Biomedical subjects
Publications and source records attributed to A U Lekmanov.
The urgent porto-system bypass has been used in 26 children with portal hypertension to prevent acute gastro-esophageal bleeding. This method may be used in all types of portal circulation blockade. The bleeding stopped within first two postoperative days and there were no cases of its relapse within 6 years.
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The blood coagulation system and fibrinolysis were studied in 16 children with chronic bronchopulmonary diseases, aged from 4 to 15 years, before surgery, immediately, and on the first day after the operation. The method of infusion hemodilution, under the control of hematocrit, hemoglobin and total protein, was used for the treatment of operation hemorrhage. The investigations conducted have revealed hypercoagulation signs in the patients before the beginning of the operation (as compared to normal children). Operative intervention has intensified many signs of hypercoagulation, however, in the postoperative period no clinical signs of hypercoagulation were observed in all the cases, that was associated with the positive effect of hemodilution.
The effect of infusion hemodilution on hemodynamic parameters and oxygen-transport homeostasis was studied during elective chest surgery in 18 children with chronic bronchopulmonary diseases. The data obtained have evidenced the expediency of using the method of infusion hemodilution in children for the operative hemorrhage therapy, ensuring the adequate hemodynamics and oxygen-transport supply at all the operation stages and in the early postoperative period.
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An analysis of results of the conservative and operative tactics in the treatment of 89 esophago-gastric bleedings in children with extrahepatic blockade of the portal blood circulation has shown high effectiveness of the conservative therapy (78.7% of the observations). The optimal operative treatment of the bleedings is thought to be gastrotomy with suturing the veins of the submucosa plexus of the stomach and esophagus. The total positive result of using the conservative and operative tactics was noted in 93.3% of observations.
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The responses of m. adductor pollici to TOF stimulation of the ulnar nerve were recorded by electromyography (EMG) and acceleromyography (AMG) in 36 children aged 2-12 years with ASA classes I-II during 36 planned surgeries. In 14 children myoplegia was attained by intravenous bolus and infusion atracurium (Tracrium) and in 22 by cisatracurium (nimbex). The data on the function of this muscle after the initial bolus injection of myoplegics do not provide reliable information on the function of the larynx and respiratory muscles during intubation and do not allow a conclusion on the possibility of endotracheal intubation. The threshold sensitivities of EMG and AMG recording of the neuromuscular function starting from the fifth minute after the myorelaxant injection till the end of anesthesia are different. EMG permits evaluating the recovery of neuromuscular conduction early after the infusion of myoplegics; complete recovery of the block is shown virtually simultaneously by AMG and EMG. EMG as a more accurate method is preferable for research, while AMG is a simpler and stable method, preferable for routine practice.
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The adequacy of anesthesia with propofol is evaluated in 48 children aged 3 months to 7 years (ASA I-III) subjected to abdominal and urological interventions. The children were divided into groups administered different general anesthesias: 9 children aged 3-7 years operated under total intravenous anesthesia (TIVA) with propofol and fentanyl and 39 children aged 3 months to 6 years operated under TIVA with propofol, ketamine, and fentanyl. The efficiency of anesthesia was evaluated by electroencephalography and hemodynamic monitoring. TIVA with propofol, fentanyl, and ketamine did not notably decrease arterial pressure during induction; the course of anesthesia and recovery ran a smooth course; the doses of propofol and fentanyl were appreciably decreased. Use of this protocol in children aged under 3 years ensured adequate anesthesia with the minimum risk of hemodynamic disorders.
The efficiency and safety of low flow inhalation anesthesia for children were evaluated on the basis of oxygen transport parameters. Sixty-seven children aged 3 months to 15 years (mean age 5.7 +/- 2.5 years) were subjected to inhalation halothane and isoflurane anesthesia with fresh gas flow of 0.5 liter/min. Oxygen delivery, consumption, and tissue extraction were evaluated. Oxygen transport parameters remained optimal at all stages of anesthesia, which confirmed the safety of this method in children for routine interventions.
The advantages and disadvantages of intravenous and inhalation anesthesias in pediatric anesthesiology are analyzed. Causes of complications induced by myorelaxants and measures for preventing these complications are discussed. Basic protocols of intravenous or inhalation anesthesias with the minimum fresh gas flow for pediatric anesthesiology are presented.
It has been observed that controlled lung ventilation during surgery in children is accompanied by an increase in intrapulmonary blood shunting, which averages 7.3% in urological surgery, 12% in abdominal surgery and 16.8% in thoracic surgery. The shunting is caused by ventilation-perfusion disturbances. The use of high-frequency jet ventilation, i.e. application of 16.7 Hertz oscillatory modulations together with conventional controlled lung ventilation enables one to decrease intrapulmonary shunting, reduce the signs of circulatory hyperdynamia and the load on the heart ventricles and leads to normalization of pulmonary flow in thoracic surgery.
Nondepolarizing shortly acting myorelaxant trakrium (0.5 mg/kg) during surgical interventions in children makes it possible to perform tracheal intubation 1.5 min later and to maintain optimal myoplegia at various stages of the operation by bolus injections in doses making up 1/2-1/3 of the initial one or by non-stop infusion at a rate of 0.008 mg/kg per min. Trakrium may be used along with arduan administered at the end of the operation. Trakrium administration is accompanied by the recovery of adequate respiration 25-30 min after discontinuation of administration. Trakrium has no unfavourable effect on hemodynamics and ensures retention of the myocardial reserve capacities.