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Biomedical subjects

M I Neĭmark

Publications and source records attributed to M I Neĭmark.

At least 37 records · Page 2Linked to original sources
PubMedDate not supplied

[Blood loss compensation during surgery of abdominal aortic aneurysms].

Two methods of intraoperative compensation of blood loss in patients with aortic aneurysm are compared in 30 patients: transfusion of donor blood preparations and reinfusion of washed autoerythrocytes. Changes in hemostasis system, central hemodynamics, and oxygen transport were analyzed. Reinfusion of washed autoerythrocytes proved to be more safe and involved no serious complications.

Aged↗
PubMedDate not supplied

[Choice of local anesthetic for epidural anesthesia in physiological labor].

In comparative analysis of epidural anesthesia by bupivacaine and ropivacaine the latter was shown to give smaller motor block and so can be applied at the end of both first and second stage of labor. Adequate anesthesia provides uneventful course of the second stage of labor, decreases its duration and eliminates the disorders of central hemodynamics and hormonal homeostasis. Currently naropin seems to be anesthetic of choice for epidural anesthesia of in labor by way of natural maternal passages.

Amides↗
PubMedDate not supplied

[A risk of myocardial ischemia and the nature of infusion-transfusion therapy in scheduled surgical treatment of infrarenal aneurisms of the aorta].

The authors analyzed effects produced by different variations of the infusion-transfusion therapy on the risk of cardiovascular complications that can develop in the scheduled surgical treatment of the aorta abdominal part. The patients were randomized in 2 groups. Intraoperative hemodilution was made in group-1 patients (n = 50) before aorta clipping. Hemodynamics was stabilized by colloids and crystacolloids during clip removal; donor packed red blood cells were used at the hemoglobin level below 80 g/l. Group 2 comprised 66 patients for whom autoblood was prepared preoperatively. The infusion volume was limited before aorta clipping; blood losses were compensated for by autoblood and autoerythrocytes collected from surgical blood by "Cell Saver". The below results were obtained on the basis of conducted research: preventive infusion load aggravates, before aorta clipping, the risk of cardiac complications. Maintenance of Hb below the level of 90 g/l is accompanied by an impaired transport of oxygen to tissues; it speeds up the heart beat and provokes an increased cardiac need in oxygen, which enhances the risk of myocardium ischemia. Preparation of autoblood and hardware-based reinfusion of autoerythrocytes provide for an adequate compensation of blood losses and diminish the risk of cardiac complications in the scheduled surgical treatment of infrarenal aneurisms of the aorta.

Aged↗
PubMedDate not supplied

[Total intravenous anesthesia with ketamine and the condition of the higher psychic function in the early and remote postoperative periods].

Influence of total intravenous anesthesia with ketamine on the higher psychic function was studied, immediately after surgery and in the remote postoperative period, in 143 patients with different typological properties of the nervous system after a scheduled surgery--supravaginal uterectomy in fibromyoma of the uterine body. The authors defined 6 groups of patients with different typological properties of the nervous system. Persistent impairment of the higher nervous functions were established, immediately after surgery and in the remote postoperative period, in patients with a weak nervous system, biased nervous balance towards excitation, and with lability of nervous processes. Total intravenous anesthesia with ketamine, when used in patients with the robust nervous system, biased nervous balance towards excitation, and with lability of nervous processes, caused changes in the higher nervous functions and an intensified level of nervous-and-psychic loads, which were unstable and were arrested by the 30th postoperative day. The use of such anesthetic scheme was found to be inadvisable in the above groups of patients. The described impairments were not registered when total intravenous anesthesia was used in patients with a balanced nervous system irrespective of its type, a biased nervous balance towards inhibition and with inertness of nervous processes. The above anesthetic management is acceptable for such patients.

Adult↗
PubMedDate not supplied

[Renal protective function in surgical treatment for chronic infrarenal aortic aneurysms].

The authors analyzed different modes of prevention of acute renal failure (ARF) in the planned surgical treatment of abdominal aortic aneurysms. A hundred patients randomly divided into 4 groups were examined. In patients from a control group, prevention of renal failure included no use of aminoglycosides, prevention of hyperglycemia, and provision of steady-state hemodynamics. In Group 2 patients, the reperfusion syndrome was prevented through a preventive load and early administration of antioxidants, for which they were enterally fed with Berlamine-modular for 5 days before surgery and in the postoperative period. The authors made efforts for Group 3 patients to have high oxygen supply values at all stages of surgical treatment. For this, they optimized infusion therapy and compensated for intraoperative blood loss by preoperatively prepared autoblood and through reinfusion of the blood collected from an operation wound with "Cell saver" apparatus. In Group 4 patients, the prevention of ischemia and reperfusion were simultaneously made and blood oxygen-transporting function was optimized. Renal function was evaluated from the activity of urinary enzymes and from nitrogen metabolic parameters. The studies have indicated that activation of free radical lipid peroxidation in the presence of ischemia/reperfusion and blood oxygen-transporting dysfunction plays an important role in the genesis of renal failure during surgical treatment for infrarenal aortic aneurysms. According to the data on changes occurring in urinary enzymatic activities, the preventive load with antioxidants and their early postoperative use ameliorate renal lesion. The similar effect is achieved by the provision of high tissue oxygen supply and uptake at all the stages of surgical treatment. The best effect shown, in addition to enzymuria diminution, by a clinical reduction in the frequency of renal dysfunction is achieved by applying a comprehensive approach to preventing ARF.

Acute Kidney Injury↗
PubMedDate not supplied

[Effect of anesthesia and anticoagulant prophylaxis on the occurrence of postoperative thromboembolic complications in orthopedic patients].

Different prevention regimens of venous thromboembolism, by using the low molecular-weight heparin Fraxiparin, were studied in 152 patients who had undergone major orthopedic leg surgery under spinal and general anesthesia. The regimens differed in the time of Fraxiparin administration (before or after surgery). Fraxiparin and spinal anesthesia were found to promote the lower incidence of venous thromboembolism. The preoperative preventive treatment of venous thromboembolism, by using a low molecular-weight heparin in patients undergoing spinal anesthesia is unnecessary because of a high risk of epidural hematomas. If the risk for venous thromboembolism is higher before surgery and remains the same after it, thromboprophylaxis should be prolonged for at least one month.

Adult↗
PubMedDate not supplied

[Comparative assessment of the efficacy of selective and discrete plasmapheresis in combined preoperative preparation of patients with diffuse toxic goiter].

The paper is concerned with comparative assessment of two methods of plasmapheresis (discrete and selective), employed for preoperative preparation of patients with a severe type of thyrotoxicosis. Selective plasmapheresis by its effect on immunity indices, hormonal status, central hemodynamics and clinical symptomatology was shown to be no inferior to the discrete method. At the same time selective plasmapheresis was not accompanied by allergic reactions, excluding the danger of infection and making preoperative preparation cheaper.

Combined Modality Therapy↗
PubMedDate not supplied

[The choice of a program of discrete plasmapheresis in the preoperative preparation of patients with diffuse toxic goiter].

The state of circulation and its impact on the nature of hemodynamic response during discrete plasmapheresis has been studied in 91 patients with hyperthyroidism. It has been established that the nature of cardio- and hemodynamics depends on the severity of the disease and the cardiac rhythm. In patients with mild hyperthyroidism the volume of single blood exfusion (BE) should not exceed 800 ml of blood and plasma should be replaced by colloid and crystalloid preparations in the ratio of 1:1. In patients with severe hyperthyroidism and normal cardiac rhythm the volume of single exfusion should not exceed 600 ml and plasma should be replaced by cryoplasma. In patients with severe hyperthyroidism and atrial fibrillation blood exfusion should be limited to 400 ml of blood. Simultaneously with blood exfusion it is expedient to perform cryoplasma infusion. Glycerol trinitrate and calcium antagonists may be used to prevent pulmonary hypertension.

Combined Modality Therapy↗
PubMedDate not supplied

[Changes in the oxygen transport function in patients with chronic kidney failure during hemodialysis].

Some parameters of oxygen transport blood function have been studied prior to hemodialysis treatment and following 5, 25, 50 and 100 hemodialysis procedures. It has been established that programmed hemodialysis decreases O2 transport and reserve. These changes may be associated with an unfavourable effect of the procedure itself on the body, accompanied by anemia, microthromboembolisms in lung vessels, hypercapnia and arteriovenous blood shunt. Partial compensation of O2 transport decrease is achieved due to cardiac output increase and O2 tissue excretion. These compensatory mechanisms cannot ensure normal values of O2 reserve and transport and are fairly quickly depleted in the course of hemodialysis.

Adult↗