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Biomedical subjects

S P Kozlov

Publications and source records attributed to S P Kozlov.

At least 19 recordsLinked to original sources
PubMed2004

[Lumbar sympathectomy in treatment of obliterating diseases of lower limbs: state of the art].

The article deals with analysing examination and surgical treatment of 80 patients with predominant lesions to the distal arterial bed of the lower extremities, who were operated on at the RRSC from 1996 to 2003 with various degree on the background of chronic obliterating diseases of lower limbs arteries. All the patients were subdivided into two groups according to the outcomes of the epidural block: Group I -- with positive outcomes consisted of 36 (45 %) patients, and Group II -- with a negative outcome -- included 44 (55 %) patients. The patients from the both groups underwent the following operations: lumbar sympathectomy combined with direct and indirect methods of revascularisation, as well as lumbar sympathectomy as an independent therapeutic method. To solve the problem concerning feasibility of either done, or concomitant lumbar sympathectomy, we devised assessment of microcirculation state (alterations in volumetric blood flow indices in epidural block in relation to the indices at rest, as well as in the immediate or remote postoperative period) and peripheral haemocirculation (dynamics of the onkle brachial index values on the background of epidural block test, nitroglycerine test in relation to the ARI at rest both in the short-, and long-term postoperative period) by data of scintigraphy and dopplerography of the lower limbs.

Arteriosclerosis↗
PubMed1997

[Current local anesthetics in segmental nerve blocks].

The evolution of central segmental blockades was studied in 133 patients by using epidural and spinal anesthesias. The efficiencies of 2% Ultracaine (Hoechst) and 2% Lidocaine (Egis) solutions used for epidural anesthesia and 5% Ultracaine (Hoechst) and 0.75% Bupivacaine (Astra) hyperbaric solutions were evaluated. Central segmental blockade induced by Ultracaine was found to be similar to Lidocaine and Bupivacaine in clinical parameters. At epidural blockade, the latent period was identical for the two agents and the duration of analgesia caused by Ultracaine was 20 minutes longer than that with Lidocaine, the consumption of the former being 20% less. At spinal anesthesia, there were no great differences in the depth and duration of conduction block, but with 5% Ultracaine, the analgesic zone was large (13.2 +/- 1.0 and 15.1 +/- 0.6 segments, p < 0.05). No differences were found in the magnitude of hemodynamic changes both with various anesthetics and different types of segmental blockades. The findings make it possible to regard Ultracaine as an drug that has some advantage over Lidocaine for prolonged epidural anesthesia and similar to the latter in pharmacological characteristics. Ultracaine may be regarded as alternative to Bupivacaine for spinal anesthesia.

Adult↗
PubMed1990

[High conduction block of the brachial plexus using axillary approach].

An original technique of the brachial plexus block from the axillary approach is presented. The recommended technique suggests introduction of a rigid catheter into the paraneural space of the plexus up to the level of the sternoclavicular triangle. This provides for a high efficacy of the anesthesia and prevents development of complications. The methodology was elaborated on the basis of anatomic (n = 20) and clinicoradiological (n = 29) studies. The clinical evidence was obtained from 115 anesthesias for long-term reconstructive and plastic operations on the upper limb. A protocol for conduction anesthesia maintenance by repeated administration of lidocaine, trimecaine, and bupivacaine solutions is offered.

Adolescent↗
PubMedDate not supplied

[The anesthesiological support for limb segment replantations (20 years' experience)].

Anesthesias for urgent replantations of the limb segments in 1980-1998 are analyzed. A retrospective analysis of case histories and protocols of anesthesia of patients aged 16-64 years is carried out. Specific features of anesthesia for surgery of this kind are demonstrated. The authors suggest an algorithm of preoperative treatment of patients, determined by the severity of injury, and discuss the choice of anesthesia: variants of regional anesthesia, balanced anesthesia based on conduction blocking, and balanced anesthesia with forced ventilation of the lungs. Special attention is paid to components of anesthesia which regulate adequate bloodflow in revascularized segments of the limbs: infusion-transfusion therapy with attaining the hypervolemic hemodilution, maintenance of thermal homeostasis, prevention of "toxic shock" during incorporation of the replanted segment into the bloodflow, and strategy of patient's awakening after long operation and anesthesia.

Adolescent↗
PubMedDate not supplied

[Subarachnoidal anesthesia: the limits of its potentials].

A total of 250 subarachnoidal anesthesias (SA) have been performed in patients operated on the lower limbs, perineum, external genitals, pelvic organs, and anterior abdominal wall at department for plastic and reconstructive surgery. The efficacy and safety of SA in everyday practice has been evaluated. A total of simultaneous 228 SA with three hyperbaric solutions were carried out: 5% ultracaine, 0.75% bupivacaine, 0.5% marcaine, and one isobaric solution 0.5% bupivacaine. Prolonged SA was administered to 10 patients and combined spinal-epidural anesthesia (CSEA) to 19. The sensory block was assessed by the pin prick test and the motor blocking by Bromage score. Of the central segmentary blockades, SA has been preferred for the above-listed interventions in recent years. Hyperbaric and isobaric solutions caused analgesia of different duration, latent period, and dissemination of the anesthetic under different clinical situations. Prolonged SA is justified in patients with limited hemodynamic reserves, and CSEA should be preferred when the expected duration of the intervention is longer than the estimated duration of SA effects. SA is an effective and safe method for surgical anesthesia on condition of proper choice of the local anesthetic, use of high-quality kits, and strict adherence to the protocol of subarachnoidal puncture and injection.

Adolescent↗
PubMedDate not supplied

[A clinical trial of the use of 2 forms of bupivacaine hydrochloride (Anecaine and Marcaine) for epidural anesthesia].

Two forms of 0.5% bupivacaine hydrochloride, Anecaine (Pliva) (n = 15) and Marcaine (Astra) (n = 15) were used for epidural anesthesia. The clinical picture of conduction block induced by the two local anesthetics varied. It manifested by a shorter latent period of analgesia development at the level of catheter and the drug infusion (LII) and relatively delayed development of analgesia in peripheral zones for Anecaine in comparison with marcaine. The authors conclude that solutions of local anesthetics containing the same active agent in the same concentrations under different commercial names manufactured by different companies may be characterized by different clinical picture of conduction blockade.

Adult↗
PubMedDate not supplied

[Hazards and complications of central segmental blockade. I. Epidural anesthesia (retrospective analysis)].

A total of 700 reports about complications of epidural anesthesia over more than 30 years are analyzed. Four groups of complications have been distinguished: 1) errors and complications caused by technological errors; 2) complications caused by atypical dissemination of an anesthetic; 3) complications caused by side and toxic effects of local anesthetics or effects of epidural block; and 4) complications caused by damage to nerve structures. Causes, pathogenesis, prevention and treatment of complications are discussed. The cause-and-effect analysis of complications of epidural anesthesia helped objectively formulate and validate the relative and absolute contraindications to the use of this method.

Adult↗
PubMedDate not supplied

[Sleep and sedation: clinical and electrophysiological parallels].

Clinical and electrophysiological studies were performed in 10 volunteers and 45 patients with Classes I and II, as stated by the American Society of Anesthesiologists, to evaluate consciousness during sedation. Prior studies on volunteers showed that there was a clear correlation between N-REM sleep and SEF in 90% of cases. Based on these findings, the authors propose a modified suppressed consciousness scale whose rating was adjusted to the levels of N-REM sleep. Irrespective of the type and technique of sedation (infusion of thiopental and propofol; PCS, midazolam), changes in the levels of drug-depressed consciousness were found to be the same.

Adult↗
PubMedDate not supplied

[Clinical-and-pathophysiological prerequisites of impaired breathing and ensuring of safety in drug-induced depression of consciousness].

Seventy-three patients operated on under anesthesia based on regional blocks were examined. Thiopental-sodium (T; n = 29), myadozalam (M; n = 10) and propofol (P; n = 24) were used for sedation. The conditions of breathing and of gas exchange were evaluated by the findings of pneumotachography: V(peak insp), P(peak insp), P(100) Raw, breathing pattern, SpO2, PEtCO2 and EMG from mouth-diagram muscles. The obtained results were made use of to draw up a rating scale for impaired breathing, which is based on the respiratory volume and respiration rate of gas exchange as well as on different variations of respiratory support. Irrespective of a sedation type and of a degree of consciousness suppression, the impaired breathing was registered in 90-100% of cases: obstruction of the respiratory tracts was predominant in T (higher Raw); in M--depression of the respiratory center (lower P(100); in P--a pronouncedly lower of EMG, and, respectively, a weakened contraction of diaphragm (lower P(peak insp)). Depression of the respiratory center was found to occur irrespectively of a drug used in sedation, however, the mechanisms of obstruction were different: in T--impaired breathing; in M--impaired phase muscle activity. Sedation by P was not accompanied by any clinically valuable obstructive signs.

Procedural Sedation↗
PubMedDate not supplied

[Subarachnoid anesthesia in patients with high surgical risk].

The hemodynamics was intraoperatively studied in 43 patients with multicentric atherosclerosis, ASA III-IV, operated on the peripheral vessels of legs with balanced anesthesia based on subarachnoid block. It was established in regional sympathetic block and in the course of the whole surgery that the parameter of AP were decreased by 20-25%, those of heart rate--by 15% and of TPVR--50%, whereas, the parameters of cardiac performance were stable. The authors discuss the specificity of hemodynamic restructuring under subarachnoid block in patients with at surgical risk due to vascular pathology.

Aged↗
PubMedDate not supplied

[A new method of monitoring the psycho-emotional condition in patients during balanced anesthesia based on regional blockades].

The potentialities of a skin-galvanic reaction (SGR) were studied, to evaluate the psycho-emotional status, in 9 sedated (midazole, thiopental-sodium, propofol) classes I and II ASA patients operated (10 interventions) under regional block. An original software was designed to analyze the SGR; it detects the signs of psycho-emotional discomfort (including positional discomfort) in drug-induced depression of consciousness as well as the uncontrollable moments of falling-asleep and awakening.

Adult↗
PubMedDate not supplied

[Subarachnoidal anesthesia in patients with concomitant diseases of the cardiovascular system].

Age-related changes limit blood circulatory reserves in vital organs, by increasing the risk of ischemic and hypoxic lesions. Patients from a peripheral vascular surgery department form a high cardiac risk group. Subarachnoidal anesthesia is the most optimal anesthetic support (if there are no absolute contraindications) during operations for lower extremity varicose veins. Thirty patients operated on for this condition were examined to solve the problem associated with the effectiveness and safety of this method of anesthesia and to define the pattern of hemodynamic rearrangement more precisely. All the patients had concomitant cardiovascular diseases, which forced them to be referred to as ASA Classes III-IV. The authors monitored basic hemodynamic parameters, such as systolic blood pressure (BP), diastolic BP, mean BP (BP(mean)), heart rate, and cardiac output, by using a noninvasive procedure by means of a computer equipped with a Doppler flowmetric transducer, and ST-segment changes by ECG). The values of total and specific peripheral vascular resistance and cardiac index were estimated by a calculating method. Analysis of hemodynamic changes revealed no significant differences between the groups of elderly and senile patients. On examination, all the patients were divided into 2 groups by the type of circulation: 1) those with eukinetic circulation and 2) those with hypokinetic circulation. Hyperkinetic circulation was not found in the study groups of patients. The patients with cardiac disease were observed to have increased vascular resistance, in those with hypokinetic circulation, this increase being more marked (p < 0.05). In addition, ST-segment had a more stable position in patients with hypokinetic circulation. There was a great scatter in ST-segment changes in patients with eukinetic circulation in the presence of decreased peripheral resistance under preganglionic sympathetic block. With the described changes, noteworthy was the stability of BP(mean) values that did not decreased below the critical ones. This fact permitted the authors to state that the compensatory reserves of the cardiovascular system were preserved under subarachnoidal blockade, which in turn suggests the effectiveness and safety of the used anesthetic procedure.

Aged↗
PubMedDate not supplied

[Epidural block as a component of anesthesiological provision during abdominal operations].

Two modes of general anesthesia with artificial ventilation in combination with epidural block differing in a hypnotic component (inhalational or intravenous) were studied in 27 patients. A combination of general and epidural anesthesia afforded the best protection from surgical stress during major abdominal operations. Inhalational or intravenous anesthetics may be equally used to induce unconsciousness. The fact that there may be blood loss is not an absolute contraindication to epidural anesthesia. The safety and controllability of combined anesthesia increase when its individual components are monitored and the protocol is strictly observed. There is a need for further development of objective criteria for efficient regional block under general anesthesia.

Abdomen↗
PubMedDate not supplied

[The inguinal paravascular technique of lumbar plexus block--anatomical pretests were unsuccessful].

Using 28 anatomic preparations, the boundaries of dye expansion in tissues adjacent to nervous stems have been experimentally studied during the application of lumbar plexus local anesthesia technique via inguinal paravascular approach according to A. Winnie. It has been established that the above technique is not associated with anatomic conditions for simultaneous contact of a model dye solution with 3 basic derivates of the lumbar plexus both at the level of formation and further on. There is massive dye diffusion from femoral nerve perineural space into the intermuscular connective tissues. Compact structure of perineural spaces in musculus psoas major prevents lumbar plexus infiltration. The junction of lumbar and obturator fascia, forming the fascial node between large and small pelvis, excludes any possible contacts between the dye solution and the obturator nerve.

Female↗