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Biomedical subjects

R N Lebedeva

Publications and source records attributed to R N Lebedeva.

At least 19 recordsLinked to original sources
PubMed1996

[The problem of acute pain in postoperative period].

The problem of postoperative pain remains actual despite the existence of a variety of pharmaceutical and nonpharmaceutical methods of anesthesia. Acute postoperative pain is an essential component of the surgical stress syndrome. Opioid analgetics (Buprenorfin, Nubain, Tramal, Promedol, Morphine) take the leading position among other types of analgetics. Present-day individual approach to administration of analgetics is still imperfect. The use of a standard dose of analgetics appears to be inadequate in a number of patients. The increase of opioids dose may lead to adverse reactions. In view of this it is valid to use nonsteroid antinflammatory medicines (Ketorolac). The choice of a proper dose of an analgetic is critically important in achieving adequate anesthesia. Patient-controlled analgesia (PCA) or "analgesia on demand" is an alternative to administration of analgetics. The major advantage of PCA is the opportunity to achieve the rate of analgesia, according to individual demand of a patient. Besides, PCA allows to reach the desired effect much faster and to maintain the stable plasma level of an analgetic. 2-year experience of the PCA use in more than 200 patients of the National Research Centre for Surgery ICU has been analysed. The authors advocate use of PCA in clinical practice.

Acute Disease↗
PubMed1991

[Prevention and treatment of early complications in patients after reconstructive surgery of the esophagus].

The work deals with clinical appraisal of the course of the early postoperative period and the prevention and treatment of complications after reconstructive operations on the esophagus. The postoperative period was studied in 99 patients. Complications occurred in the early postoperative period in 48.5% of patients, obstructive processes in the lungs were of principal importance among them. The authors conclude that particular significance in the prevention of acute respiratory failure in patients after one-stage plasty of the esophagus should be attached to the early diagnosis of pulmonary complications, prolonged artificial lung respiration, and measures for maintaining normal passage of the respiratory tract (cleansing bronchoscopy, early activation of patients, adequate anesthesia). The main importance in reducing mortality after one-stage esophageal plasty belongs to the measures of prevention and treatment of incompetence of the sutures of the esophageal anastomosis and mediastinitis.

Acute Disease↗
PubMed1991

[Computerized monitoring of patients in the intensive care and resuscitation unit].

Monitoring-computed systems were used during the therapeutic-diagnostic process at the resuscitation department of the All-Union Surgery Research Center in more than 1,000 patients who underwent operations on the heart, coronary arteries, bronchi, trachea, and esophagus. The main importance is attached to examination of the cardiorespiratory system. More than 90 derived parameters characterizing intracardiac hemodynamics, ventricular contractility, and oxygen transport are calculated according to special programs. For evaluation of the function of the lungs in an automated regimen, 32 parameters characterizing lung ventilation, gas exchange in the lungs, mechanism of respiration, and metabolism are calculated. Monitoring-computed care makes it possible to appraise the patient's condition in a given situation, the transient nature of changes in the physiological systems of the organism under the effect of therapy, and helps in choice of the optimal regimens of artificial lung ventilation and the methods of treatment. Computed appraisal of hemodynamics by means of the algorithm of the nearest point was found to be correct in 93% of cases. Storage of the results in the computer memory ensures an operative approach to information on any of the patients.

Diagnosis, Computer-Assisted↗
PubMed1986

[Use of sympathomimetic agents in the treatment of acute circulatory insufficiency in the immediate postoperative period of heart surgery patients].

Sympathomimetic agents: isoproterenol (novodrin), dopamine, noradrenalin, adrenalin were used in 137 patients with acute circulatory insufficiency. Their hemodynamic effects were assessed, using catheterization of heart chambers and radiocardiography, and studies of circulating blood oxygen transport, acid-base state and metabolic product levels. A differential approach to sympathomimetic treatment has been developed. Isoproterenol is primarily indicated in those cases where myocardial failure is combined with decreased heart rate, conductivity disorders and markedly increased total peripheral resistance. Dopamine is more justified in cases where increasing the heart rate is more desirable, and there are signs of renal failure and heart rhythm disorders. The possibility of dopamine-induced pulmonary hypertension and pO2 fall should not be dismissed. Correct choice of an agent or a combination of agents makes it possible to control the patient's condition through action on various hemodynamic mechanisms that determine the magnitude of cardiac output.

Acute Disease↗
PubMed1984

[Low cardiac output syndrome in heart surgery patients].

Using cardiac chamber catheterization and isotope methods, the systemic and intracardiac hemodynamics was studied in 232 patients who had undergone heart surgery under conditions of extracorporeal circulation. The syndrome of a low cardiac output was detected in 46.9% of the patients and was caused by various forms of heart failure, by hypovolemia, a postoperative shock and pericardiac tamponade. The functional state of the right and the left ventricles of the heart in various types of circulatory insufficiency was shown to vary in different directions. The volume of the circulating blood in the postoperative period was determined by the adequacy of the blood loss compensation, by blood deposition, the redistribution of fluid between the vascular, interstitial and cellular spaces of the body and also by the functional condition of the myocardium. The syndrome of a low cardiac output associated with cardiac tamponade is due largely to the diastolic insufficiency of the myocardium. The shock noted in the open heart surgery patients is a polyetiological syndrome in which the impaired circulation is secondary to myocardial failure, deficit of the circulation blood volume, and microcirculatory disorders.

Blood Transfusion↗
PubMed1978

[Radioisotope studies in the practice of an intensive therapy department].

The article discusses the 10-year experience in the use of radioisotop diagnosis in the practice of an intensive therapy department. The results of the examination of over 300 patients who had been operated on under conditions of extracorporeal circulation are analyzed. With the use of radioactive indicators some new aspects of the pathophysiology of acute circulatory disorders were revealed, among others those related to the problem of blood deposition, the correlation between the functioning of the right and left parts of the heart; the diagnostic possibilities in appraising the causes of the disorders of circulation, functioning of the parenchymatous organs, and tissue blood flow were widened; the therapeutic tactics in the development of hypovolemia, acute cardiac failure, and disturbances in tissue perfusion could be elaborated.

Blood Flow Velocity↗
PubMed1978

[Prolonged catheterization of the left atrium in assessing the circulatory state following the surgical correction of a mitral heart defect].

Left-atrial pressure was measured in 36 patients 24 hours to 6 days after surgical correction of the mitral valve under conditions of extracorporeal circulation. The interrelation of the average pressure in the left atrium and the pressure in the right atrium, the end-diastolic pressure in the pulmonary trunk, the cardiac index, and the circulation volume was studied. Normal relation between the average pressure in the left atrium and that in the right atrium was observed in only 1/3 of the patients. The end-diastolic pressure in the pulmonary trunk was close to the pressure in the left atrium in value only in patients with pulmonary-arterial resistance below 220 dyn.s.cm--5. Normal values of the cardiac index were in most patients encountered when the average pressure in the left atrium ranged from 12 to 15 mm Hg. On the basis of the measurement of average pressure in the left atrium, the value of the cardiac index, and the average arterial pressure the tactics in the management of patients after surgical correction of mitral heart disease have been developed.

Blood Circulation↗
PubMed1977

[Evaluation of the indicators of acid-base equilibrium, oxygen and electrolyte blood levels for early diagnosis of hemodynamic disorders after heart surgery].

In 30 patients operated on under extracorporeal circulation the acid-base, oxygen and electrolytes balance parameters were studied in order to evaluate their potentials as additional diagnostic tests for various clinical forms of acute circulatory disorders in the early post-operative period. Cardiac insufficiency is predominantly characterized by a reduced oxygen saturation of mixed venous blood, an increased oxygen arterio-venous gradient and "lactate excess", hypokalemia and hypernatremia in plasma and erythrocytes. Metabolic and gas parameters of acid-base balance cannot be used for the diagnosis of postoperative cardiac insufficiency. In cases of hypovolemia the changes of the laboratory tests data are determined by the compensatory capacities of the human body in response to circulating blood volume deficit.

Acid-Base Equilibrium↗