Biomedical subjects
Publications and source records attributed to A L Levit.
Under study were results of antibacterial therapy used in 40 patients with rheumatic heart diseases operated upon under conditions of artificial blood circulation. A conclusion is made that preventive endolymphatic infusion of antibiotics is expedient.
The comparative analysis of the effectiveness of the use of blood and crystalloid cardioplegia in valve prosthetics with prolonged clamping of the aorta was carried out. The use of blood cardioplegia is preferable, especially in patients with low functional myocardial reserve.
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Using a new method of express diagnosis, the authors proved that activation of the fibrinolytic system, which occurs after open-heart operations, can be the cause of excessive hypo coagulation and massive haemorrhage. Partial correction of hyperfibrinolysis, attained by adequate dosage of antifibrinolytic drugs and administered under the control of the proposed diagnostic method, makes possible to attain normalization of haemostatic processes in the operation wound and to avoid intensification of the syndrome of disseminated intravascular coagulation of blood.
Two groups of patients (30 patients each) operated and reoperated upon for rheumatic mitral valve failure were compared by different parameters. The authors consider that risk of reoperations on the mitral valve is dependent upon the critical initial state of such patients and upon technical problems in maximum cardiolysis.
The article presents an experience with using the method of general moderate hypothermia (28-30 degrees C) in 260 patients operated for congenital heart failures aged from 3 to 45. The duration of the isolation of the heart from blood circulation was from 3 till 25 minutes. The significance of preoperative topical diagnosis, perfect surgical technique and adequate narcosis is emphasized.
The experience with peridural analgesia used in the postoperative period in 183 patients has shown advantages of morphine, phentanyl and dipydolor over routine methods of analgesia. The peridural injection of the drugs mentioned has been shown to give a longer analgetic effect than local anesthetics, to facilitate stabilization of hemodynamics in the postoperative period.
Prolonged peridural blockade with trimekain used in 1000 cardiosurgical patients is shown to be an effective prophylactic measure against postoperative complications. This method should not be widely used in patients with blood circulation insufficiency.
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According to the authors' data, droperidol (5-10 mg.) or seduxen (15-25 mg.), injected intramuscularly 90-120 minutes before operation, are more efficient than the premedication by traditional scheme (barbamil, pipolphene, promedol and atropine).
Application of blood-saving methods during open-heart and aorta surgeries is discussed as exemplified by 86 patients. Platelet-rich plasma was prepared before surgery and infused during heart valve replacement, which decreased the postoperative blood loss 1.5 times. Reinfusion of patient's blood during aortocoronary shunting decreased the need in fluid replacement by 67% and utilization of the Cell Saver device in surgery on the aorta decreased the needed amount of donor blood by 50%.
A scale is proposed for estimating the severity of multiple organ dysfunction in surgical patients and its changes in the course of treatment. The scale was tried in 37 patients after abdominal operations. Estimations performed by means of the scale ore revealed good correlation with the patient's clinical status. Routine parameters are used in the scale, which facilitates its utilization in any surgical intensive care. The scale helps evaluate the severity of each system damage.
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The comparison was made of analgetic action of tramadol and buprenorphine+diazepam in extracorporeal impulse lithotripsy. Opiate agonist-antagonist buprenorphine can provide high-quality analgesia in a drastic lowering of sHbO2. Nonnarcotic analgetic tramadol does not depress external respiration and provides adequate analgesia.
Changes in the central hemodynamics were followed up by echocardiography and the linear velocity of the bloodflow by transcranial dopplerography in 15 patients with ASA classes I-II during induction bolus anesthesia with propofol in a dose 2.7 mg/kg without opioids. The diastolic and mean arterial pressure decreased by 12.3 and 15.4 %, respectively, the rate of cardiac contractions by 7.8%, cardiac index by 13.4%, and the resistive index on the radial and middle cerebral arteries by 13.4 and 10.2%, respectively, after administration of the above dose of propofol. The reaction to intubation of the trachea was the minimal, consisting in an increase of the mean and systolic arterial pressure by 22.2 and 22.7%, respectively, and of diastolic by 16.1%. The rest parameters were as initially. The linear velocity of the bloodflow in the middle cerebral artery did not reliably change. Hence, the central hemodynamic parameters are stable on condition that the deficit in the central bloodflow during induction anesthesia with propofol in a dose of 2.7 mg/kg is compensated for, adequate protection from intubation stress is provided, and autoregulation of the cerebral bloodflow is preserved.
A case with 155-day artificial ventilation of the lungs (AVL) in a patient with the poliencephalomyelitic form of tick-borne encephalitis is described. AVL was conducted through tracheostoma by the Puritan-Bennett 720ae device in the CMU mode for 26 days, then in the SIMU + PS accessory mode for 7 days, and in the CPAP + PS mode for 155 days. Despite the recovery of spontaneous respiration, vital capacity of the lungs did not normalize (1.1 liter) and the involvement at the level of the spine and the nuclei of the craniocerebral nerves was not corrected. The compensation was evidently due to training the diaphragm and the respiratory muscles and joining the accessory muscles.