Vol 15, No 4 (2021)

AIM: This study aimed to improve the treatment results of patients with diabetic foot syndrome by substantiating the optimal type of spinal anesthesia during foot surgery.

MATERIALS AND METHODS: Sixty-four patients undergoing purulent surgery were examined and group as follows: Group 1 – patients operated on under monolateral (unilateral) spinal anesthesia and Group 2 – patients operated on under conditions of bilateral (traditional) spinal anesthesia.

RESEARCH METHODS: Assessment of the level and intensity of pain and the level of catecholamines in urine was conducted in the first postoperative day. Cardiovascular system indicators and the temperature of the skin of the leg during anesthesia were monitored, and the Doppler scanning of peripheral circulation in the foot was performed.

RESULTS: Pain sensitivity during lower limb movement was 20% less pronounced in group 1 than in group 2. A 4.4% decrease in heart rate, a 4.7% decrease in saturation level recorded 20 minutes after the onset of anesthesia, and a 9.8% decrease in mean arterial pressure were observed in group 2. In both groups, systolic blood pressure in the toe increased by 18% after anesthesia, and the temperature of the skin on the lateral surface of the leg increased by 3%. Adrenaline concentration in the daily portion of urine in group 2 was 34.4% higher than that in group 1 in the next postoperative day.

CONCLUSIONS: The general condition of patients during anesthesia was more stable in group 1 than in group 2. After anesthesia, improved peripheral hemodynamics in the operated limb was noted. Compared with traditional spinal anesthesia, monolateral spinal anesthesia has a positive effect on the stress response of the patient’s body to surgical intervention.

BACKGROUND: The number of surgical interventions for the knee joint increases annually due the increase in the total number of patients and the improvement of operation techniques. The provision of modern anesthesiology and intensive care is associated with a positive treatment outcome, which is based on adequate pain relief in the perioperative period, suppressed complications, and reduction in hospital stay. Regional analgesia is a modern and effective method of pain relief after knee surgery. However, the location of peripheral blockade may affect the timing of activation and rehabilitation in these patients.

AIM: This study aimed to evaluate the use of femoral nerve and adductor canal blockade in the framework of the accelerated recovery program after knee arthroplasty.

MATERIALS AND METHODS: A prospective, randomized, single-center study included 80 patients who underwent primary knee arthroplasty and were randomly assigned to two clinical groups. Group 1 (n=40) included patients who underwent femoral nerve blockade in the postoperative period, and group 2 (n=40) included patients who underwent adductor canal blockade in the postoperative period. In the postoperative period, the level of pain at rest and during movement was analyzed using a visual analog pain level scale after 6, 12, 24, and 48 hours. The amount of prescribed narcotic analgesic in the postoperative period was recorded, and the total distance that patients were able to walk after 6, 12, 24, and 48 hours was measured.

RESULTS: For the level of pain at rest and during movement, no significant differences at all time intervals were observed for both groups (p >0.05). No additional prescription of narcotic analgesics was required. Compared with group 1, group 2 covered a significantly greater distance in the first 24 after the operation. After 48 hours, no significant differences were found between the two groups (p >0.05).

CONCLUSIONS: Femoral nerve and adductor canal blockades provide an adequate level of analgesia after knee arthroplasty. In particular, adductor canal blockade significantly increase the distance of movement by patients in the first 24 hours after surgery.

BACKGROUND: Anesthetic management during interventions on the adrenal glands is quite complex. Difficulties in conducting anesthesia are often determined by concomitant obesity, which is associated with an increased sensitivity of the respiratory center to the action of opioids. This condition contributes to an increase in the frequency of respiratory and other disorders with the use of opioids.

AIM: This work aimed to study the influence of different variants of perioperative anesthesia and analgesia administered during retroperitoneoscopic adrenalectomy in obese patients during the perioperative period.

MATERIALS AND METHODS: A randomized study of 94 patients who underwent retroperitoneoscopic adrenalectomy for adrenal neoplasms was performed. Depending on the type of perioperative analgesia, the patients were divided into two groups. In group 1 (n=33), the operation was performed under combined anesthesia based on the low-flow desflurane inhalation; for perioperative analgesia, only systemic opioid administration was provided. In group 2 (n=30), the operation was performed under anesthesia based on low-flow desflurane inhalation in combination with the blockade of the fascial space of the erector muscle. In group 3 (n=31), the operation was performed under anesthesia based on desflurane in combination with drugs for non-opioid analgesia. critical incidents.

RESULTS: Surgical intervention of the wound under inhalation anesthesia with ESP blockade (ropivacaine) and a combination of drugs for non-opioid analgesia promotes faster post-anesthetic rehabilitation, effective postoperative analgesia, and fewer complications in the early postoperative period compared with anesthesia using systemic opioid analgesics. This effect contributed to significantly shorter hospitalization of 97 hours for group 2 (95% CI 85-102) (p=0,042) and 94 hours for group 3 (95% CI 82-101) (p=0,039) compared with the 126 hours for group 1 (95% CI 114-135).

CONCLUSIONS: Anesthesia based on desflurane in combination with ESP blockade and a multiple drugs for non-opioid anesthesia is an effective method that promotes fast post-anesthesia rehabilitation and shortens the hospitalization period for retroperitoneoscopic adrenalectomy for aldostectomy in the perioperative period.

BACKGROUND: The method of choice for anesthetic support of orthopedic interventions for hip deformities in children is a combination of inhalation and prolonged epidural analgesia. Nevertheless, no consensus was found in the medical community about the advisable usage of neuraxial blockades in patients with osteogenesis imperfect (OI) due to the risk of hemorrhagic complications, as well as increased intracranial pressure against the background of hydrocephalus, as a manifestation of a craniocervical junction anomaly.

AIM: To assess the efficacy and safety of prolonged epidural blockade as the main component of anesthesia and postoperative pain relief in children with OI during orthopedic correction of hip deformities.

MATERIALS AND METHODS: A retrospective analysis from 2018 to 2020 included 40 children who underwent orthopedic interventions on the lower extremities. Considering a similar concomitant neurological pathology (epilepsy and hydrocephalus) and severity of hip surgical interventions, 2 groups of 20 persons were formed: the main group had OI and the control group had cerebral palsy (CP). The hemodynamic parameters, perioperative need for analgesics, volume of external blood loss and need for blood transfusion, and structure of complications were evaluated.

RESULTS: Statistically significant differences were detected in hemodynamic parameters at the stage of tracheal intubation and the end of the surgery but without clinical significance, since they were within the acceptable physiological values. The recorded differences in the hemoglobin level of the capillary blood before the surgery are probably due to the initial hypovolemia and hemoconcentration in the CP group.

CONCLUSIONS: Prolonged epidural analgesia in children with OI during orthopedic correction of hip deformities is an effective and safe component of anesthesia and postoperative pain relief.

The monograph is devoted to the history of anesthesiology at the Pavlov First Saint Petersburg State Medical University. In the first chapter titled «The beginning of the epoch of anesthesia», the author emphasized the role of coryphaeus. Russian world surgeon and anesthesiologist, Nikolay I Pirogov, enumerated the merits of Vasily von Anrep, the first rector of the women’s medical institute who discovered the local anesthetic property of cocaine. The second chapter, «Development of anesthesia: from 1918 to 1950», shows the role of Professors V.A. Shaak, L.A. Andreev, K.K. Skrobansky, and A.A. Zykov. The third chapter, «Development of Anesthesiology: from 1945 till 1970», describes the beginning of the application of the apparatus method of general anesthesia and the first dissertations in anesthesiology. The fourth chapter, «Development of Anesthesiology and Intensive Care since 1971», describes the establishment of the Department of Anesthesiology and Intensive Care in 1974 and the results of its scientific work, particularly the role of epidural anesthesia in the anesthesiological support of lung surgery, the development of combined spinal–epidural anesthesia, and the establishment of a new direction - adrenergic analgesia. The fifth chapter, «Development of Anesthesiology and Intensive Care since 2001», includes data about monographs and is written by the department staff. The sixth chapter, «Development of Anesthesiology since 2013», shows the changes in the educational activities of the department and the challenges of providing emergency care to individuals with various qualifications. The monograph will be useful for students, clinical residents, practical physicians, and historians of medicine.