Method for preventing pain and psychoemotional responses in endovascular x-ray surgeries

FIELD: medicine.

SUBSTANCE: at the initial stage of the intraoperative period, immediately before the local anaesthesia and the femoral artery puncture, ketorolac tromethamine is administered intravenously as an analgesic, and propofol as a sedative agent. Ketorolac tromethamine is administered in a dose of 15-75 mg, while propofol is administered in a dose of 50-250 mg.

EFFECT: method prevents developing pain and psychoemotional responses caused by the given interventions, including postoperatively by the fast development of the adequate analgesic effect accompanied by the controlled sedation level.

1 tbl, 10 ex

 

The invention relates to medicine, namely to anesthesiology, and is intended for clinical practice in the form of intrapersonal analgesia and sedation in endovascular x-ray surgical interventions.

The known method of intraoperative analgesia, which is traditional in endovascular and x-ray surgical interventions, using local infiltration anesthesia, including the blockade of the femoral nerve (Bunyatyan A. A. Manual of anesthesiology. - 1994. - 300 C.). The known method is carried out using a syringe infiltration of the soft tissues of the front-inner surface of the upper third of the thigh the local anesthetic solution (typically - 0.5% solution of novocaine or 2% lidocaine solution). Anesthesia in position of the patient on the back. The index finger of the left hand is determined by the pulsations of the position of the femoral artery. The needle is injected laterally from it, directly below the inguinal crease, on average, at a depth of 3-4 cm On the correct position of the needle indicates transmitted to it by the pulsation of the femoral artery. Local anesthetic solution at the recommended concentrations injected in the amount of 10-15 ml

Disadvantages: the presence of cardiac pain syndrome in the perioperative period, the presence of unwanted emotional reactions, and treforest and/or depression in the intraoperative period, the presence of pain in the area of the puncture of an artery in the postoperative period.

The known method of intraoperative analgesia with spinal anesthesia (Morgan J. E., Mikhail S. M. Clinical anesthesiology: the first book, 2001. - S. 202). The known method is as follows. Is the introduction of local anesthetic solution (typically, ropivacaine or bupivacaine) in the immediate vicinity of the spinal cord. The technique of the method includes providing relevant provisions of the patient (usually on the side with flexion position of the back and lower extremities), antiseptic skin treatment, syringe infiltration of the soft tissue by local anesthetic solution, the introduction of using a special puncture needle of a solution of local anesthetic into the epidural or spinal fluid space in the projection of the selected segments of the spinal cord.

Disadvantages: the high complexity of the method, namely the need to perform technically complex manipulation - spinal anesthesia, the presence of unwanted emotional reactions, namely anxiety and/or depression in the intraoperative period.

The closest to the technical nature of the present method is a method of postoperative analgesia and sedation with ataralgesia (Bunyatyan A. A. Leadership paresthesiae. - 1994. - N-233-236). There is a method in the prototype is as follows. With sedation for 30-40 minutes preoperatively injected intramuscularly with atropine and diazepam. Begin the induction with inhalation of a mixture of nitrous oxide and oxygen in the ratio 2: 1 through the mask anesthesia apparatus. Then intravenous General reingestion anesthetics (thiopental sodium, geksenala), narcotic analgesics (fentanyl) and muscle relaxants (ditilina, tubocurarine, ardoyne), followed by tracheal intubation and implementation of artificial lung ventilation. Specific is the withdrawal of the patient from a state of General anesthesia: is the cessation of inhalation and reingestion anesthetics, over time is achieved recovery of spontaneous breathing, adequate levels of consciousness and muscle tone.

Disadvantages: the high complexity of the method, namely the need to use additional equipment high level of technical complexity, namely, oxygen equipment, anaesthetic equipment, apparatus for artificial ventilation of lungs, devices for securing the airway, the presence of pain in the area of the puncture of an artery in the postoperative period.

Technical result: no cardiac painful is th syndrome in the perioperative period, unwanted emotional reactions, namely anxiety and/or depression in the intraoperative period, pain in the area of the puncture of an artery in the postoperative period.

The technical result is achieved due to the fact that the way to prevent pain and emotional reactions when performing endovascular x-ray surgical interventions, including Ketorolac tromethamine as a means of analgesia and propofol as a means of sedation at the initial stage of intraoperative period, characterized in that the drugs Ketorolac tromethamine dose of 15-75 mg (0.5-2.5 ml officinal solution) and propofol dose of 50-250 mg (5-25 ml-official emulsion) injected immediately before the execution of local anesthesia and puncture of the femoral artery.

Ensuring non-cardiac pain syndrome in the perioperative period is achieved by the fact that intravenous Ketorolac tromethamine dose of 15-75 mg (0.5-2.5 ml officinal solution) and propofol dose of 50-250 mg (5-25 ml-official emulsion) immediately prior to local anesthesia and puncture of the femoral artery.

Ensure there is no unwanted emotional reactions, namely anxiety and/or depression in the intraoperative period is achieved by the fact that intravenous prop is a foul in the dose of 50-250 mg (5-25 ml-official emulsion) immediately prior to local anesthesia and puncture of the femoral artery.

Ensure there is no pain in the area of the puncture of an artery in the postoperative period is achieved by the fact that intravenous Ketorolac tromethamine dose of 15-75 mg (0.5-2.5 ml officinal solution) immediately before the execution of local anesthesia and puncture of the femoral artery.

In the present method, in contrast to the process, is the introduction of drugs Ketorolac tromethamine dose of 15-75 mg (0.5-2.5 ml officinal solution) and propofol dose of 50-250 mg (5-25 ml-official emulsion) are entered during the intraoperative period immediately prior to local anesthesia and puncture of the femoral artery.

The advantages of the proposed method are the absence of cardiac pain syndrome in the perioperative period, no unwanted emotional reactions, namely anxiety and/or depression in the intraoperative period, the absence of pain in the area of the puncture of an artery in the postoperative period.

The distinctive techniques of the proposed method are: intravenous Ketorolac tromethamine dose 15-75 mg (0.5-2.5 ml officinal solution) and propofol in a dose of 50-250 mg (5-25 ml-official emulsion) in endovascular x-ray surgical interventions directly before performing local anesthesia and puncture of the femoral artery.

Use the of intravenous Ketorolac tromethamine and propofol enables rapid development allegationsthe effect in quickly achievable and manageable level of sedation. The inventive method has no side effects, subject technique, which consists in the slow introduction of propofol 50 mg (5 ml officinal emulsion) with the intervals of 1-2 minutes to assess the level of sedation. When the level of sedation, corresponding to a level of consciousness "moderate stun" or "deep stunned, discontinue injection of propofol. The rate of administration of Ketorolac tromethamine dose 15-75 mg does not affect the security of the method.

Comparative analysis of the proposed solutions with the prototype allows to make a conclusion that the claimed invention meets the patentability requirements: is new, involves an inventive step and is industrially applicable.

The proposed method allows to obtain perceived by the applicant technical result - ensuring non-cardiac pain syndrome in the perioperative period, unwanted emotional reactions, namely anxiety and/or depression in the intraoperative period, pain in the area of the puncture of an artery in the postoperative period, reducing the complexity of the method.

The inventive method is as follows.

The preparations are injected at the initial stage of intraoperative period immediately prior to local anesthesia and puncture the thigh is Noah artery.

The drug Ketorolac tromethamine in number 15-75 mg (0.5-2.5 ml officinal solution) with a syringe single use is entered in the Central or peripheral vein available for venipuncture. The rate of introduction variable and is not decisive.

Drug propofol in the amount of 50-250 mg (5-25 ml-official emulsion) with a syringe single use is entered in the Central or peripheral vein available for venipuncture. The injection mode is the following: 50 mg (5 ml officinal emulsion) is injected intravenously bolus for 10-30 seconds; made a pause to assess the level achieved sedation; when a sufficient level of sedation introduction propofol is terminated; when insufficient or no sedation is made repeat bolus in a similar mode to the onset of clinical signs of severe sedation. The total dose of propofol may be from 50 to 250 mg (i.e., from 5 to 25 ml officinal emulsion).

The result is the absence of cardiac pain syndrome in the perioperative period; the absence of unwanted emotional reactions, namely anxiety and/or depression in the intraoperative period; the absence of pain in the area of the puncture of an artery in the postoperative period. The duration of sedation is from 30 to 60 minutes that t is d corresponds to the length of most of endovascular x-ray surgical manipulation, namely, coronary angiography, coronary stenting.

Minimum dose of Ketorolac tromethamine is 15 mg (0.5 ml officinal solution), because a smaller dose is ineffective. Maximum dose of Ketorolac tromethamine is 75 mg (2.5 ml officinal solution), because most of the dose associated with risk of development effects overdose (nausea, vomiting, deterioration of health).

Minimum dose of propofol 50 mg of active substance (i.e., 5 ml-official emulsion), because a smaller dose is ineffective. Maximum dose of propofol is 250 mg of active substance (i.e., 25 ml-official emulsion), because most of the dose is subconsiously for the vast majority of patients and leads to pharmacological depression of the respiratory center, creating a risk of death, the necessity of applying mechanical ventilation and the use of additional time for the removal of the patient from a state of deep sedation / General anesthesia.

The optimal dose of Ketorolac tromethamine for absolute statistical majority of patients is 30 mg (1 ml officinal solution). The optimal dose of propofol is determined empirically in the range of 50-250 mg according to the above mode of administration, but, nevertheless, for most patients it is 100 mg (10 ml of TINLEY emulsion).

The proposed method is illustrated by examples of specific performance.

Example 1.

The patient Sobolev Peter A., 56 years history No. 07520/2, the diagnosis of ischemic heart disease, unstable angina, acute coronary syndrome," study date: 14.05.2012, According to indications in the conditions of the separation x-ray surgical methods of diagnosis and treatment performed coronary angiography. Prevention of intraoperative pain and unwanted emotional reactions performed by the claimed method: Ketorolac tromethamine 1 ml officinal solution intravenous + propofol 10 ml officinal emulsion intravenously (2 bolus 5 ml in 20 seconds with 1 minute interval) immediately before the execution of local infiltration anesthesia and puncture of the femoral artery. Found the complete absence of intraoperative development of pain and emotional reactions: the maximum level of pain syndrome - 0 points on the visual analogue scale means the complete absence of pain, the maximum level of anxiety 25 points on a scale of situational anxiety of Spilberger means her actual absence, level of consciousness - moderate stun (14 points on the scale of Glasgow). Confirmed the absence of postoperative pain syndrome in the area of the puncture of the femoral artery.

Example 2.

The patient Polyakov Sergey who vanovich, 58 years old, medical history, No. 07522/2, the diagnosis of ischemic heart disease, unstable angina, acute coronary syndrome," study date: 17.05.2012, According to indications in the conditions of the separation x-ray surgical methods of diagnosis and treatment performed coronary angiography. Prevention of intraoperative pain and unwanted emotional reactions performed by the claimed method: Ketorolac tromethamine 2.5 ml officinal solution intravenous + propofol 25 ml officinal emulsion intravenously (5 boles for 20 seconds with 1 minute interval) immediately before the execution of local infiltration anesthesia and puncture of the femoral artery. Found the complete absence of intraoperative development of pain and emotional reactions: the maximum level of pain syndrome - 0 points on the visual analogue scale means the complete absence of pain, the maximum level of anxiety - 26 score of situational anxiety of Spilberger means her actual absence, level of consciousness - moderate stun (13 points on the scale of Glasgow). Confirmed the absence of postoperative pain syndrome in the area of the puncture of the femoral artery.

Example 3.

The patient Krylov, Alexander, 65 years, history of No. 07526/2, the diagnosis of ischemic heart disease, stable angina, FC III-IV, coronary artery atherosclerosis risk CCO III-IV century", study date: 14.05.2012, According to indications in the conditions of the separation x-ray surgical methods of diagnosis and treatment performed coronary angiography. Prevention of intraoperative pain and unwanted emotional reactions performed by the claimed method: Ketorolac tromethamine 1 ml officinal solution intravenous + propofol 10 ml officinal emulsion intravenously (2 bolus 5 ml in 20 seconds with 1 minute interval) immediately before the execution of local infiltration anesthesia and puncture of the femoral artery. Found the complete absence of intraoperative development of pain and emotional reactions: the maximum level of pain syndrome - 0 points on the visual analogue scale means the complete absence of pain, the maximum level of anxiety - 24 score of situational anxiety of Spilberger means her actual absence, level of consciousness - moderate stun (13 points on the scale of Glasgow). Confirmed the absence of postoperative pain syndrome in the area of the puncture of the femoral artery.

Example 4.

The patient Mukhin Yuriy V., 67 years old, medical history, No. 07527/2, the diagnosis of ischemic heart disease, stable angina, FC III-IV, atherosclerosis of the coronary arteries, the risk CCO III-IV century", study date: 14.05.2012, According to the indications in terms of x-ray surgical Department is erodov diagnosis and treatment performed coronary angiography. Prevention / treatment of postoperative pain was performed by the claimed method: Ketorolac tromethamine 0.5 ml officinal solution intravenous + propofol 5 ml officinal emulsion intravenously (1 bolus within 20 seconds) immediately before the execution of local infiltration anesthesia and puncture of the femoral artery. Found the complete absence of intraoperative development of pain and emotional reactions: the maximum level of pain syndrome - 0 points on the visual analogue scale means the complete absence of pain, the maximum level of anxiety - 27 points on a scale of situational anxiety of Spilberger means her actual absence, level of consciousness - moderate stun (14 points on the scale of Glasgow). Confirmed the absence of postoperative pain syndrome in the area of the puncture of the femoral artery.

Example 5.

The patient Samoilov, Alexander, 68 years old, medical history, No. 07531/2, the diagnosis of ischemic heart disease, stable angina, FC III-IV, atherosclerosis of the coronary arteries, the risk CCO III-IV century", study date: 15.05.2012, According to indications in the conditions of the separation x-ray surgical methods of diagnosis and treatment performed coronary angiography. Prevention of intraoperative pain and unwanted emotional reactions performed by the claimed method: Ketorolac is trometamin 1 ml officinal solution intravenous + propofol 10 ml officinal emulsion intravenously (2 bolus 5 ml in 20 seconds with 1 minute interval) immediately before the execution of local infiltration anesthesia and puncture of the femoral artery. Found the complete absence of intraoperative development of pain and emotional reactions: the maximum level of pain syndrome - 0 points on the visual analogue scale means the complete absence of pain, the maximum level of anxiety - 23 score on the scale of situational anxiety of Spilberger means her actual absence, level of consciousness - moderate stun (14 points on the scale of Glasgow). Confirmed the absence of postoperative pain syndrome in the area of the puncture of the femoral artery.

Example 6.

The patient Danilov, Mikhail Ilyich, 65 years, history of No. 07534/2, the diagnosis of ischemic heart disease, unstable angina, acute coronary syndrome," study date: 23.05.2012, According to indications in the conditions of the separation x-ray surgical methods of diagnosis and treatment operation performed stenting of the coronary artery. Prevention / treatment of postoperative pain was performed by the claimed method: Ketorolac tromethamine 2.0 ml officinal solution intravenous + propofol 20 ml officinal emulsion intravenously (4 bolus 5 ml in 20 seconds with 1 minute interval) immediately before the execution of local infiltration anesthesia and puncture of the femoral artery. Found the complete absence of intraoperative development of pain and psychoemotional the x reactions: the maximum level of pain syndrome - 0 points on the visual analogue scale means the complete absence of pain, the maximum level of anxiety 25 points on a scale of situational anxiety of Spilberger means her actual absence, level of consciousness - moderate stun (13 points on the scale of Glasgow). Confirmed the absence of postoperative pain syndrome in the area of the puncture of the femoral artery.

Example 7.

The patient Yuri Maximov V., 76 years, 07534/2, the diagnosis of ischemic heart disease, unstable angina, acute coronary syndrome," study date: 23.05.2012, According to indications in the conditions of the separation x-ray surgical methods of diagnosis and treatment operation performed stenting of the coronary artery. Prevention of intraoperative pain and unwanted emotional reactions performed by the claimed method: Ketorolac tromethamine 2 ml officinal solution intravenous + propofol 20 ml officinal emulsion intravenously (4 bolus 5 ml in 20 seconds with 1 minute interval) immediately before the execution of local infiltration anesthesia and puncture of the femoral artery. Found the complete absence of intraoperative development of pain and emotional reactions: the maximum level of pain syndrome - 0 points on the visual analogue scale means the complete absence of pain, the maximum level tre is agnosti - 26 points on a scale of situational anxiety of Spilberger means her actual absence, level of consciousness - moderate stun (14 points on the scale of Glasgow). Confirmed the absence of postoperative pain syndrome in the area of the puncture of the femoral artery.

Example 8.

The patient Gordeev Anatoly Vladimirovich, 68, 07537/2, the diagnosis of ischemic heart disease, stable angina, FC III-IV, atherosclerosis of the coronary arteries, the risk CCO III-IV century", study date: 25.05.2012, According to indications in the conditions of the separation x-ray surgical methods of diagnosis and treatment operation performed stenting of the coronary artery. Prevention of intraoperative pain and unwanted emotional reactions performed by the claimed method: Ketorolac tromethamine 1 ml officinal solution intravenous + propofol 10 ml officinal emulsion intravenously (2 bolus 5 ml in 20 seconds with 1 minute interval) immediately before the execution of local infiltration anesthesia and puncture of the femoral artery. Found the complete absence of intraoperative development of pain and emotional reactions: the maximum level of pain syndrome - 0 points on the visual analogue scale means the complete absence of pain, the maximum level of anxiety - 24 score of situational anxiety of Spilberger means e is actual absence, level of consciousness - moderate stun (13 points on the scale of Glasgow). Confirmed the absence of postoperative pain syndrome in the area of the puncture of the femoral artery.

Example 9.

The patient Cats Gennady Ivanovich, 59 years old, 07538/2, the diagnosis of ischemic heart disease, stable angina, FC III-IV, atherosclerosis of the coronary arteries, the risk CCO III-IV century", study date: 25.05.2012, According to indications in the conditions of the separation x-ray surgical methods of diagnosis and treatment operation performed stenting of the coronary artery. Prevention of intraoperative pain and unwanted emotional reactions performed by the claimed method: Ketorolac tromethamine 0.5 ml officinal solution intravenous + propofol 5 ml officinal emulsion intravenously (1 bolus within 20 seconds) immediately before the execution of local infiltration anesthesia and puncture of the femoral artery. Found the complete absence of intraoperative development of pain and emotional reactions: the maximum level of pain syndrome - 0 points on the visual analogue scale means the complete absence of pain, the maximum level of anxiety 25 points on a scale of situational anxiety of Spilberger means her actual absence, level of consciousness - moderate stun (14 points on the scale of Glasgow). Confirmed no polomer the ment of pain in the area of the puncture of the femoral artery.

Example 10.

The patient Andrei A. Ivanov, 67 years, 07542/2, the diagnosis of ischemic heart disease, stable angina, FC III-IV, atherosclerosis of the coronary arteries, the risk CCO III-IV century", study date: 31.05.2012, According to indications in the conditions of the separation x-ray surgical methods of diagnosis and treatment operation performed stenting of the coronary artery. Prevention of intraoperative pain and unwanted emotional reactions performed by the claimed method: Ketorolac tromethamine 1 officinal solution intravenous + propofol 10 ml officinal emulsion intravenously (2 bolus 5 ml in 20 seconds with 1 minute interval) immediately before the execution of local infiltration anesthesia and puncture of the femoral artery. Found the complete absence of intraoperative development of pain and emotional reactions: the maximum level of pain syndrome - 0 points on the visual analogue scale means the complete absence of pain, the maximum level of anxiety - 26 score of situational anxiety of Spilberger means her actual absence, level of consciousness - moderate stun - 14 score of Glasgow. Confirmed the absence of postoperative pain syndrome in the area of the puncture of the femoral artery.

The method applied in 100 patients with indications for endovascular Ren is generalizedtime interventions. Results were examined 200 patients with indications for endovascular x-ray surgical interventions. Research conducted throughout the intraoperative and early postoperative day period. The data obtained are statistically significant and are presented in table 1.

Thus, from the data presented in table 1, it follows that improving the quality of analgesia / sedation for endovascular x-ray surgical intervention is possible using the proposed method. The data in table 1 show that under the influence of combined preventive intravenous administration of Ketorolac tromethamine and propofol indicators of the effectiveness of intraoperative analgesia / sedation statistically significant change in a positive way. Clinical parameters of the adequacy of analgesia and sedation in the conditions of application of the known and declared various ways in absolute and relative value, the difference between them is greater than 99%, i.e., the differences are statistically significant.

Thus, the inventive method differs from known allows you to result in zero probability of development characteristic of endovascular x-ray surgical interventions pathological conditions, and the time - intraoperational cardiac pain, intraoperative emotional discomfort and post-operative pain in the area of the puncture of the femoral artery at the same time. The same is not true when using methods analogous.

Technical and economic effect

Using the proposed method currently in Voronezh regional clinical hospital №1 ensures that cardiac pain syndrome in the perioperative period, unwanted emotional reactions, namely anxiety and/or depression in the intraoperative period, pain in the area of the puncture of an artery in the postoperative period, reduce the complexity of the method in the postoperative period in all cases, endovascular x-ray surgical interventions.

The way to prevent pain and emotional reactions when performing endovascular x-ray surgical interventions, including Ketorolac tromethamine as a means of analgesia and propofol as a means of sedation at the initial stage of intraoperative period, characterized in that the drugs Ketorolac tromethamine dose of 15-75 mg and propofol dose of 50-250 mg administered intravenously immediately prior to local anesthesia and puncture of the femoral artery.



 

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1 tbl

FIELD: medicine.

SUBSTANCE: invention refers to medicine, namely to gynaecology, and can be used for diagnosing the transport dysfunction of the uterine tubes. That is ensured by hysteroscopy accompanied by inserting catheters into the uterine cavity within openings of the uterine tubes, bringing them out through the vagina and fixing to the inner thigh. A colour solution is introduced into the abdominal cavity through a puncture of the posterior vaginal vault. That is followed by a double-side block of the round ligament of the uterus with the anaesthetic solution in an amount of 15.0 ml every 4-6 hours. Keeping the transport function is shown by observing the colour solution 24 hours later in the catheter lumen. The transport dysfunction of the uterine tubes is shown by no ingress of the colour solution into the catheter.

EFFECT: technique provides the reliable diagnosis of the transport dysfunction of the uterine tubes, including their intramural departments, except for the functional component of the transport dysfunction, with no surgical intervention required.

1 ex

FIELD: medicine.

SUBSTANCE: invention refers to medicine, namely to neurology, surgery orthopaedics and traumatology, and can be used for treating inflammatory-degenerative arthropathies. That is ensured by determining an access parameters for a local therapeutic injection in accordance with the fact which inflammatory-degenerative disease of which periarticular tissue is diagnosed in the patient and which somatotype is specific for the patient. The local therapeutic injection is performed in a CLB tendon and a rotator cuff, or in a deltoid muscle, or in a subdeltoid burse, or in a supraspinous muscle, or in an infraspinatus muscle. The access parameter for the local therapeutic injection into the above periarticular tissues is a location of an injection needle point, as well as a needle direction and depth.

EFFECT: by the most accurate local administration of the drug preparation taking into account a patient's somatotype, the method provides the effective treatment in the above category of patients.

19 cl, 11 tbl, 2 ex

FIELD: medicine.

SUBSTANCE: patient is laid on his/her side opposite a block region. A guide mark is a vertical line in a projection of Petit's triangle from the twelfth rib to a wing of ilium. A needle is pricked into the skin on the vertical line at 1.5-2.5cm above the wing of ilium. 0.25% Novocaine is administered in layers into the skin and subcutaneous fat. The needle is advanced into the lumbar region from back to front in the medial direction along the lateral edge of broadest muscle of back at 6-8cm. Novocaine 120ml is administered into the lower order of the lumboiliac fossa formed in this region.

EFFECT: effective and safe pain management in the given category of patients by providing the required Novocaine concentration in the retroperitoneal space.

1 dwg, 1 ex

FIELD: medicine.

SUBSTANCE: recording ECG is followed by a perianal block with an anaesthetic solution in an amount of 10.0-15.0 ml. Then 60-90 min later ECG is recorded once again, and this recording is compared to the pre-block recording. If observing a positive dynamics of the ECG results, ischemia caused by the anorectal cardioinhibitory reflex is diagnosed. No positive dynamics observed enables diagnosing cardiogenic myocardial ischemia.

EFFECT: method makes it possible to perform the more accurate differential diagnosis of the above pathologies by following a specific procedure in case of pain syndrome in the given category of patients.

1 ex

FIELD: medicine.

SUBSTANCE: recording ECG is followed by a bilateral translumbar block with an anaesthetic solution in an amount of 120-140 ml from each side. Then 60-90 min later ECG is recorded once again, and this recording is compared to the pre-block recording. If observing a positive dynamics of the ECG results, ischemia caused by the enteral cardioinhibitory reflex with underlying intraluminal intestinal hypertension is diagnosed. No positive dynamics observed enables diagnosing myocardial ischemia caused by a cardiac pathology.

EFFECT: enabling performing the more accurate differential diagnosis of the above pathologies by following a specific procedure in case of pain syndrome in the given category of patients.

1 ex

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

FIELD: medicine.

SUBSTANCE: radionuclide indicator is administered to record the dynamics of its distribution in limb tissues by a radionuclide method. The examination is performed at rest and during a load test. The load test represents an epidural block by gradual administration of bupivacaine 25-30 mg between L2-L3 vertebrae for 5-7 minutes. That is followed by measuring a blood flow as a percentage of its value to the same level in an analogous segment of a collateral limb.

EFFECT: qualitative assessment of the circulation reserve in various categories of patients, including disabled ones by inhibiting sympathetic and minimally sensory activity with maintaining the patients' motor activity.

2 dwg, 2 ex

FIELD: medicine.

SUBSTANCE: invention refers to medicine, namely to abdominal surgery and anaesthesiology, and can be used where it is necessary to anaesthetise after the prosthetic hernioplasty for median postoperative ventral hernias. That is ensured by placing an endoprosthesis under the aponeurosis, a polyvinylchloride catheter is placed into the formed spaced around the periphery of a postoperative wound in the form of an oval above the endoprosthesis plane at 2.5-3 cm from its edges. Along its full length, the catheter has multiple side holes. Single openings are created in a projection of a lower corner of the wound, and the catheter ends are brought out onto the skin. An inlet of the catheter is attached to a local anaesthetic dosage device by means of a cannula. That is followed by a controlled prolonged irrigation with 2.5% Ropivacaine 20 ml every 6-8 hours during 2-3 days.

EFFECT: method enables the adequate postoperative anaesthesia, as well as the length of the postoperative intestinal distention by providing the uniform controlled administration of the local anaesthesia solution.

7 dwg, 1 ex

FIELD: medicine.

SUBSTANCE: what is involved is infusion therapy with crystalloid solutions at 15 ml/kg of a patient's body weight. That is followed by puncturing and catheterising an epidural space at the level of ThVII-ThVIII according to the standard practice and introducing a test dose of 2% lidocaine 3 ml. If observing no signs of intrathecal introduction of local anaesthetics 10 minutes later, a basic dose containing 0.75-1% naropin 10 ml or 0.25-0.5% marcaine 10 ml and clofelin 3-5 mcg/kg is introduced. Total intravenous anaesthesia follows 20 minutes after pre-medication with atropine 0.01 mg/kg, 1% diphenylhydramine 1 ml and relanium 10 mg and urethral catheterisation. A narcosis is induced with propofol in a dose of 2 mg/kg. Anaesthesia is maintained with propofol 2-4 mg/kg·h. After that, within the first hour following the detoxification, naloxone 12 mg is introduced intravenously; a naloxone measurement rate is supposed to make 0.8 mg/h for 4-5 following hours of general anaesthesia. The repeated introduction of 0.75-1% naropin 6 ml or 0.25-0.5% marcaine 6 ml and clofelin 2-3 mcg/kg into the epidural space is performed 90 minutes later. After the procedure is terminated, and the patient recovers, prolonged epidural analgesia is conducted by introducing 0.2% naropin 10 ml and clofelin 1 mcg/kg into the epidural space every 4 hours for 24-48 hours.

EFFECT: method provides safety of ultrafast opioid detoxification and prolongs the remission in the given category of patients.

1 ex

FIELD: medicine.

SUBSTANCE: invention refers to medicine, namely to surgery, and can be used for treating sternomediastinitis. That is ensured by introducing a therapeutic mixture prepared ex tempore containing a broad-spectrum antibiotic tropic to bone tissue in a half a compendially recommended average therapeutic daily dose, 1 ml of lidase 32 thousand units, 1 ml of a lincomycine solution in a dose of 0.3 g, 1 ml of ketorolac tromethamine in a dose of 0.03 g, 1 ml of dexamethasone solution in a dose of 0.004 g, 1 ml of a 10% lidocaine solution and 5 ml of a 40% glucose solution. The therapeutic mixture is administered into interspinous ligaments of the spinal column at Th2-Th3, Th3-Th4, Th4-Th5, at a depth of 1.5-2 cm in a dose of 3 ml into each injection point into a patient lying on his/her side with bringing the knees to the stomach and bending the head as forward as possible. The length of treatment makes 12-14 days with the first 3 injections performed daily; the residual injections - every second day, 8-9 injections in total.

EFFECT: invention provides reducing a dose of the administered preparations and a rate of administration as compared to the systemic antibacterial therapy by an ability of the administered mixture to be accumulated in the inflammation centre, providing the therapeutic concentration with the total dose of the administered preparations reduced as compared to the systemic antibiotic therapy.

2 ex

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