Method for measuring sympathetic block in epidural anaesthesia (analgesia)

FIELD: medicine.

SUBSTANCE: invention refers to medicine, namely to anaesthesiology and resuscitation, and may be used in epidural anaesthesia. That is ensured by administering slowly intravenously a basic dose of the local anaesthetic: 0.2-1% naropin or 0.2-0.5% marcaine, or 1-2% lidocaine; 1% Sol. Nicotini acidi 1% - 0.5-1 ml into the epidural space 10-20 minutes later. After 5-10 minutes, nicotine test results are visually evaluated by determining a clear interface of skin colour - hyperemic and normal - along an axillary line from both sides. The normal skin interface corresponds to the sympathetic block.

EFFECT: method provides higher accuracy and simplification of measuring the sympathetic block.

1 ex

 

The invention relates to medicine, in particular to anesthesiology and surgery, and for determining the level of sympathetic blockade with epidural anesthesia.

Epidural anesthesia has long been successfully used in various surgical interventions. Its widespread use is due not only to adequate pain relief, but also a number of positive effects (improved circulation, relaxation of sphincters of the gastrointestinal tract, increased peristalsis, and others) sympathetic blockade. But when different surgical interventions, depending on the designated operating aggression and the desired effect, it is necessary to block the pathological impulses of different segments of the spinal cord[1, 2, 3].

There is a way to determine the level of sympathetic blockade with epidural anesthesia, based on the belief that sympathetic blockade always 2-3 segment above and below the nociceptive blockade.

The disadvantage of this method is its low accuracy and bias due to the fact that the level of sympathetic blockade affects both the level of puncture of the epidural space and pharmacological properties and concentration of the applied local anesthetic.

Known second method of determining the level of sympathetic blockade with epidural anesthesia with the use of the hall the annual sample (prototype). Cold test based on detection of changes in the microcirculation of the skin in areas with preserved sympathetic innervation in response to local cooling. Assess changes in the microcirculation visually or with the use of laser Doppler flowmetre.

The disadvantages of this method are its lack of accuracy when visual assessment or the high cost and complexity when using flowmetre.

The technical result of the claimed method is to improve the accuracy and simplify the determination of the level of sympathetic blockade with epidural anesthesia.

The technical result is achieved in that the method of determining the level of sympathetic blockade with epidural anesthesia needed 10-20 minutes after injection into the epidural space of the patient primary doses of local anesthetics: solutions naropin 0.2 to 1%, or marcaine of 0.2-0.5%or lidocaine 1-2%, intravenously slowly enter Sol. Nicotini acidi 1% - 0,5-1 ml and 5-10 minutes to visually assess the results of nicotine samples", defining in the mid-axillary line with the two sides a clear boundary separating skin color - damaged and normal color, and the border of normal skin color match the level of sympathetic blockade.

The essence of the proposed method

Improving the accuracy and simplification of the definition in the anti-shudder performance of sympathetic blockade with epidural anesthesia is achieved by slow intravenous introduction of Sol. Nicotini acidi 1% - 0,5-1 ml 10-20 minutes after injection into the epidural space of the patient primary doses of local anesthetics: solutions naropin 0.2 to 1%, or marcaine of 0.2-0.5%or lidocaine 1-2%, followed by 5-10 minutes a visual assessment of color changes of the skin in the mid-axillary line on two sides, with the boundaries of normal skin color match the level of sympathetic blockade.

During the prospective study in the state budgetary educational institution of higher professional education "Volgograd state medical University Clinic No. 1 in 2010-2012 in 214 patients it was shown that the application of this method of determining the level of sympathetic blockade with epidural anesthesia in 93.6% of observations helps to accurately determine the boundaries of sympathetic block.

When using the inventive method equivocal results were obtained in patients with severe jaundice (total bilirubin more than 300 µmol/l) and in patients with advanced atherosclerosis.

Methodology the proposed method

The method is as follows. 10-20 minutes after injection into the epidural space of the patient primary doses of local anesthetics: solutions naropin 0.2 to 1%, or marcaine of 0.2-0.5%or lidocaine 1-2%, you intravenously slowly enter Sol. Nicotini acidi 1% - 0,5-1 ml and 5-10 minutes to visually assess the results of nicotine samples", Opredelitel the mid-axillary line with the two sides a clear boundary separating skin color - damaged and plain color, with the boundaries of normal skin color match the level of sympathetic blockade.

Specific example

Patient N., 81 year history No. 2518, was admitted to the surgical Department of the hospital №1 Wagga 09.06.11 at 09.40 hours with a diagnosis of post-cholecystectomy syndrome. Choledocholithiasis. Acute pancreatitis.

Patient transferred to the intensive care unit for preparation for endoscopic papillosphincterotomy. As anesthesia due to significant pain syndrome decided to use thoracic epidural analgesia.

The Protocol thoracic epidural analgesia

Infusion therapy: P-p NaCl 0,9% - 400 ml, P-p Glucose 5% - 400 ml.

Under aseptic conditions, under local anesthesia Sol. Lidocaini 2% - 2 ml, level ThVIII - ThIX with technical difficulties produced puncture and catheterization of the epidural space, the catheter is pulled to 5 cm in the cranial direction, the suction test is negative, put a test dose of Sol. Lidocaini 2% to 4 ml. After 5 min of signs of intrathecal injection of anesthetic no. Entered the main dose - Sol. Marcaini 0,2% - 12 ml. Pain the patient has not decreased. To control the level of sympathetic blockade after 20 minutes after introduction of the basic dose/slowly entered Sol. Nicotini acidi 1% to 0.5 ml. After 5 minutes the redness of the skin of the whole body. DM the LAN conclusion about the absence of sympathetic blockade, the epidural catheter was removed and decided to try catheterization of the epidural space.

Level ThVII - ThVIII produced puncture and catheterization of the epidural space, the catheter is pulled to 5 cm in the cranial direction, the suction test is negative, put a test dose of Sol. Lidocaini 2% to 4 ml. After 5 min of signs of intrathecal injection of anesthetic no. Entered the main dose - Sol. Marcaini 0,2% - 12 ml. Pain the patient is decreased. The skin of the patient and the regular color. To control the level of sympathetic blockade after 20 minutes after introduction of the basic dose/slowly entered Sol. Nicotini acidi 1% to 0.5 ml. After 5 minutes the redness of the skin up to 4 intercostal space in the mid-axillary line on both sides. The level of sympathetic block is considered sufficient. Aseptic dressing, catheter fixed with adhesive tape.

09.06.11 was made urgent endoscopic papillosphincterotomy with instrumental revision, lithoextraction, readjustment of the choledochus.

Advantages, the positive effect of the claimed method:

- this method is simple in execution;

- the claimed method allows you to verify that produced catheterization of the epidural space;

- proven reliability of result;

- safe in patients with severe comorbidity;

- does not require much material is s costs.

Literature

1. Gorobets Y.S., Garyaev W. reflections on postoperative analgesia and the introduction of epidural analgesia in the national surgical clinic // Regional anesthesia and acute pain management, 2007; 1 (1): 42-51.

2. Ovechkin A.M. Postoperative pain syndrome: clinical and pathophysiological significance and future directions of therapy. //Consilium medicum 2005; 7 (6): 485-490.

3. Park, W.Y., Thompson J.S, Lee K.K. Effect of epidural anesthesia and analgesia on perioperative outcome: a randomized, controlled veterans affairs cooperative study//Ann. Surg. 2001; 234: 560-569.

The method of determining the level of sympathetic blockade with epidural anesthesia, characterized in that in 10-20 minutes after injection into the epidural space of the patient is the primary dose of local anesthetic: solutions naropin 0.2 to 1%, or marcaine of 0.2-0.5%or lidocaine 1-2%, intravenously slowly introducing Sol. Nicotini acidi 1% - 0,5-1 ml and 5-10 minutes to visually assess the results of nicotine samples", defining in the mid-axillary line with the two sides a clear boundary separating skin color - damaged and normal color, and the border of normal skin color match the level of sympathetic blockade.



 

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FIELD: medicine.

SUBSTANCE: thoracic epidural analgesia is conducted by puncturing and catheterisation of an epidural space at ThVIII - ThIX before the expiry of 24 hours from the onset of a disease after a moderate intravenous infusion therapy in the amount of 15-20 mg/kg of crystalloid solutions. 20 minutes before an expected endoscopic papillosphincterotomy, a catheter is moved 4-5 cm in a cranial direction. At ThV-ThX, 0.4% naropin 10-12 ml or 0.2% Marcaine 10-12 ml and clonidine 100 mcg are administered through a catheter. That is followed by a pre-medication by administering 0.1% atropine 0.5-1 ml and 0.5% relanium 1-2 ml. Thereafter, the patient is taken to an X-ray operation room to conduct the endoscopic papillosphincterotomy without an endoscopic retrograde cholangiopancreatography with general pancreatic duct stenting. After the operation has been completed, the patient is taken to an intensive care unit wherein an extended epidural analgesia is conducted by administering 0.2% naropin 10-12 ml or 0.15% marcaine 10-12 ml into the epidural space every 4 hours until the patient is taken to a department of surgery.

EFFECT: early intestinal motility recovery, increased pancreatic secretion, prevented spasm of the gastrointestinal sphincter ensured by a pathological complete blockade of sympathetic impulsing.

1 ex

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2 tbl, 2 ex

FIELD: medicine.

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4 cl, 3 ex

FIELD: medicine.

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1 tbl, 5 ex

FIELD: medicine.

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8 cl, 3 ex

FIELD: medicine.

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2 ex

FIELD: medicine, pharmaceutics.

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10 cl, 1 tbl, 2 ex

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2 tbl, 5 ex

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14 cl, 15 ex, 8 tbl, 3 dwg

FIELD: medicine.

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4 dwg, 3 ex

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3 ex

FIELD: medicine.

SUBSTANCE: thoracic epidural analgesia is conducted by puncturing and catheterisation of an epidural space at ThVIII - ThIX before the expiry of 24 hours from the onset of a disease after a moderate intravenous infusion therapy in the amount of 15-20 mg/kg of crystalloid solutions. 20 minutes before an expected endoscopic papillosphincterotomy, a catheter is moved 4-5 cm in a cranial direction. At ThV-ThX, 0.4% naropin 10-12 ml or 0.2% Marcaine 10-12 ml and clonidine 100 mcg are administered through a catheter. That is followed by a pre-medication by administering 0.1% atropine 0.5-1 ml and 0.5% relanium 1-2 ml. Thereafter, the patient is taken to an X-ray operation room to conduct the endoscopic papillosphincterotomy without an endoscopic retrograde cholangiopancreatography with general pancreatic duct stenting. After the operation has been completed, the patient is taken to an intensive care unit wherein an extended epidural analgesia is conducted by administering 0.2% naropin 10-12 ml or 0.15% marcaine 10-12 ml into the epidural space every 4 hours until the patient is taken to a department of surgery.

EFFECT: early intestinal motility recovery, increased pancreatic secretion, prevented spasm of the gastrointestinal sphincter ensured by a pathological complete blockade of sympathetic impulsing.

1 ex

FIELD: medicine.

SUBSTANCE: group of inventions refers to medicine, namely otorhinolaryngology and may be used for various ear diseases. That is ensured by presenting the systems for electrophoresis drug delivery to a human or animal ear drum. The system contains an ear tampon having distal and proximal portions with a tube passing in between and having a smaller rigidity as compared to the proximal and distal portions of the ear tampon. One flexible sealing element extending from an external surface of the tube and closer to a distal end than to a proximal one. An electrode consisting of an extended shaft, a tip having a greater diameter as compared to the trunk. The electrode is placed inside of the tube of the ear tampon from the retracted position wherein a fluid can flow in the tube round the electrode into the extended position, wherein the electrode tip is in contact with the internal surface of the tube thereby preventing the fluid flow in the tube. The system can also comprise two flexible sealing members integrated with the extended tube. There are also presented methods for anaesthetising the ear drum by using the given system. There are presented kit for anaesthetising comprising the drug delivery system and controller coupled with the electrode.

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23 cl, 12 dwg

FIELD: medicine.

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EFFECT: method ensures prevention of development of high spinal blockade due to correction of local anesthetic dose before surgical intervention with taking into account patient's individual peculiarities.

1 tbl, 1 dwg, 3 ex

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

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: group of inventions refers to the veterinary science and is applicable for treating hyperthyroidism of felines. There are declared a method, a composition, a kit and using selenium for treating hyperthyroidism of felines. The method involves feeding a feline with the composition containing approximately 0.1 to less than approximately 1 mg/kg of selenium at a dry basis in a combination with administering an antithyroid agent into the feline. The declared composition contains approximately 0.1 to less than approximately 1 mg/kg of selenium at a dry basis and a therapeutically effective amount of the antithyroid agent. The kit comprises the composition containing approximately 0.1 to less than approximately 1 mg/kg of selenium at a dry basis, the antithyroid agent, and a package insert. What is also declared is using selenium for preparing the declared composition.

EFFECT: group of inventions is high effective for treating hyperthyroidism of felines.

5 tbl, 3 ex

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