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V V Likhvantsev

Publications and source records attributed to V V Likhvantsev.

30 records · Page 2Linked to original sources

[Some methodological aspects of modern anesthesia].

The paper provides evidence for that it is necessity to introduce anesthesia standards (protocols). The anesthesia protocols (standards) are meant as a combination of the principles, rules, and provisions to be binding. The constituents of these protocols are all stages of anesthesia: preoperative examination of patients, choice of a method of anesthesia, a mode of provision of upper airways patency, the scope of monitoring, recording of the use of drugs. The minimum requirements below which an anesthesiologist cannot do his/her work are worked out for each constituent of the protocol. The wide introduction of anesthesia protocols in foreign countries could largely level differences in the quality of anesthesiological support and resulted in the emergence of a middle-leveled anesthesiologist. The paper considers the advantages and disadvantages of setting up of protocols above and their establishment in some clinical and clinical amalgamations. The author considers that there are so far two known ways to avoid the "parochiality", incompetence in determining local standards: (1) the use of the points of evidence-based medicine, i.e. the whole experience accumulated by the international anesthesiological community. To have such recommendations is not a problem if internet is available; (2) medical audit is a relatively new method for assessing the quality of anesthesia, which makes it possible through clinical analysis of the collected data to identify the areas that require developments and their introduction. It is local audit on whose basis the administration, the head of units, senior physicians generally develop and make amendments into different protocols and instructions that regulate the principles of clinical activities.

Anesthesia↗

[Combined monitoring of the central and autonomic nervous system during operations on the liver and pancreas].

Thirty patients from 3 groups that differed only in the scope of monitoring were examined to study the efficiency of combined neurophysiological and autonomic nervous monitoring in the assess of the quality of anesthesiological protection during highly traumatic surgical interventions made in abdominal patients under combined general anesthesia based on long-term graded epidural naropine (3 mg/ml) infusion at the thoracic level Addition of the Harvard standard with monitoring the information saturation of EEG made it possible to maintain the depth of anesthesia, by reducing the dose of dormicum by 20% (p < 0.05). The use of combined monitoring of EEG information saturation and the tension index after R. M. Bayevsky could reduce the dose of fentanyl by 2.3-2.7 times (p < 0.05) and the incidence of critical cardiovascular incidents by 39% (p < 0.05).

Adult↗

[The first experience in using sevoflurane].

The paper analyzes the first experience in using the halogen-containing anesthetic sevoflurane, which is new for Russia, as an agent for initial narcosis and anesthesia maintenance in adult patients. For induction, delivery of sevoflurane was initiated in a dose of 0.7 r.% through the mask of an anesthetic-respiratory apparatus. After 3-5 breaths, the dose of sevoflurane was increased up to 2 r.%. The time of inhalation to the level of INEEG being achieved 40-45% was 3.2 +/- 0.5 min, while that with propofol was 3.3 +/- 1.0 min. Initial inhalational anesthesia was smooth, which did not exclude a slight short-term motor activity in 2 patients. Sevofluorane has a pronounced hypnotic, but a weak analgesic effect in adults, which requires the co-administration of fentanyl. Sevofluorane will be mostly demanded for initial narcosis and anesthesia maintenance in children and for the induction and maintenance of anesthesia in ambulatory anesthesiology and thriving one-day hospitals. The foregoing does not rule out the use of servofluorane for the induction and maintenance of anesthesia in adults.

Adult↗

[To the effective concentration of xenon].

The present literature discusses what effective concentration of xenon may be used to induce adequate anesthesia. To examine the analgesic properties of the substance, 38 patients undergone laparoscopic operations for calculous cholecystitis under informational saturation EEG (INEEG) monitoring were included into this study. All the patients were divided into 3 groups in accordance to the mode of anesthesia maintenance and INEEG monitoring. In Groups 1 and 2, the concentration of xenon was maintained at 70%; INEEG monitoring was made in the of-line mode. In Group 3, the concentration of xenon was gradually decreased from 70% to the minimum value at which the level of INEEG was 40-50%, which corresponds to the adequate depth of anesthesia. The use of 70% xenon concentration and the standard doses offentanyl (3.1 +/- 1.6 microg/kg/h) resulted in excessively deep anesthesia (38 +/- 4% INEEG). Reduction of the dose of fentanyl on an average to 1.5 +/- 0.8 microg/kg/h permitted more adequate anesthesia; however, an excessively deep anesthesia is encountered in 40% of cases, as evidenced by INEEG. The active use of INEEG monitoring in Group 3 makes it possible to perform an adequate anesthesia (46 +/- 4% INEEG) and to determine the xenon concentration necessary for this, which is equivalent to 42 +/- 11% with the dose of fentanyl of 0.9 +/- 0.8 microg/kg/h.

Acalculous Cholecystitis↗

[Blood oxygen-transporting function during different anesthesiological provision procedures in the surgery of the hepatopancreatoduodenal area].

A comparative analysis of blood oxygen-transportingfunction (BOTF) under 6 types of combined general anesthesia (low-flow inhalational anesthesia in combination with a narcotic analgesic or with continuous graded epidural infusion (CGEI) of local anesthetics) during high-traumatic and prolonged operations on the hepatopancreaoduodenal area has revealed no significant abnormalities of tissue oxygen transport and metabolism. At the same time when a procedure of anesthesia is chosen for this category of patients, preference should be given to a combination of CGEI and low-flow inhalational anesthesia with isoflurane in nitrous-oxide mixture, which provides a minimum drug load, optimal conditionsfor cardiovascular performance, and stability of BOTF parameters even in baseline endotoxicosis.

Adolescent↗

[Dalargin--a basic means of intraoperative protection of a patient during correction of an atrial septal defect under conditions of artificial circulation: a new method of anesthesia].

The paper presents results of application of the Soviet synthetic neuropeptide Dalargin as a major agent of anesthesiologic protection in the correction of a secondary atrial septal defect under general artificial circulation. From the findings obtained from examinations of central and peripheral hemodynamic parameters and blood oxygen transport function it was concluded that the anesthesiological protection was adequate at all the stages of an operation. The authors also give data on the optimization of the afterload of the right ventricle and preload of the left ventricle under anesthesia in which dalargin was used by directly affecting the elasticity of pulmonary vessels. The nature of changes in the ventilation-perfusion relationships, in the postoperative period, in particular, also enables the author to recommend the preferable employment of the described method for anesthesia while correcting this type of heart disease.

Adolescent↗

[Testosterone regulation of hexokinase and phosphofructokinase activity in androgen-sensitive tissues].

Possible regulatory effect of testosterone on hexokinase and phosphofructokinase activities was studied in rats seminal vesicles and prostatic gland. cAMP, but not cGMP, was shown to stimulate the testosterone induction of these enzymes in androgen-sensitive tissues. Cooperative increase in efficiency, observed after simultaneous administration of testosterone and inhibitors of phosphodiesterase, suggested the possible mechanism of cyclonucleotide-mediated regulation of enzymes by androgens. Regulation of the glycolysis kev enzymes appears to be carried out via two mechanisms; binding with androgen receptors of cytosol and an increase of intracellular cAMP concentration apparently by means of phosphodiesterase inhibition.

Animals↗

[Prospects of using non-narcotic analgesics in present-day methods of general anesthesia].

Efficacies of several relatively new methods of anesthesia are compared. The data of electroencephalographic monitoring, early components of somatosensory evoked potentials, parameters of the central and peripheral hemodynamics (pulsometry supplemented with estimation of photoplethysmography coefficient, among other things), acid-base balance, were used as criteria of the adequacy of analgesia. A total of 369 anesthesiologic modalities are analyzed, which were compared with traditional and modified neuroleptanalgesia (NLA) with inhalation of fluothane vapors. A high efficacy of NLA carried out in parallel with inhalation of gaseous anesthetics (fluothane) was confirmed. If traditional NLA is used in long traumatic operations, fentanyl in dose at least 10 mcg/(kg.h) should be infused during the main stage of the intervention to provide effective anesthesia; during cardiopulmonary bypass surgery fentanyl dose should be at least 15 mcg/(kg.h). Use of moradol as the principal analgesic in surgery on the open heart and aorta and in long traumatic interventions on the thoracic and abdominal organs was found unjustified. Combined total anesthesia with fentanyl, droperidol, seduxen, dalargin, and clofelin may be effectively used for intraoperative protection in interventions of any kind. Clinical significance of the phenomena detected is discussed.

Analgesics, Non-Narcotic↗

[Comparative aspects of the use of dalargin in comprehensive anesthesiologic protection during the surgical correction of congenital heart disease].

The use of graded infusion of dalargin (a home-made synthetic analogue of leu-enkephalin) in a complex of anesthesiological protection has been analysed in patients with radical correction of tetralogy of Fallot and atrial septal defect. It has been shown that delargin has a pulmonoprotective effect, moreover, it is supposed to possess a certain analgetic activity. Dalargin reduces total pulmonary resistance, the normalizing effect of the drug on the vascular tone and the degree of pulmonoprotecive action being higher in cases when the preceding pathological shifts were more pronounced. The author believes it is indicated to apply the drug in a complex of anesthesiological protection during radical correction of tetralogy of Fallot and atrial septal defect primarily to ensure intraoperative pulmonoprotection and optimization of the vascular tone in the pulmonary artery.

Adolescent↗

[Monitoring of the informative saturation of EEG: a new method for intraoperative assessment of antinociceptive defense of the organism].

EEG is the result of brain activity aimed at processing the external and internal information. Intraoperative pain (as a specific type of information) developing because of inadequate anesthesia increases the total amount of information on the EEG. A new original method is proposed for assessing the efficacy of analgesia, based on computer monitoring of information saturation of EEG in the on-line regimen during an operative intervention under combined total anesthesia. Physiological and clinical significance of the detected phenomena is discussed.

Adolescent↗