PubMed Health⌕ Search

Biomedical subjects

S M Stepanenko

Publications and source records attributed to S M Stepanenko.

At least 19 recordsLinked to original sources
PubMed1995

Haemodynamic changes in children with portal hypertension during the postoperative period.

The cardiovascular changes following portosystemic shunt surgery (PSSS) in 33 children with extrahepatic portal hypertension (EPH) were studied to determine if portosystemic shunt surgery had any influence on the cardiovascular state. Haemodynamic data were obtained using two-dimensional and M-mode echocardiography, pulsed-wave Doppler and direct invasive techniques. Postoperatively all patients developed a hyperdynamic state, associated with an increase in cardiac index (CI), heart rate (HR) and a decrease in systemic vascular resistance index (SVRI). In 16 patients (group I), who preoperatively exhibited a hyperdynamic state accompanied by pulmonary hypertension, postoperative studies found an increase in acceleration time to ejection time ratio (AT/ET) in the pulmonary artery from 0.32 +/- 0.05 (mean +/- SEM) to 0.43 +/- 0.01; P < 0.01. Nine patients (group II) who were normodynamic preoperatively developed pulmonary hypertension and right ventricular (RV) dysfunction postoperatively: decrease in AT/ET from 0.42 +/- 0.02 (mean +/- SEM) to 0.32 +/- 0.01; P < 0.01 and an increase in maximal peak pulmonary artery velocity to acceleration time ratio (Vmax/AT) from 702.56 +/- 69.10 (mean +/- SEM) to 1127 +/- 105.30 cm.sec-2; P < 0.01. In eight patients (group III) who were normodynamic preoperatively and were treated with dobutamine infusions at a rate of 5 micrograms.kg-1.min-1 postoperatively, the CI was found to increase from 5.28 +/- 1.1 (mean +/- SEM) to 7.97 +/- 1.64 L.min-1.m-2; P < 0.01, left ventricular ejection fraction (LVEF) from 69.0 +/- 4.1 (mean +/- SEM) to 81.0 +/- 2.9%; P < 0.01 and AT/ET from 0.37 +/- 0.04 (mean +/- SEM) to 0.44 +/- 0.03; P < 0.01.(ABSTRACT TRUNCATED AT 250 WORDS)

Acceleration↗
PubMed1990

[The diagnostic and prognostic value of the indices of the colloid-osmotic state of the blood in children with the crush syndrome].

Eighteen infants with compression syndrome (CS) were managed with simultaneous evaluation of changes in the blood colloid osmotic status. The examination findings showed that plasma osmolality is an integral index of endogenous intoxication which objectively reflects the gravity of the general condition of patients and requires adequate correction. The osmolality gap was measured by the difference between the measured and calculated osmolalities; its stable two- or threefold increase was found to be the most unfavourable factor in the disease course and prognosis. It was found that control of osmotic homeostasis in infants with CS is essential to decide that extracorporeal blood clearance techniques be used and to elaborate effective infusion therapy programmes.

Adolescent↗
PubMedDate not supplied

[Pediatric regional anesthesia: rational approaches and practical aspects].

Regional anesthesia in children is to be carried out with due consideration for anatomy, physiology (specifically, neurophysiology), pharmacology of local anesthetics, and detailed knowledge of pediatric protocols of numerous regional blockades. Age-specific differences in the pharmacokinetics of local anesthetics should be borne in mind when choosing safe doses and protocols. The pharmacokinetic factors may involve the risk of toxic reactions to local anesthetics. The protocols of central neuroaxial blockades in children are characterized by certain differences, concerning the indications, anatomic reference points, choice of special equipment, doses, and schemes of administration.

Age Factors↗
PubMedDate not supplied

[Characteristics of anesthesia in children operated on for extrahepatic portal hypertension].

Portocaval shunting reliably preventing hemorrhages from esophagogastric veins is most often used in surgery for extrahepatic portal hypertension (EPH) in children. Difficulties of anesthesia for this intervention consists in essential alteration of volume bloodflow as a result of massive outflow of deposited blood to systemic circulation through the new bypass. This necessitates search for an adequate method of general anesthesia and variants of infusion therapy for surgical venous shunting in children with EPH. Sixty-eight children aged 1-15 years with the EPH syndrome were subjected to elective surgery under general analgesia (multicomponent balanced neuroanesthesia with evaluation of some hemodynamic and metabolic parameters). The proposed protocol of general anesthesia in combination with epidural analgesia by local anesthetics and promedole and infusion therapy in the hypervolemic hemodilution mode create the most favorable conditions for adaptation of hemodynamics to increased preloand.

Adolescent↗
PubMedDate not supplied

[Ways to reduce mortality of newborns with developmental defects].

Technological progress contributed to progress in surgery on the newborns. However, despite the progress in surgery and intensive care of the newborns, the results of treatment of patients with congenital defects are sometimes disappointing. The priority problems for today are the respiratory distress syndrome, hemodynamic disorders, and renal dysfunction, which can be united into the syndrome of general dysadaptation of the newborns. Based on experience gained in the treatment of newborns in pediatric surgical hospital, protocols of treating newborns with developmental defects (congenital diaphragmatic hernia, esophageal atresia, and gastroschisis) have been developed. These protocols are a stage and a prerequisite for development of more effective methods for treating such patients. Common intensive care should be supplemented by such important measures as maintenance of adequate temperature regimen at all stages of medical transportation and therapy of a newborn, obligatory preoperative preparation for stabilization of vital functions, multicomponent endotracheal anesthesia, use of inotropic agents (dopamine and dobutrex), synchronic prolonged artificial ventilation of the lungs and prolonged analgesia, limitation of indications to the use of blood preparations and wide use of hydroxyethylated starch solutions in infusion therapy, rational antibiotic therapy with constant monitoring of the microecological status, and early detection and correction of concomitant diseases. Solution of these problems will essentially decrease the postoperative mortality of newborns with developmental defects.

Analgesia↗
PubMedDate not supplied

[Behavioral response to an acute pain in newborn children with surgical diseases].

The article is dedicated to studying the behavioral response to an acute pain in the newborns with surgical pathologies. The videotaped facial activity (a total of 12 parameters), the general locomotive activity (6 parameters) and cry were studied in 93 newborn children with different surgical pathologies. It was found that the newborn children response differentially to the painful and non-painful stimuli. A combination of 6 signs, i.e. frowning eyebrows, tight eyes, aggravated nasolabial folds, open mouth, and motion of foot, was detected in 93.5% of cases (87 of the 93 children) as a response to a painful stimulus. Such behavior indicates the presence of the painful syndrome in the newborn with a sensitivity of 93.5% and with a specificity of 78.5%. The combination of these signs can signify a characteristic painful behavior in the newborn children and it can be used as a criterion of the painful syndrome in the neonatal period.

Acute Disease↗
PubMedDate not supplied

[Postoperative analgesia with tramal in newborn children using the method of continuous intravenous infusion].

The purpose of the study was to evaluate the efficiency of postoperative analgesia with tramal in the newborns. Analgesia with tramal (5% solution for injections, "Gruonental GmbH", Germany) was administered postoperatively in 20 newborn children. Thirteen children were operated for congenital malformations in the gastrointestinal and urinary tracts, three children were operated for purulent-septic diseases and four children were operated for neoplasms. Hemodynamics indices, i.e. heart rate (HR) and arterial pressure, as well as SaO2, respiratory rate (RR), acid-base condition and behavioral reactions were assessed. Analgesia was implemented by the method of continuous intravenous infusion of tramal, 0.1-0.2 mg/kg.h combined with boluses, 1-2 mg/kg. The newborns were asleep for a major part of time during analgesia with tamal; the stable indices of hemodynamics, acid-base balance, glycemia and of the cortisol level were registered. Arterial hypertension, caused by several factors including the effect produced by tamal, was noted in 70% of children. Dose-dependent hypercapnia was registered in 80% of tests in children at unassisted respiration during the infusion of tamal, which is indicative of that tamal affects the respiratory center during the neonatal period and that it is necessary to monitor thoroughly the respiratory functions, i.e. RR, SatO2, pO2, pCO2, and to choose accurately a preparation dose. The continuous infusion of tamal ensures a sufficient analgesia after different operations and especially after medium-traumatic operations.

Analgesics, Opioid↗
PubMedDate not supplied

[Method of continuous intravenous postoperative analgesia with promedol in newborn children].

Continuous intravenous infusion of promedol, 0.1 mg/kg, with additional boluses, 0.5 mg/kg, was used as postoperative analgesia in 20 newborns. Fifteen (25%) children were operated for congenital gastrointestinal defects or peritonitis, 2 children (10%)--for chylothorax, and tumor was eradicated in 3 (15%) children. On the basis of behavioral reactions, physiological indices (cardiac rate, arterial pressure, SpO2, and respiration rate/artificial pulmonary ventilation--APL) as well as of laboratory "stress" tests (blood glucose and cortisol and acid-base balance) it was proven that analgesia with continuous intravenous promedol infusion was effective. It was shown as possible to administer the promedol infusion in newborns while switching them from APL to independent breathing until the spontaneous breathing with constant positive pressure is ensured provided the pO2, pCO2 and SpO2 respiration indices are satisfactory.

Analgesics, Opioid↗
PubMedDate not supplied

[Nutritional therapy in children during perioperative period].

The efficiency of nutritive therapy was analyzed in cases of 37 patients with gastrointestinal pathologies. Group 1 comprised 12 patients with fistulas of different etiologies and localizations; and group 2 comprised 15 patients with esophageal pathologies, including 7 children with esophageal atresia and 8 children with post-burn cicatricial stenosis of the esophagus. A method of nutrition-status correction by means of both enteral and parenteral feeding is suggested on the basis of examination findings comprising both clinical and laboratory-and-instrumental data. Preparations for parenteral feeding, i.e. 10-20% fatty emulsions, 10% amino acids solutions and 15-20% glucose solutions, were made use of. Enteral diets: semi-element oligopeptide solutions, like Nutrilon pepti TSC, Alphare. Balanced mixtures: sour-milk Nan, AL 110, Nutrizon, Nutridrink. Practical recommendations were defined, on the basis of study results, as to the therapeutic feeding schemes during the in-hospital treatment stages.

APACHE↗
PubMedDate not supplied

[Hemodynamic disorders and their correction in the newborn following abdominal surgery].

Central hemodynamics was studied, using echocardiography and dopplercardiometry in 48 newborn operated on the abdominal organs. General regularities of hemodynamic changes in the first postoperative hours irrespective of the initial type of circulation have been established. Two types of cardiovascular system response to the operation stress are described; an increase and a drop in the cardiac output, which is extremely important for the diagnosis of impaired compensatory-adaptive mechanisms in the newborn. Special attention was paid to the assessment of the adequacy of the infusion therapy. Volume-load test facilitates the diagnosis of latent heart failure. Timely prescription of cardiotonic drugs and differential approach to infusion therapy prevent the onset of circulatory disturbances.

Abdomen↗
PubMedDate not supplied

[The effect of collagen-normalizing therapy on the incidence and severity of anesthetic and postoperative complications in children with connective tissue syndromes].

A new method of collagen-normalizing therapy has been worked out to prevent specific anesthesia-induced, operative and postoperative complications and to treat some symptoms in children with Ehlers-Danlos and Marfan's syndromes and with non-classified Marfan-like malformations. The technique involves a combined use of beta-adrenoblocker in the age-matched doses and vitamins C/0.03 g/(kg.day)/, B2/0.0004 g/(kg.day)/and B6/0.002 g/(kg.day)/ for 2.5 months before surgery and during the first 2 weeks of the postoperative period. The above therapy reduces the incidence of delayed recovery of the muscular tone and adequate respiration, spontaneous and recurrent pneumothorax, hemorrhagic and gastroenterologic complications, as well as the incidence and severity of intestinal paresis. The indexes of effective collagen-normalizing therapy are as follows: body weight increase, echocardiographic pattern of reduced diameter of the aorta and mitral valve prolapse, normalization of the urinary excretion of total and polypeptide-bound oxyproline. The efficacy of therapy depends on the baseline level of oxyproline excretion.

Adolescent↗