Vol 9, No 1 (2015)

The present overview is devoted to the problems of anesthetic management for surgical procedures and analgesia in patients with blood diseases. The authors highlight particularities and possibilities of various methods of analgesia in patients with hemophilia, thrombocytopenia and other blood pathological conditions. Main factors defining the choice of tactics and technique of analgesia are considered in details.

The choice of anesthetic modality for thoracic surgeries is due to effective analgesia, neurovisceral protection, early awakening and activation while minimizing side effects and complications of anesthesia itself. Thoracic epidural analgesia (EA) is considered to be a method of choice for pediatric thoracic surgeries. To reduce the risk of complications associated with EA authors consider less invasive methods of regional anesthesia, particularly, paravertebral block (PVB). Application of ultrasound guidance during regional anesthesia can reduce the rate of complications and increase efficiency by visualization of anatomic structures, needle and the spread of local anesthetic in real time.

The prospective study included 220 patients with severe acute pancreatitis. From this group 105 individuals received continuous epidural blockade (EB) with 0.2% ropivacain solution for 3-7 days. The rest of patients were enrolled into control group. Continuous EB promoted the decrease of intra-abdomenal pressure and allowed introducing the enteral nutrition 2-3 days earlier. Patients from EB group have less lung complications comparing with control group. Total incidence of purulent intra-abdomenal complications was 20,0% in EB group while in control group - 51,3%. The EB conducting contributed into decrease of period of staying in intensive care unit and in hospital as a whole. The incidence of mortality was 11,4% in EB group while in control group it was 15,6%. We concluded that performing of continuous epidural block at early stage of severe acute pancreatitis as an intensive therapy component results in decreasing of frequency of life-threatening complications and mortality.