Method for anaesthesia accompanying adenotomy and tonsillotomy in children

FIELD: medicine.

SUBSTANCE: invention refers to medicine, namely to anaesthesiology and emergency medicine, and can be used in anaesthetic management of nasal and oropharyngeal operations in otorhinolaryngeal surgery in children. To this effect, the surgical intervention is preceded by inhalations of 2% lidocaine through a nebuliser at 4 mg/kg of body weight in the maximum dose of 200 mg. A peripheral vein is catheterised. A riskless challenging trancheal intubation requires inducing anaesthesia with Sevorane 8 vol %, N2O/O2 1/1 6 l/min. The intubation is preceded by 2 forced inhalations through an anaesthetic apparatus with a face mask. The pulmonary ventilation effectiveness is assessed by the respiratory excursion. The adequate pulmonary ventilation requires intravenous administration of the nondepolarising muscle relaxant Tracrium 0.4 mg/kg. Once reaching stage III2 narcosis, the trachea is intubated, and a gas flow in the contour is reduced to 1.0 l/min. Anaesthesia is maintained with Sevorane 1.5-2 vol %, 0.7 MAK, with N2O/O2 1/1 1 l/min, 0.5 MAK. The signs of the challenging trancheal intubation enable inducing anaesthesia with Sevorane 8 vol % at a high O2 gas flow at 6 l/min. The intubation is preceded by 2 forced inhalations through the anaesthetic apparatus with the face mask. The pulmonary ventilation effectiveness is assessed by the respiratory excursion. Once reaching stage III2 narcosis with adequate pulmonary ventilation and maintained unassisted respiration, the trachea is intubated, and the gas flow in the contour is reduced to 1.0 l/min. The nondepolarising muscle relaxant Tracrium 0.4 mg/kg is administered intravenously. Anaesthesia is maintained with Sevorane 2-3 vol %, 1 MAK with the artificial pulmonary ventilation with the gas mixture of O2/Air - 0.5/0.5 l/min. Once the operation is completed, inhalation with 100% O2 in a semi-open contour with a high gas flow at 5.0 l/min is performed.

EFFECT: method provides the adequate anaesthesia in the given category of patients with no narcotic analgesics used by a differentiated approach to a dose schedule of inhalation anaesthetics and a myorelaxant caused by a risk degree of the challenging tracheal intubation.

4 tbl, 2 ex

 

The invention relates to medicine and can be used for anesthetic management of surgical interventions in the oral cavity and oropharynx in ENT surgery in children.

Inhalation anesthesia is a common type of anesthesia and is often used for induction and maintenance of anaesthesia. Regardless of the age of inhalation anesthesia provides: rapid achievement of the desired concentration of anesthetic in the body and its rapid decline, good handling anesthesia, the possibility of approximate control of the content of anaesthetic in systemic blood on information about the concentration of anesthetic in the circuit exhalation.

The known method combined analgesia as a component of anesthesia during adenotomy and tonsillotomy, which consists in the introduction at the beginning of the operation of narcotic analgesics (codeine or fentanyl), the purpose of paracetamol and NSAIDs. For induction of anesthesia used as intravenous and inhalation anesthetics, the airway provide either a laryngeal mask or endotracheal tube during anesthesia child or breathe on their own, or you spend a ventilator on the background of myorelaxation (black, E. child / E. black, A. MacEwan; Ed. by A. M. Zeitlin. - M.: Practice, 2007. - p.100-102).

Significant the disadvantages of the proposed method are: the postoperative period is often complicated by nausea and vomiting, especially, when using fentanyl narcotic analgesics lengthen the period of awakening, can cause bradypnoea, apnea especially in younger children in the early postoperative period.

Known method of analgesia when nasotracheal intubation in the form of inhalation of lidocaine with oxygen through the transparent mask. Lidocaine is rapidly absorbed through the mucous membranes, which makes it necessary for the exact calculation of the total dosage of the drug. You should not assign it in doses greater than 4-5 mg/kg Concentration of lidocaine in the blood plasma of children who achieved a 3.0 µg/ml after inhalation of aerosols of lidocaine in a dose of 3 mg/kg. This level is much lower than the toxic equal to 6-10 µg/ml, sometimes causing toxicity CNS. Patients with a body weight of 10-15 kg can get 1.0 to 1.5 ml of 4% lidocaine in 2 ml of normal saline. Infants weighing 15-20 kg can get 1.5-2.0 ml of 4% lidocaine in 2 ml of normal saline. In children weighing 20-30 kg volume of this solution (4% lidocaine in 2 ml of normal saline) can be increased to 3-4 ml of the Dilution of 4% lidocaine solution not necessarily for the older children (body weight above 35 kg). They can also get 3-4 ml of 4% lidocaine solution (Gregory GA Anesthesia in Pediatrics: Per. s angl. Ed. GA Gregory. - M.: Copper is in, 2003. - s).

The disadvantage of the proposed method of anesthesia is the limited field of application, in particular ensuring compliance with nasotracheal intubation, not developed an accurate dose in mg/kg, and concentration of inhalation solution for analgesia when adenoidectomy and tonsillotomy.

The closest is the way inhalation anesthesia in combination of preparation and nitrous oxide, selected as a prototype. For 40 min before the operation is performed by atropine 0.01 mg/kg intramuscularly and midazolam (0.2 mg/kg intramuscularly). The induction is performed in a semi-open circulation circuit with high Gattaca (HFA, 5,0 l/min) according to the scheme N2O/O22:1 was launched immediately, on application of the facial mask (denitrogenization nitrous oxide). Upon reaching III2under anaesthesia set laryngeal mask or perform tracheal intubation. Before intubation intravenous fentanyl (3 μg/kg) and one of the depolarizing relaxants (tracrium 0.6 mg/kg nimbeks of 0.12 mg/kg).

After installing the endotracheal tube or laryngeal mask inflate their sealing cuff, then reduce gazook in the circuit up to 0.5 l/min (MFA) or 1.0 l/min (LFA). Further readings perform regional anesthesia (lumbar or caudal epidural blockade, blockade of peripheral nerves or splice the s) solutions of local anesthetic (0.25% bupivacaine, 0,2% ropivacaine) without epinephrine at a standard dosage. Maintenance of anesthesia are in semi-closed circuit with minimal (0.5 l/min, MFA) or low (1.0 l/min, LFA) Gattaca scheme 0,6 MAC N2O + 0.7 POPPY anesthetic, that is, (1.3 MAC), i.e., N2O/O22:1 + moreover, 1,4% (volumetric concentration at the end of exhalation). Upon completion of the operation stop supply of all volatile anesthetics, getting to inhalation of 100% O2on a semi-open circuit with high Gattaca (5,0 l/min) (Sidorov VA, Tsypin LE, Grebennikov, VA Inhalation anesthesia in Pediatrics. - M.: OOO "Medical information Agency, - 2010. - s-126).

The disadvantage of the proposed method of anesthesia in combination of preparation and nitrous oxide is that to ensure adequate analgesia is required intravenous fentanyl. The use of narcotic analgesics is associated with an increased risk of postoperative nausea and vomiting, depression of respiration and circulation. In the proposed method does not take into account the individual peculiarities of the patient, in particular whether the risk of difficult intubation. Intravenous muscle relaxant prior to intubation, not convinced of the feasibility of conducting a mask ventilation, can cause a rare situation as "the inability to ventilate the inability to intubirovti", but divodasa complications, posing an immediate threat to life in the form of severe hypoxia and hypoxic brain damage.

The objective of the invention is to improve the quality of anesthesia due to differential selection inhalation anesthetics, selection of an optimum mode of inhalation anesthesia preparation time and the introduction of local anesthetic and muscle relaxant, taking into account individual patient characteristics, in particular the risk of difficult intubation of the trachea, preventing postoperative complications.

The task is achieved by injection of local anesthetic before surgery by inhalation of 2% lidocaine solution via nebulizer (4 mg/kg body weight, maximum dose of 200 mg Perform catheterization of peripheral veins. In the absence of the risk of difficult intubation spend the induction of anesthesia moreover, about 8 %, N2O/O21/1 6 l/min Before intubation perform 2 compulsory inhalation anesthesia apparatus through facial mask, evaluate the effectiveness of ventilation by excursions of the thorax. When adequate ventilation intravenous nedepoliarizuth the muscle relaxant tracrium 0.4 mg/kg On reaching III2under anaesthesia perform tracheal intubation, and reduces gazook in the circuit to 1.0 l/min Maintenance of anesthesia the preparation of 1,5-2 %, 0.7 POPPY, with N2 O/O21/1 1 l/min, 0.5 MAC. If there are signs of difficult intubation induction of anesthesia moreover, about 8 % with high Gattaca O26 l/min Before intubation perform 2 compulsory inhalation anesthesia apparatus through facial mask, evaluate the effectiveness of ventilation by excursions of the thorax. When adequate ventilation for the achievement III2under anaesthesia saved with an independent breathing perform tracheal intubation, then reduce getpatch in the circuit to 1.0 l/min Intravenously injected depolarizing muscle relaxant tracrium 0.4 mg/kg Maintenance of anesthesia moreover, about 2-3 %, 1 MAC with ventilation air-oxygen mixture O2/Air - 0,5/0,5 l/min when breathing 100% O2on a semi-open circuit with high Gattaca 5,0 l/min

The novelty of the invention.

- Injection of local anesthetic performed before surgery by inhalation of 2% lidocaine solution via nebulizer (4 mg/kg body weight, maximum dose of 200 mg Perform catheterization of peripheral veins. The introduction of lidocaine through the nebulizer provides a combination of effective analgesia with minimal invasiveness delivery of local anesthetic. Nebulizer allows spraying the substance on the particles, the formation of polydisperse aerosol and lidocaine the helped it become one of the et in all the departments of the respiratory system and quickly absorbed. Application of lidocaine 2% solution reduces the risk of overdose and toxicity of the local anesthetic. The quality of analgesia increases.

- In the absence of the risk of difficult intubation spend the induction of anesthesia moreover, about 8 %, NaO/O21/1 6 l/min before intubation perform 2 compulsory inhalation anesthesia apparatus through the front mask. Assess the effectiveness of ventilation by excursions of the thorax. When adequate ventilation intravenous nedepoliarizuth the muscle relaxant tracrium 0.4 mg/kg On reaching III2under anaesthesia perform tracheal intubation, and reduces gazook in the circuit to 1.0 l/min Maintenance of anesthesia the preparation of 1,5-2 %, 0.7 POPPY, with N2O/O21/1 1 l/min, 0.5 MAC. Before intubation, 2 forced breaths can prevent the situation where it is not possible to ventilate through the front mask and it is not possible to intubirovti the trachea, because despite the preoperative examination, it is not possible in 100% of cases to predict that the patient will not be difficult tracheal intubations. Introduction muscle relaxant can improve conditions for intubation of the trachea, which reduces the likelihood of trauma to the structures of the larynx and trachea in the process of securing the airway. The muscle relaxant tracrium is introduced at a dose of 0.4 mg/kg vsledstvii the small duration adenotomy and tonsillotomy, on average, surgery lasts from 20 to 30 minutes. A mixture of nitrous oxide with oxygen is used at a ratio of 1/1 because of the nature of the child's body is the high oxygen demand of 6 ml/kg/min and a low functional residual capacity, which leads to rapid development of hypoxia in sleep apnea, even in the face of preoxygenation.

- If there are signs of difficult intubation induction of anesthesia moreover, about 8 %, with a high Gattaca O26 l/min before intubation perform 2 compulsory inhalation anesthesia apparatus through facial mask, evaluate the effectiveness of ventilation by excursions of the thorax. When adequate ventilation for the achievement III2under anaesthesia saved with an independent breathing perform tracheal intubation, then reduce getpatch in the circuit to 1.0 l/min Intravenously injected depolarizing muscle relaxant tracrium 0.3-0.4 mg/kg, maintenance of anesthesia moreover, about 2-3 %, 1 MAC with ventilation air-oxygen mixture O2/Air - 0,5/0,5 l/min, at the end of the operation, the inhalation of 100% O2on a semi-open circuit with high Gattaca 5,0 l/min as in the preoperative examination revealed a high risk of difficult intubation, it is necessary to protect the patient from the development of severe hypoxemia and associated damage is based brain. Therefore, when the induction is not applicable nitrous oxide, which accelerates the development of hypoxemia due to diffusion hypoxia, muscle relaxant not entered before intubation to maintain spontaneous breathing and the ability to withdraw the patient from the anesthesia with no intubation, preventing the development of complications, bearing an immediate threat to life.

The technical result of the invention is: to provide adequate analgesia with adenotomy and tonsillotomy in children, without the use of narcotic analgesics. The use of only 2% lidocaine solution for inhalation through a nebulizer in children reduces the risk of overdose when incorrect dilution of lidocaine.

The method allows to differentiate the approach to the choice of inhalation anesthetics, time of administration of the muscle relaxant depending on the degree of risk of difficult intubation, adequate analgesia with lidocaine inhalation via nebulizer in combination with total inhalation anaesthesia, preparation and nitrous oxide.

The method can prevent the development of complications, bearing an immediate threat to life, such as asphyxia, hypoxia, hypoxic brain damage during induction of anesthesia and intubation of the trachea.

According to the above aggregate of distinctive signs analgesia when and what anatomie and tonsillotomy is a combination of local anesthesia with lidocaine and anesthesia preparation with nitrous oxide, if there are signs of difficult intubation, the combination of lidocaine and anesthesia preparation with air-oxygen mixture.

The method is as follows. Spend analgesia with lidocaine 2% solution by inhalation directly before surgery through the nebulizer 4 mg/kg, maximum dose of 200 mg. Then perform catheterization of peripheral veins. Choosing the induction and maintenance of anesthesia suitable differentiation, depending on whether or not the signs of a difficult intubation. If there is no risk of difficult intubation of the trachea, conduct the induction of anesthesia preparation 8 vol.%, N2O/O21/1 6 l/min Before intubation spend 2 inhalation anesthesia apparatus through a face mask, with the aim to ensure that mask ventilation. Assess the effectiveness of ventilation by excursions of the thorax, Intravenous nedepoliarizuth the muscle relaxant tracrium 0.4 mg/kg On reaching III2under anaesthesia perform tracheal intubation. After installing the endotracheal tube inflate their sealing cuff, then reduce gazook in the circuit to 1.0 l/min Maintenance of anesthesia the preparation of 1,5-2 % 0.7 POPPY, with N2O/O21/1 1 l/min 0.5 MAC.

If there are signs of difficult intubation, induction of anaesthesia provide behold what Oran about 8 %, high Gattaca O26 l/min Before intubation spend 2 inhalation anesthesia apparatus through facial mask in order to ensure that mask ventilation. Assess the effectiveness of ventilation by excursions of the thorax. When adequate ventilation for the achievement III2under anaesthesia saved with an independent breathing perform tracheal intubation. After installing the endotracheal tube inflate their sealing cuff, then reduce gazook in the circuit to 1.0 l/min After intubation intravenous depolarizing muscle relaxant tracrium 0.4 mg/kg Maintenance of anesthesia is carried out moreover about 2-3 % 1 MAC with ventilation air-oxygen mixture O2/Air - 0,5/0,5 l/min At the end of the operation was ceased sending all volatile anesthetics, getting to inhalation of 100% O2on a semi-open circuit with high Gattaca 5,0 l/min

Below are examples of the implementation of the proposed method

Example No. 1.

The patient Smirnov, Alexei V. 4 years. Weight 18 kg Diagnosed with Hypertrophy of adenoids 2 degrees. Concomitant diagnosis: hypertrophy of the Palatine tonsils of 2 degrees.

Action 1: endoscopic Severna adenotomy.

Step 2: tonsillotomy.

General condition according to a survey satisfactory. Clear consciousness. The risk of difficult intubation in the Calais Mallampati modification Samsoon & Young 2 degrees. Skin flesh-colored, clean, vesicular breathing, wheezing no heart sounds are clear. Rhythmic HR - 103 min, AD - 101/54 mm Hg

Planned total inhalation anesthesia in combination preparation with nitrous oxide and local anesthesia lidocaine through a nebulizer. Risk ASA - 2 degrees.

Directly before surgery performed inhalation of lidocaine 2% - 3.5 ml via nebulizer. Made catheterization peripheral vein of the left forearm. Induction of anesthesia: preparation of 8 vol.%, with a flow of 6 l/min N2O/O21/1. Before intubation was performed 2 inhalation anesthesia apparatus through facial mask in order to ensure that mask ventilation. Chest excursion sufficient ventilation is adequate. Intravenously injected nedepoliarizuth the muscle relaxant tracrium 7 mg. Upon reaching III2under anaesthesia performed tracheal intubation, endotracheal tube ID to 4.5 with cuff, with the 1st attempt. Visualization of the larynx on a scale R.S. Cormack and Lehane J. was 1 degree. After installing the endotracheal tube is inflated sealing cuff, then lowered gazook in the circuit to 1.0 l/min. and Maintaining anesthesia preparation 2 vol.%, at the stage of hemostasis about 1,5 % 0,7 POPPY, with N2O/O21/1 1 l/min 0.5 MAC. Mechanical ventilation was carried out with the apparatus Drager Fabius mode VC Vt - 160 ml. Pin 20 mBar, PEEP - 3 mBar, Rae 26 in minutes the Duration of operation of 30 minutes. At the end of the operation, the inhalation of 100% Oz semi contour with high Gattaca 5,0 l/min for 5 min, before extubation trachea. Exuberan after 5 minutes of operation, with 9 points on a scale Aldrete et al.

Table 1
The reaction of the cardiovascular system and gas exchange during surgery
Admission to the operating roomInductionIntubationThe incisionTraumatic stageExtubateThe translation Department
HR103115129132136117116
Dt10183107112114119105
Add54325060506958
Map79578376799983
SpO29999100999897100
EtCO240383634

HR - heart rate, SBP - systolic blood pressure, Add - diastolic blood pressure, SpO2- saturation of oxygen in peripheral tissues, EtCO2the pressure of carbon dioxide in the exhaled air.

As can be seen from table 1, parameters of gas exchange during anaesthesia are within the normal range, which confirms the Venti is aciu lungs. During anaesthesia were observed tachycardia and hypertension, which argues in favor of adequate analgesia.

Table 2
Indicators of stress response during surgery
Admission to the operating roomIntubationTraumatic stageAfter extubation
Cortisol nmol/l (N - 83-580)794670600728
Blood glucose mmol/l (N - 3,33-5,55)the 3.84,3the 3.84,1

As can be seen from table 2, during anaesthesia was not observed increased levels of cortisol and glucose in venous blood, which also testifies in favor of adequate analgesia.

During anaesthesia and in the early postoperative period there were no complications. Pain on visual analogue scale and before transfer to the ward after extubation - 0 points.

Example No. 2.

The patient Guryanov Bogdan A. No. IMS is AI D 100504, 7 years. Weight 25 kg Diagnosed with Hypertrophy of adenoids 2 degrees. Concomitant diagnosis: Chronic otitis media. Action 1: endoscopic Severna adenotomy.

General condition according to a survey satisfactory. Clear consciousness. The risk of difficult intubation on a scale Mallampati modification Samsoon & Young 3 degrees. Skin flesh-colored, clean, vesicular breathing, wheezing no heart sounds are clear. Rhythmic heart rate is 86 / min, AD - 111/58 mm Hg

Planned total inhalation anesthesia in combination preparation with oxygen under local anesthesia lidocaine through a nebulizer. Risk ASA - 2 degrees.

Directly before surgery performed inhalation of lidocaine 2% - 5 ml via nebulizer. Made catheterization peripheral vein of the left forearm. Induction of anesthesia: moreover, about 8 %, with a stream 02 6 l/min Before intubation was performed 2 forced inhalation anesthesia apparatus through the front mask. Chest excursion sufficient ventilation is adequate.

Upon reaching III2under anaesthesia performed tracheal intubation, endotracheal tube ID 5 with the sleeve, with the 1st attempt. Visualization of the larynx on a scale R.S. Cormack and Lehane J. was 1 degree. After installing the endotracheal tube is inflated sealing cuff, then lowered gazook in the circuit to 1.0 l/min Nutrion is introduced depolarizing muscle relaxant tracrium 10 mg Maintenance of anesthesia the preparation of the traumatic stage 3 vol.%, at the stage of hemostasis 2% vol. 1 MAC. Mechanical ventilation was carried out with the apparatus Drager Fabius mode VC Vt - 200 ml, Pin 20 mBar, PEEP - 3 mBar, the Rate is 22 / min of air-oxygen mixture O2/Air - 0,5/0, 5 l/min when breathing 100% O2on a semi-open circuit with high Gattaca 5,0 l/min for 6 min, until extubation trachea.

The duration of operation 40 minutes. Exuberan after 6 minutes after the operation, with 9 points on a scale Aldrete et al.

Table 3
The reaction of the cardiovascular system and gas exchange during surgery
Admission to the operating roomInductionIntubationThe incisionTraumatic stageExtubateThe translation Department
HR110100117125120132106
Dt111 9198110120125111
Add58343843537356
Map79565684708674
SpO298100100999910098
EtCO231323232

HR - heart rate, SBP - systolic blood pressure, Add - diastolic blood pressure, SpO2- saturation of oxygen in peripheral tissues, EtCO2- pressure places the CSOs gas in the exhaled air.

As can be seen from table 3, the indices of gas exchange during anaesthesia are within the normal range, which confirms the ventilation of the lungs. During anaesthesia were observed tachycardia and hypertension, which argues in favor of adequate analgesia.

Table 4
Indicators of stress response during surgery
Admission to the operating roomIntubationTraumatic stageAfter extubation
Cortisol nmol/l (N - 83-580)281365421389
Blood glucose mmol/l (N - 3,33-5,55)3,53,54,55,2

During anaesthesia and in the early postoperative period there were no complications. Pain on visual analogue scale and before transfer to the ward after extubation - 0 points.

As can be seen from table 4, during anaesthesia increased levels of cortisol and glucose in venous blood is within normal limits, that, too, testifies in favor of adequate analgesia.

The method of anesthesia when adenotomy and tonsillotomy in children, including inhalation anesthetic preparation, tracheal intubation, intravenous muscle relaxant, injection of local anesthetic, characterized in that the injection of local anesthetic performed before surgery by inhalation of 2% lidocaine solution via nebulizer (4 mg/kg body weight, maximum dose of 200 mg, perform catheterization of peripheral veins: in the absence of the risk of difficult intubation spend the induction of anesthesia preparation 8 vol.%, N2O/O21/16 l/min before intubation perform 2 compulsory inhalation anesthesia apparatus through facial mask, evaluate the effectiveness of ventilation by excursions of the thorax, with adequate ventilation intravenous nedepoliarizuth the muscle relaxant tracrium 0.4 mg/kg, at III2under anaesthesia perform tracheal intubation, and reduces gazook in the circuit to 1.0 l/min, maintaining anesthesia preparation of 1,5-2%vol., 0.7 POPPY, with N2O/O21/11 l/min, 0.5 MAC; if there are signs of difficult intubation induction of anesthesia preparation 8 vol.%, high Gattaca O26 l/min before intubation perform 2 compulsory inhalation anesthesia apparatus through facial mask, appreciate the effect is of ventilation on excursions of the thorax, when adequate ventilation for the achievement III2under anaesthesia saved with an independent breathing perform tracheal intubation, then reduce gazook in the circuit to 1.0 l/min, intravenous depolarizing muscle relaxant tracrium 0.4 mg/kg, maintenance of anesthesia preparation 2-3 vol.%, 1 MAC with ventilation air-oxygen mixture O2/Air - 0,5/0,5 l/min, at the end of the operation, the inhalation of 100% O2on a semi-open circuit with high Gattaca 5,0 l/min



 

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23 cl, 12 dwg

FIELD: medicine.

SUBSTANCE: invention relates to medicine, namely, to anesthesiology and reanimatology, and can be used in carrying out spinal blockade in pregnant women in Cesarian section operation. For this purpose height, body weight index and intra-abdominal pressure are determined. After that, point evaluation of obtained parameters is carried out: height (cm) higher than 171 - 1 point, 170-166 - 2 points, 165-161 - 3 points, 160-156 - 4 points, 155-150 - 5 points, lower than 150 - 6 points. Body weight index 20-24.9 - 1 point, 25-29.9 - 2 points, 30-34.9 - 3 points, 35-39.9 - 4 points, more than 40-5 points. Intra-abdominal pressure (cm H20) lower than 16 - 1 point, 17-19 - 2 points, 20-21 - 3 points, 22-23 - 4 points, higher than 24 - 5 points. If sum of points constitutes 3-6, risk is estimated as low, if sum of points is 7-9, risk is estimated as moderate, if sum of points is 10-12, risk is high, is sum of points constitutes more than 13 points, risk is estimated as extremely high.

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, anesthesiology.

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

EFFECT: higher accuracy of detection.

1 cl, 2 ex

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

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

EFFECT: higher efficiency.

1 ex, 2 tbl

FIELD: medicine, orthopedics, traumatology.

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

EFFECT: higher efficiency of conservative therapy.

1 dwg, 1 ex

FIELD: medicine, anesthesiology, surgery.

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

EFFECT: higher efficiency.

FIELD: medicine, anesthesiology.

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

EFFECT: higher efficiency of anesthetization.

1 cl, 2 ex

FIELD: medicine, ophthalmology.

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

EFFECT: higher efficiency.

FIELD: medicine.

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

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

2 cl

FIELD: medicine, surgery.

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

EFFECT: higher efficiency of therapy.

1 ex, 3 tbl

FIELD: medicine.

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

EFFECT: avoided bloodstream overload.

FIELD: medicine, anesthesiology.

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

EFFECT: higher efficiency of anesthesia.

2 cl, 1 ex

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