Vol 12, No 3 (2018)

In ophthalmic surgery, the choice of the method of anesthesia presents certain difficulties for both the anesthesiologist and the ophthalmologist. According to world statistics, the most frequently performed ophthalmic operations are performed in patients of the older age group who have concomitant chronic somatic diseases (diabetes mellitus, hypertension, atherosclerosis, etc.). It is advisable to use local anesthesia in the elderly, as well as in patients with severe co-morbidities or contraindications to general anesthesia. The review presents the characteristics of local anesthetics and the types of local anesthesia used in ophthalmic surgery (vesicular blockade, facial nerve blockade, retrobulbar anesthesia, peribulbar anesthesia, instillation or topical anesthesia). Also in the article, possible complications of these methods of regional anesthesia, their prevention and the principles of emergency care in case of their occurrence are described. Particular attention in the review is given to the toxicity of local anesthetics.

Aim: to evaluate the effects of intravenous dexamethasone on postoperative analgesia in patients after arthroscopic knee joint surgery in conditions of peripheral regional blockade. Material and methods: 60 patients were included in the study, divided into 2 groups. In the first group, patients underwent peripheral regional blockade of the femoral and sciatic nerves with a 0.5% solution of levobupivacaine. In the second, the traditional peripheral regional blockade was supplemented by intravenous administration of 8 mg (0.4% - 2 ml) of dexamethasone immediately after catarrhization of the peripheral vein. Results: The duration of the sensory blockade in the group using dexamethasone was 25% greater than in the first group. In the postoperative period, patients who were intraoperatively injected with dexamethasone required 33% less additional anesthesia. The duration of motor blockade in the group with dexamethasone was 26.5% higher than in the patients of the first group. Conclusion: intravenous dexamethasone injection with levobupivacaine peripheral regional anesthesia with arthroscopic knee joint surgery, increases the duration of the sensory block and the duration of postoperative analgesia. The use of dexamethasone led to a decrease in the need for additional anesthesia in the early postoperative period.

Relevance. The problem of postoperative analgesia don’t lose it’s relevance despite the large implementation in practice the multimodal analgesia strategy. In prescribing the analgesia in the most cases don’t consider the predictors of intensive postoperative pain, which could to contribute the choice of ineffective postoperative analgesia. Purpose. The determination of predictors of intensive pain after hysterectomy. Materials and methods. We have observed women from 18 to 70 years old which have undergone a hysterectomy under general anesthesia. We have studied socio-demographic data, the presence of chronic abdominal pain before surgery, pain threshold and pain tolerance, type of surgical access and pain expectation. Results. A mathematical model was developed for predicting a moderate and severe (> 40 mm visual analogue scale) dynamic pain 2 hours after the operation with a 60% cut-off point, implemented as a calculator in MS Excel. As a set of predictors, the following signs were used: the presence of pain in the lower abdomen before the operation, tolerance to pain, the expected pain intensity and the type of surgical access. The predictive value of the positive model result was 79%, CI [69%, 86%]. Conclusion. Women who have a prediction of moderate and severe pain after the extirpation of the uterus are 60% or more likely to develop it, in order to achieve adequate analgesia, it may be recommended to use more intensive postoperative analgesia, including using regional techniques, which will improve the quality of postoperative analgesia.

Objective. To assess the frequency and intensity of painful muscle spasms (cramps) in patients with end-stage CKD during hemodialysis; to determine the impact of potentially modifiable risk factors on their development. Materials and Methods. The study involved 111 male and female patients receiving treatment on hemodialysis program. Crumps intensity was assessed using a brief pain questionnaire two hours after hemodialysis initiation, during three consecutive procedures. The HADS questionnaire was used to detect anxiety and depression. Blood pressure, interdialysis weight gain were evaluated during three consecutive dialysis procedures. Phosphate binders were taken into account for all patients in the sample. Serum concentrations of phosphorus (P), total calcium (Ca) and parathyroid hormone (iPTG) were determined in all patients. Results. The mean age of patients was 51.8 ± 2.3 years, the mean duration of hemodialysis treatment was 7.7 ± 0.9 years, the mean procedure duration was 12 ± 0.24 hours per week, the mean level of KT/V was 1.4 ± 0.03. The frequency of crumps was 55%, the mean intensity was 5.2±1.8 points by the numerical rating scale (NRS). Compared with the group of patients without crumps, the risk of pain muscle spasms increased with increasing age of patients, hemodialysis experience, interdialysis weight gain. An important modifiable risk factor was intradialysis hypotension (or 10.9 (95%CI 3,0; 38.9) p = 0.0002). Statistically significant differences between the groups with or without cramps not obtained on any of the three indicators of mineral metabolism (PTH (p = 0,87); P (p = 0,25); overall Ca (p = 0,70)). Conclusion. Painful muscle spasms (cramps) occur in every second patient on hemodialysis program. The impact on potentially modifiable risk factors for muscle spasms, such as interdialysis weight gain, hypotension during hemodialysis, and phosphorus level correction, can reduce the frequency and intensity of this type of pain syndrome.

The article notes that the problems of anesthesia in the first half of the XX century were developed by joint efforts of surgeons and anaesthesiologists, who distinguished their discipline as a narrow specialty from clinical medicine. Local anesthesia by the method of creeping infiltrate, anatomically developed and physiologically grounded prof. A.V. Vishnevsky, has become very popular not only in our country, but also abroad. It is shown that many other surgeons began to perform under local anesthesia surgical interventions on the organs of the thoracic cavity, esophagus, lungs, and heart. About 90% of lung operations for tumors, bronchiectasis, tuberculosis were performed using the creeping infiltrate method under local anesthesia. It was stressed that in the 50s of the 20th century it became evident that in many cases of severe and deeply traumatic surgery, especially on the chest cavity, only protection against pathological reflexes in the field of intervention achieved by the Novocaine blockade is insufficient, since it was necessary to preserve and maintain the function of the whole organism. The use of barbiturates in surgery has received a lot of attention, and a technique has been developed that made it possible to carry out large operations lasting up to 2 hours or more (under the action of hexenal). It was shown that hexenal anesthesia was not injected and almost all of it was abandoned. In the post-war period, intratracheal ether-oxygen anesthesia began to be used in surgical practice. It was noted that the absence of vomiting, the patient’s open face, bronchial tamponade, the ability to increase intrabronchial pressure, spread the lungs, provide artificial ventilation and maintain a high oxygen content in the blood - all this contributed to the spread of this method. Consequently, anesthesia in surgical interventions, the use of modern pharmacological agents and anesthesia at that time, turned into special problems, the solution of which became practiced by doctors specially trained in the field of therapy, physiology, pharmacology and pathological physiology. Thus, a new discipline arose, anesthesiology, and all preparation for surgery, anesthesia during surgery and an early postoperative period is transferred to the direct management of anesthesiologists.