate was 67 beats per 1 min, and systolic blood pressure was determined at 150 mm Hg and the data entropy remained the same 52%, which indicated an adequate level of anesthesia was confirmed that hemodynamic changes were associated with activation of the sympathetic innervation zone of the carotid artery. At the time of measurement of retrograde pressure, which indirectly indicates an adequate level of compensation of cerebral blood flow at the time of clamping of the carotid artery did not need the solution of vasopressor mezatona that standard General anesthesia is a necessary condition for the establishment of pharmacological hypertension. Further during anesthesia smooth.

After the start of blood flow in the carotid artery, the number of inhalation anesthetic sharply reduced from 0.8 MAC to 0.2 MACS. This patient showed signs of spontaneous breathing. In this regard, changed the mode of ventilation forced to auxiliary support pressure. The decrease in POPPY cultivation has led to a slight increase in the activity of the Central nervous system, which according to the entropy corresponded to 67 units. The transition to the surface level of anesthesia and muscle activity of the patient allows the ILO to assess the neurological status of the patient. Occurrence of motion in the limbs contralateral operations side, which confirms the absence of a neurological deficit. At the time of suturing the muscles and platysma neck inhalation anesthetic turned off, but the flow of the air-oxygen mixture was kept at 0.8 l / min, while the MAC was at the level of 0.1, and most interesting index of 65 units At the beginning of the suturing of the skin, the flow of the air-oxygen mixture was increased to 8 l in 1 minutes the Patient was extubated after 1 min after surgery.

Neurological deficit no, blood pressure 130/70 mm Hg, heart rate of 62 1 min, pain no. After transferring the patient to the intensive care unit hemodynamic parameters remained stable and the pain was gone for 9 hours after surgery with stable hemodynamics and clear consciousness of the patient.

Achieved stability of linear blood flow velocity in the middle cerebral artery, prevented the increase in intracranial pressure, prevented the decrease in cerebral perfusion pressure and at the same time provide adequate protection from surgical aggression with preservation of stroke volume of the heart and blood pressure.

Example 3. Patient S., 32 years old, he entered the Institute of surgery named after A.A. Vishnevsky with the diagnosis of Pathological tortuosity of the rights of the th ICA. SMS 2 tbsp.". Diagnosed on the basis of medical history, physical examination, auscultation, color duplex scanning and Doppler ultrasound of the carotid arteries.

The patient operation was performed resection of the internal carotid artery in the combined General conditions in combination with regional anesthesia.

Performed a premedication before surgery, which was to receive patient per os tablet phenazepam at a dose of 0.001, the Morning of the operation for 30 minutes before the surgery, she was injected intramuscularly diazepam in a dose of 10 mg in combination with a narcotic analgesic fentanyl in a dose of 100 g. After 30 min after sedation in the operating room started ECG monitoring of the patient by counting the heart rate, pletismography with saturation of arterial blood, non-invasive blood pressure, and have implemented neuromonitoring after application of the electrodes in the frontal region of the patient with the definition of the most interesting indicators of the index. Then after catheterization of Central veins of the patient spent infusion therapy intravenous saline solution of sodium chloride in a volume of 500 ml was Started carrying inotropic therapy by intravenous administration of a solution of 200 mg of dopamine hydrochloride, dissolved in 40 ml of physiological solution, in a dose of 5 mcg/kg/min Held a card is oropou therapy by intravenous injection of a 0.5% solution of nitroglycerin in an initial dose of 0.3 mcg/kg/min The maintenance of peripheral resistance vessels was carried out by intravenous injection of 10 mg solution mezatona dissolved in 50 ml of physiological solution, the initial dose of 0.3 mcg/kg/min Then when the heart rate to 77 BPM started induction in anesthesia introduction of thiopental sodium at the dose of 1.5 mg/kg to achieve the level of depth of anaesthesia according to the most interesting index within 50 units, and analgesia was achieved by intravenous injection of 0.005% solution of fentanyl in a dose of 5 mcg/kg Warning vagusnye effects was performed by intravenous injection of a 0.1% solution of atropine sulfate in the amount of 0.3 mg. Diplegia provided by intravenous solution tracrium 0.5 mg/kg and after 95 seconds after administration of the muscle relaxant was intubated the trachea and the patient was transferred to a forced artificial lung ventilation mode volume ventilation with the level of CO2within 40 mm Hg according to capnography. Maintenance of anesthesia was carried out by applying inhalation anesthetic preparation to the level of 1.0 MAC in the flow of 0.9 liters of oxygen-air mixture containing 50% oxygen, with the control of the flow volume of inhalation anaesthetics on the level of depth of anesthesia as measured by the most interesting index. After the start of the combined General anesthesia the patient is attached to the horizontal position with her head turned in the direction opposite to the operated side. After identifying anatomical landmarks, which were selected tubercle VI cervical vertebra (carotid tubercle) and the mastoid process of the temporal bone, then the coloring antiseptic - green diamond held on the skin connecting these landmarks line and then held on the second skin line 1 cm below and parallel to the first, and to verify the site of injection of local anesthetic is determined by palpation of the transverse processes With4With3With2the cervical vertebrae of the patient, which are at a distance of 1.5 cm from each other. When the countdown started from VI cervical vertebra of the patient. Then perform regional anesthesia deep and superficial cervical plexus. Moreover, blockade of the deep cervical plexus to reduce the distance from skin to bone structures, we used the effect of the pressure of the finger, and then introduced the needle on the syringe perpendicular to the skin and a few in a caudal direction until reaching the transverse process of constant performing suction of the sample due to the slight pull of the plunger of the syringe to verify the absence of inflow of blood into the syringe. When regional anesthesia deep and superficial cervical plexus injection used standard intramuscular needle. With a clear sense of bone structures complied with the injection of 0.5% R is the cross-section of local anaesthetics marcaine hydrochloride in 5 ml each point With 4With3With2and additionally introduced 5 ml of local anesthetic solution of marcaine hydrochloride at a point at the apex of the mastoid process. Then blocked superficial cervical plexus from a point located at the middle of the lateral legs of sternocleidomastoid muscle of the patient, the introduction of the local anesthetic solution of marcaine hydrochloride in the amount of 15 ml under specified muscle is fan-shaped, 4-5 ml in each direction from one point, and the first and subsequent injections were performed at a depth of intramuscular needle perpendicular to the sternocleidomastoid muscle with the obligatory fulfillment of the aspiration of the sample. Infiltration of tissues was carried out on 5 ml in each direction during reverse needle. After starting the operation, the patient did not respond to painful stimuli (skin incision, the selection of the carotid artery), which was confirmed most interesting data index (45 units), which indicated an adequate level of anesthesia. At the moment work in vegetationatmosphere region of the carotid artery (on the back surface passes the sympathetic trunk) there was an increase in heart rate from 67 to 82 beats per 1 minute and systolic blood pressure 130 to 155 mm Hg adequacy of anesthesia was confirmed most interesting data index (50 units). At this dose n is troglycerin increased from 0.3 g/kg/min to 1 mcg/kg/min After you change the settings vasoactive infusion of funds, the heart rate was 74 beats per 1 min, and systolic blood pressure was determined at the level of 130 mm Hg When this data is the most interesting index remained the same unit 52, an adequate level of anesthesia, and this, in turn, confirmed that the hemodynamic changes were associated with activation of the sympathetic innervation zone of the carotid artery. At the time of measurement of retrograde pressure, which indirectly indicates an adequate level of compensation of cerebral blood flow at the time of clamping of the carotid artery did not need the solution of vasopressor mezatona that standard General anesthesia is a necessary condition for the establishment of pharmacological hypertension. Further during anesthesia smooth.

After the start of blood flow in the carotid artery, the number of inhalation anesthetic reduced from 0.8 MAC to 0.2 MACS. However, the patient developed spontaneous breathing. In this regard, the selected mode of spontaneous ventilation. The decrease in POPPY cultivation has led to an increase in the activity of the Central nervous system that, according to the most interesting index corresponded to 86 units. The transition to the surface level of anesthesia and muscle activity of the patient allowed us to assess her neurological status. Said singing is of movement in the limbs contralateral operations side, that was confirmed by the absence of a neurological deficit.

At the time of suturing the muscles and platysma neck inhalation anesthetic turned off, but the flow of the air-oxygen mixture was kept at 0.8 l / min, while the MAC was at the level of 0.1, and most interesting index of 78% At the beginning of the suturing of the skin, the flow of the air-oxygen mixture was increased to 8 l in 1 minutes the Patient was extubated after 1 min after surgery.

Neurological deficit no, blood pressure 130/70 mm Hg, heart rate of 62 1 min, pain no. After transferring the patient to the intensive care unit hemodynamic parameters remained stable and the pain was gone for 9 hours after surgery with stable hemodynamics and clear consciousness of the patient.

Achieved a stable linear blood flow velocity in the middle cerebral artery, prevented the increase in intracranial pressure, prevented the decrease in cerebral perfusion pressure and at the same time provide adequate protection from surgical aggression with preservation of stroke volume of the heart and blood pressure.

1. The method of combination of General anesthesia in combination with blockade of deep and superficial cervical plexus during carotid endarterectomy or resection of the internal carotid artery pathological is its deformation, includes deep blockade of the cervical plexus in conjunction with General anesthesia, characterized in that before the implementation of regional blockade deep and superficial cervical plexus are premedication, consisting of the patient before surgery per os pill phenazepam in a dose of 0.0005-0.001 g and the morning of the operation, 30 min before surgery, the introduction of the patient by intramuscular injection of diazepam in a dose of 10 mg in combination with a narcotic analgesic fentanyl in a dose of 100 g and 30 min, after which the operating start to monitor the patient's ECG counting heart rate, pletismography with saturation of arterial blood, non-invasive blood pressure and exercise neuromonitoring after application of the electrodes in the frontal region of the patient's most interesting indicators of the index or entropy, then after catheterization of peripheral or Central vein of a patient infusion therapy intravenous ringer's solution, or physiological solution of sodium chloride in 500 ml and begin to carry out inotropic therapy 200 mg of a solution of dopamine hydrochloride, dissolved in 40 ml of saline in a dose of 5 mcg/kg/min, cardioprotective therapy by intravenous injection of 0.5%solution of nitroglycerin in an initial dose of 0.3 mcg/kg/min,maintaining the peripheral resistance of the vessels is carried out by intravenous the introduction of the 10 mg solution mezatona, dissolved in 50 ml of physiological solution with an initial infusion rate in a dose of 0.3 mcg/kg/min, then when the heart rate of 80 beats per minute start induction in anesthesia by intravenous injection of a solution of propofol at a dose of 0.5-1 mg/kg or thiopental sodium at the dose of 1.5-4 mg/kg, or inhalation of preparation to achieve the level of depth of anaesthesia according to the most interesting index or entropy within 40-60 units, and achieve analgesia by intravenous injection of 0.005%-aqueous solution of fentanyl in a dose of 5 g/kg, diplegia provide by intravenous nedepoliarizuth solution muscle relaxant nimbexa at a dose of 0.15 mg/kg or tracrium at a dose of 0.5-0.6 mg/kg, or esmeron at a dose of 0.3 mg/kg, and through 90-100 with inkubiruut the trachea of the patient and transfer him to a forced artificial lung ventilation mode volume ventilation with the level of CO2within 35-45 mm Hg according to capnography, and maintenance of anesthesia are filing inhalation anesthetic preparation or isoflurane to the level of 0.8-1.0 MAC flow 0,8-0,9 l oxygen-air mixture containing 50% oxygen by volume control inhalation anesthetic supply the level of depth of anesthesia is the most interesting indicators of the index or entropy, then before performing regional anesthesia deep and superficial what about the cervical plexus anatomical points of the cervical plexus of the patient, at the same time as the first point of reference define the tubercle VI cervical vertebra (carotid tubercle), as the second reference point - the mastoid process of the temporal bone, after which a sterile marker or dye antiseptic spend on skin connecting these landmarks line, then spend the second line is 1 cm below and parallel to the first, and to verify the site of injection of local anesthetic is determined by palpation of the transverse processes of C4With3With2vertebrae, which are at a distance of 1.5 cm from each other, with the countdown starting from C6vertebra, then perform regional anesthesia deep and superficial cervical plexus, and when the blockade deep cervical plexus to reduce the distance from skin to bone structures use the effect of the pressure of the finger, whereupon the needle on the syringe perpendicular to the skin and a few in a caudal direction until reaching the transverse process of constant performing suction of the sample due to the slight pull of the plunger of the syringe, and in the absence of blood in the syringe with a clear sense of bone structures perform the injection of a 0.5%aqueous solution of local anesthetic marcaine hydrochloride or naropin hydrochloride 5-7 ml in each point of C4With3With2and impose additional 5-7 ml of local anesthetic solution Mar who ain hydrochloride or naropin hydrochloride in point, located in the apex of the mastoid process, and then block the superficial cervical plexus from a point located at the middle of the lateral legs of sternocleidomastoid muscle (sternocleidomastoid muscle) injection of local anesthetic solution of marcaine (bupivacaine) hydrochloride or naropin (ropivacaine) hydrochloride in the amount of 15 ml under specified muscle is fan-shaped, 4-5 ml in each direction from one point, and the first and subsequent injections are performed to a depth of intramuscular needle perpendicular to the sternocleidomastoid muscle.

2. The method according to claim 1, characterized in that the warning vagusnye effects conduct, in the absence of contraindications, the introduction of a 0.1%solution of atropine sulfate at a dose of 0.3-0.5 mg

3. The method according to claim 1, characterized in that as an antiseptic dye when defining anatomical landmarks of the cervical plexus using a sterile marker, antiseptic potassium iodide or brilliant green.

4. The method according to claim 1, characterized in that when regional anesthesia deep and superficial cervical plexus injection use syringe of 10 ml, and the needle 22 G or standard intramuscular needle.



 

Same patents:

FIELD: medicine.

SUBSTANCE: invention refers to medicine, namely anaesthesia, and may be used as a postoperative anaesthesia accompanying low- and medium-injury operations. For this purpose, at the stages of anaesthetising and de-anaesthetising, nonsteroidal anti-inflammatory compounds (NSAICs) are introduced intravenously. The NSAIC dose is equivalent to ketorol 0.5-3.0 ml. The introduction is performed 1-3 times.

EFFECT: method provides the complete prevention of developing postoperative pain syndrome ensured by the intravenous introduction of the NSAIC at the specific stages of anaesthesia in certain doses.

1 tbl, 5 ex

FIELD: medicine.

SUBSTANCE: presented group of inventions refers to anaesthesiology, and may be used in performing X-ray endovascular heart, aorta and other great vessel surgeries in infants and young children. For this purpose, 10-12 hours before the surgery, a patient is pre-medicated by administering benzodiazepine, antihistamine and blocker H2. The anaesthetic administration is enabled by fast induction of sevoflurane before the first surgical stage. Then, a two-flap laryngeal mask is used, its drainage duct is used to pass a gastric probe a correct placement of which is monitored by X-ray, and the gastric contents is evacuated. The probe is removed, and the same duct is used to insert an echocardiographic probe. The anaesthesia is maintained by infusion of propofol in a dose of 6-8 mg/kg/h and bolus introduction of an opioid analgesic. The artificial pulmonary ventilation is conducted through the laryngeal mask, and the patient is transferred to unassisted respiration with a dose of propofol to be reduced to 4-5 mg/kg/h. The principal stage of the surgery and ultrasonic control, or control with introducing a contrast agent, the echocardiographic probe is removed. Infusion of propofol is terminated after suturing and compression hemostasis. In the period of escaping the anaesthesia with the laryngopharyngeal reflexes recovered, air is evacuated from a cuff of the laryngeal mask, and after adequate respiration recovered, the same mask is removed.

EFFECT: group of inventions ensures the adequate anaesthesia in these patients by means of the developed method of lung ventilation using no myorelaxants, and prevented regurgitation of the gastric contents.

8 cl, 3 ex

FIELD: medicine.

SUBSTANCE: invention refers to medicine, in particular to anesthesiology and intensive care, and may be used if preoperative preparation of the patients with chronic pancreatitis and manifested pain syndrome required. For this purpose, back skin of a sitting patient is treated within a puncture at the Th7-Th8 level. Then, an epidural space is punctured, and a puncture catheter needle is introduced therein, and the catheter is pushed forward in the cranial direction to a depth of 3 cm. The needle is removed, and the catheter is placed along the spine and is brought out to the subclavian region while strapped all over. Thereafter, a test dose of 2% lidocaine 3.0 ml is introduced. If observing no effects of spinal block, prolonged permanent introduction of 0.2% ropivacaine at rate 4-5 ml/hour 3 times a day. With underlying it, 30 minutes before a meal, fractional introduction of 0.75% ropivacaine 3.0 ml and 0.005% fentanyl 1.0 ml for 4-5 days is performed.

EFFECT: method provides the adequate preparation of the patients for pancreatic surgery due to pain relief that enables supplying proteins and eliminating hypovolemia, as well as due to improved pancreatic-duodenal microcirculation.

2 ex

FIELD: medicine, pharmaceutics.

SUBSTANCE: present invention refers to new derivatives of ((phenyl)imidazolyl)methylheteroaryl of formula wherein A represents pyridyl or thienyl having 0 or 1 substitute; B represents phenyl having 0, 1 or 2 substitutes; wherein each substitute independently represents alkyl having 1 to 8 carbon atoms, -F, -Cl, -Br or -CF3. Also, the invention refers to the use of the declared compounds for the purpose of preparing a therapeutic agent, a pharmaceutical composition on the basis of the declared compounds, and to a kit containing the pharmaceutical composition above.

EFFECT: there are prepared new derivatives of ((phenyl)imidazolyl)methylheteroaryl effective in pain management.

10 cl, 1 tbl, 2 ex

FIELD: medicine.

SUBSTANCE: invention relates to field of medicine, in particular, to experimental anesthesiology and resuscitation science. Method is realised in experiment by introduction of protamine sulfate in dose 10 mg/kg of animal weight before introduction of narcotic medication such as ether, or ethanol, or droperidol, or aminasin, or sodium oxybutirate.

EFFECT: invention makes it possible with introduction of narcotic medication to ensure short time of falling asleep of operated animal and long sleep during surgery.

2 tbl, 5 ex

FIELD: medicine, pharmaceutics.

SUBSTANCE: present invention refers to a new (-)-stereoisomer of formula (I) wherein X is H, or its pharmaceutically acceptable salt which agonise GABA receptor, to a pharmaceutical composition on the basis of the presented compound, to a method for preparing the (-)-stereoisomer of formula (I) or its pharmaceutically acceptable salt, to a method for inducing or maintaining general anaesthesia, to a method for promoting pain management and to a method for promoting pain management and to a method for prototyping antiemetic activity with the use of the presented (-)-stereoisomer or its pharmaceutically acceptable salt, as well as to a new diastereoisomer (-)-2,6-di-fluoro-butylphenyl ester of carbamic acid of formula (II) wherein R1 represents a chiral amino group, and X is H, or to its pharmaceutically acceptable salt.

EFFECT: preparing the pharmaceutically acceptable salt which agonise GABA receptor.

14 cl, 15 ex, 8 tbl, 3 dwg

FIELD: medicine, pharmaceutics.

SUBSTANCE: present invention refers to a new (-)-stereoisomer of formula (I) wherein X is H, or its pharmaceutically acceptable salt which agonise GABA receptor, to a pharmaceutical composition on the basis of the presented compound, to a method for preparing the (-)-stereoisomer of formula (I) or its pharmaceutically acceptable salt, to a method for inducing or maintaining general anaesthesia, to a method for promoting pain management and to a method for promoting pain management and to a method for prototyping antiemetic activity with the use of the presented (-)-stereoisomer or its pharmaceutically acceptable salt, as well as to a new diastereoisomer (-)-2-fluoro-butyl-6-isopropylphenyl ester of carbamic acid of formula (II) wherein R1 represents a chiral amino group, and X is H.

EFFECT: preparing the pharmaceutically acceptable salt which agonise GABA receptor.

16 cl, 12 ex, 6 tbl, 4 dwg

FIELD: medicine.

SUBSTANCE: for the purpose of the anaesthetic therapy if indicated with the general anaesthesia of Sevorane and Fentanyl is combined with injecting 1% or 0.75% Naropin 5.0-25.0 ml in the beginning of the surgery in an introduction point of each Thoracoport. The surgery is followed by the non-narcotic analgesic anaesthesia if indicated.

EFFECT: invention provides preventing the postoperative pain syndrome, continuous postoperative maintenance of the anaesthesia and prevented developing chronic pain.

3 ex

FIELD: medicine.

SUBSTANCE: what is involved is preanesthetic medication with xylazine. The preparation 'Zoletil 50' 0.5 mg/kg of rat's body weight is introduced intramuscularly for conducting main anaesthesia.

EFFECT: method provides adequate anaesthesia with simultaneous reduction of time of postanesthetic recovery that reduces the possibility of developing postoperative complications.

1 ex

FIELD: medicine.

SUBSTANCE: invention relates to medicine, namely to anesthesiology, and can be used in patients during and after highly traumatic operations on thoracic and lumbar spine. For this purpose general anesthesia is performed with sevoflurane. Additionally during operation epidural analgesia is performed by infusion of mixture of 0.2% solution of ropivacaine with fentanyl 2 mcg/ml and adrenalin 2 mcg/ml at rate 5-10 ml/hour. In postoperative period anesthesia is performed by constant infusion of mixture at rate 4-8 ml/hour.

EFFECT: method makes it possible to ensure adequate and safe anesthesia during surgery due to breaking pain impulsation at the level of spine cord segments in combination with superficial sedation, as well as in postoperative period due to multidirectional action of mixture components.

1 ex

FIELD: medicine.

SUBSTANCE: invention refers to medicine, namely anaesthesia, and may be used as a postoperative anaesthesia accompanying low- and medium-injury operations. For this purpose, at the stages of anaesthetising and de-anaesthetising, nonsteroidal anti-inflammatory compounds (NSAICs) are introduced intravenously. The NSAIC dose is equivalent to ketorol 0.5-3.0 ml. The introduction is performed 1-3 times.

EFFECT: method provides the complete prevention of developing postoperative pain syndrome ensured by the intravenous introduction of the NSAIC at the specific stages of anaesthesia in certain doses.

1 tbl, 5 ex

FIELD: medicine.

SUBSTANCE: invention refers to medicine, namely to anaesthesiology and neurology, and may be used in spinal anaesthesia. Laser Doppler flowmetry is used to measure skin microcirculation on an anterolateral body surface. For this purpose, before the spinal anaesthesia the microcirculation is measured at T10 and 5 minutes after the spinal anaesthesia, at L1, T12, T11, T10, T9, T8, T7, T6, T5, T4, T3, T2. If the microcirculation appears to increase by 40% or more of the initial values, the effective sympathetic block from this segments and below is diagnosed. When the microcirculation increases less than 40%, it is stated that the sympathetic block is absent.

EFFECT: method enables the most quick determination of the levels of the sympathetic block component in the spinal anaesthesia ensured by measuring the skin microcirculation parameters of the anterolateral body surface.

1 ex

FIELD: medicine.

SUBSTANCE: invention refers to medicine, namely to anaesthesiology and neurology, and may be used in epidural anaesthesia. Laser Doppler flowmetry is used to measure skin microcirculation on an anterolateral body surface before the epidural anaesthesia at T10 and 15 minutes after the epidural anaesthesia at L5, L4, L3, L2, L1, T12, T11, T10, T9, T8, T7, T6, T5, T4, T3, T2. If the microcirculation appears to increase by 40% or more of the initial values, the effective sympathetic block within the segments that meet these conditions is diagnosed. When the perfusion growth is less than 40%, it is stated that the sympathetic block is absent.

EFFECT: method enables the most quick determination of the levels of the sympathetic block component in the epidural anaesthesia ensured by measuring the skin microcirculation parameters of the anterolateral body surface.

FIELD: medicine.

SUBSTANCE: invention refers to medicine, namely to anaesthesiology, and may be used in epidural anaesthesia. What is presented is an apparatus comprising a guide cylinder with a digital scale, with the mark pitch for an epidural needle. The guide cylinder is fixed on the periphery of a support plate window rotating in a perpendicular plane at an angle up to 160. The window is placed in a projection of the interspinous space selected for puncture. The cylinder is specified to have the length of 0.44-0.45 equal to the effective length of the epidural needle, and an internal diameter greater than an outer diameter of the needle not more than in 1.42 times.

EFFECT: provided direct needle penetration into the epidural space by preventing lateral needle deviation when passing through patient's spinal soft tissues and ligaments with puncture of the epidural space from the median approach.

3 cl, 2 tbl, 4 dwg

FIELD: medicine.

SUBSTANCE: invention refers to medicine, in particular to anesthesiology and intensive care, and may be used if preoperative preparation of the patients with chronic pancreatitis and manifested pain syndrome required. For this purpose, back skin of a sitting patient is treated within a puncture at the Th7-Th8 level. Then, an epidural space is punctured, and a puncture catheter needle is introduced therein, and the catheter is pushed forward in the cranial direction to a depth of 3 cm. The needle is removed, and the catheter is placed along the spine and is brought out to the subclavian region while strapped all over. Thereafter, a test dose of 2% lidocaine 3.0 ml is introduced. If observing no effects of spinal block, prolonged permanent introduction of 0.2% ropivacaine at rate 4-5 ml/hour 3 times a day. With underlying it, 30 minutes before a meal, fractional introduction of 0.75% ropivacaine 3.0 ml and 0.005% fentanyl 1.0 ml for 4-5 days is performed.

EFFECT: method provides the adequate preparation of the patients for pancreatic surgery due to pain relief that enables supplying proteins and eliminating hypovolemia, as well as due to improved pancreatic-duodenal microcirculation.

2 ex

FIELD: medicine.

SUBSTANCE: invention refers to medicine, namely anesthesiology, intensive therapy and endosurgery, and may be used in patients in need of endoscopic transpapillary intervention. That is ensured by an intravenous infusion therapy with crystalloid solutions in the amount of 800-1200 ml. An epidural space is punctured and catheterised at the level of Th VIII - Th IX with the catheter moved by 4-5 cm in the cranial direction. A local anaesthetic solution and Clopheline 100 mcg are introduced through the epidural catheter at the level of Th V - Th X 20 minutes before the endoscopic transpapillary intervention. It is followed by pre-medication enabled by introducing 0.1% atropine 0.5-1 ml and 0.5% relanium 1-2 ml, and the patient is wheeled into a catheterisation laboratory. After the endoscopic transpapillary intervention completed, the patient is transferred into an intensive therapy unit wherein prolonged epidural analgesia is enabled by introducing 0.5-1% lidocaine 10 ml into the epidural space every 4 hours. If observing no clinical manifestations of postoperative pancreatitis, the epidural catheter is removed, and the patient is transferred into a department of surgery for symptomatic treatment.

EFFECT: method enables preventing acute postoperative pancreatitis following such interventions due to action of a general mechanism of pathogenesis of the given pathology.

1 ex

FIELD: medicine.

SUBSTANCE: invention relates to ophthalmology and can be applied for instillation anaesthesia in cavity eye operations on anterior segment of eye, in particular in phacoemulsification of cataract with implantation of IOL. For this purpose two hours before operation instillations of viceine or vita-iodurol in dose 2 drops into conjunctival cavity of operated eye are carried out every 15 minutes, eight times in total. One hour before operation simultaneously started is instillation of local anesthetic inocaine or alcaine in dose 2 drops every 10 minutes, five times. Interval of instillation between vitaiodineurol or viceine and local anesthetic constitutes five minutes.

EFFECT: method ensures increased anaesthesia efficiency due to increase of cornea permeability and reduction of operation and post-operation complications due to reduction of toxic action of anesthetic.

2 ex

FIELD: medicine.

SUBSTANCE: invention relates to medicine, namely to anesthesiology, and can be used in carrying out spinal anesthesia. For this purpose before and during spinal anesthesia constant monitoring of diastolic and mean arterial blood is performed. If their values are lower than 47 and 68 mm Hg, risk of postpuncture syndrome development is estimated as high.

EFFECT: method makes it possible to prevent development of postpuncture syndrome due to estimation of selected parameters.

1 tbl, 3 ex

FIELD: medicine.

SUBSTANCE: invention relates to medicine, namely, to vascular surgery and anesthesiology, and can be applied in surgical treatment of varicose disease of lower extremities with application of endovasal laser coagulation of veins. For this purpose paravasal infiltration of tumescent solution is realised. As such, cooled to 6-7C0 ozonised 4-5 mkg/l physiological solution is introduced. Introduction is carried out under continuous ultrasonic navigation into fascial sheath of coagulating vessel and hypodermic cellular tissue.

EFFECT: method makes it possible to ensure reduction of expression of post-operative pain syndrome, as well as prevent development of local inflammatory complications due to vein spasm and neutralisation of warming up of cellular-tissue structures at the moment to laser exposure.

FIELD: medicine.

SUBSTANCE: after performing main stage of surgery, under visual control needle puncture is performed into retroperitoneum space of right iliac fossa perpendicularly to skin, 1 cm inward from anterior superior iliac spine. Needle is passed inward, downward and frontward to the depth 6-8 cm, sliding on internal surface of iliac bone. Conductor is introduced through needle lumen and polyethylene catheter, through which after the end of operation, after 4-6 and 10-12 hours introduced is naropin in dose 2.5 mg/ml in 0.9% sodium chloride solution, is installed.

EFFECT: method makes it possible to ensure adequate and safe anesthetics in post-operative period due to accuracy of introduction of anesthetic directly in the zone of surgery.

2 ex

FIELD: medicine.

SUBSTANCE: inventions relate to medicine, namely, to thoracic surgery, and can be applied for control of pneumostasis. For this purpose indicator substance is additionally introduced into breathing mixture in carrying out artificial lung ventilation (ALV). As such means sulfur hexafluoride in ratio 1:5000 is applied. Detection of indicator means and intensity of its leakage flow in real time mode is used to judge about presence and degree of microdefect in the area of sutured tissue.

EFFECT: group of inventions makes it possible to realise effective control of lung tissue, bronchus stump and tracheobronchial sutures impermeability.

2 cl, 2 ex

Up!