Saratov JOURNAL of Medical and Scientific Research

Prigorodov M.B.

Saratov Military Medical Institute, начальник центра анестезиологии и реаниматологии и интенсивной терапии, Candidate of Medical Science

The history of epidural anesthesia (review)

Year: 2019, volume 15 Issue: №3 Pages: 657-661
Heading: Anaesthesiology and Reanimatology Article type: Review
Authors: Prigorodov M.V.
Organization: Saratov State Medical University
Summary:

The method of a long-term epidural anesthesia has been significantly improved and acquired the status of a well-developed and widely used clinical manipulation. Epidural anesthesia is a type of local anesthesia. Until now, there is no single definition of «epidural anesthesia» (or «epidural blockade»). The review is devoted to the history of the formation of epidural anesthesia and substantiation of the term «epidural anesthesia».

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Controlled physical activity for functional operability determination

Year: 2014, volume 10 Issue: №2 Pages: 324-328
Heading: Proceedings of all-Russia week of science with international participants Article type: Original article
Authors: Luchenkov А.А., Prigorodov M.V.
Organization: Saratov State Medical University
Summary:

The aim: to use veloergometry test at patients of high anaeshtesiology-operative risk before traumatic operations for functional operability determination. Material and methods: Randomized prospective research with the double "blind" control has been performed at 95 patients of high risk (ASA>III), undergoing long and traumatic operations on thoracic and abdominal organs. Patients have divided into groups without complications and with complications (51 and 44 patients) which one day prior to operation have spent veloergometry test (VEMT). Average dynamic pressure (ADP), the general peripheral resistance of vessels (GPRV), a core index (Cl); arterio-venous (a-v) difference on oxygen, oxygen delivery to tissues, consumption of oxygen and coefficients extraction oxygen in tissues; energy consumption have been investigated. Statistics has been done by nonparametric methods. Results. In response to veloergometry test in both groups growth of Cl at the expense of a tachycardia and GPRV fall which in complication group remains above norm is noted. In group without complications coefficients extraction oxygen in tissues were normalised, a-v difference on 02 became above norm, in other group — coefficients extraction oxygen in tissues and a-v difference on 02 began to exceed norm, and oxygen consumption has grown almost in 2 times. After VEMT a-v a difference on О and oxygen consumption were essentially above in group with complications. Under the influence of VEMT markecT stabilization of function of vegetative nervous systems (VNS). The number of complications made 39: intraoperation cardiovascular — 23, postoperative respiratory — 16. Clinically important connection (p=0,069) of perioperative complications with growth a-v differences on oxygen and a power interchanging have been received. Conclusion. Thus, the oxygen-energy exchange and the vegetative status can be referred to clinical functional operability determination.

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Anaesthesiological maintenance in total endo-prosthesis of large joints

Year: 2013, volume 9 Issue: №2 Pages: 241-246
Heading: Anaesthesiology and Reanimatology Article type: Original article
Authors: Prigorodov М.V., Pominova I.V., Noskova I.L, Tashkaev I.V., Virsta A.M.
Organization: Clinical hospital n.a. S. R. Mirotvortsev SSMU, Saratov State Medical University
Summary:

Purpose: To improve the quality of anesthetic protection in prosthetics of large joints based on a steady state energy balance. Materials and methods: Prospective, randomized study on the basis of a controlled hemodilution (CM) double mask has been performed. In the first group of patients (32-19 women) hemodilution (HS) has not been done. The second group of patients (31-17) consisted of patients with HS. Three phases of the survey have been selected — before surgery, traumatic phase of the operation, after the operation. Analyzed the parameters of central hemodynamics (Cl (I/ min/m2) and total peripheral vascular resistance TPVR (dyn * sec1 * cm5), gas exchange (DO (ml / min) and V02 (ml / min), energy metabolism (kcal / min; kcal / day). For data processing statistical package STATISTICA6,0 was used. Results: Central hemodynamic parameters in both groups did not significantly change, and did not differ between the groups. A significant reduction in D02. DO differences between groups of patients at all stages of the studies found has been determined in both groups of patients. Oxygen consumption in the first group of patients decreased significantly to traumatic phase of the operation, and the next stage rose to baseline. Oxygen consumption in the group with CM increased by traumatic phase of the operation, but then returned to baseline. In patients with CM oxygen consumption was significantly higher than in patients without CM at all time points. It is found that there is a significant drop in energy metabolism in the first group of patients in traumatic phase of the operation, followed by reduction of the energy poten-
tial. It is noted that insignificant increase of energy on stage traumatic operation in the second group of patients, with a subsequent decrease to the original level. Energy exchange at all stages of the study was significantly higher in the second group of patients. Logistic regression analysis found that controlled hemodilution is associated with increased energy metabolism at the stage prior to surgery for traumatic stage and after the intervention. Conclusion: It has been established a connection with the growth of energy controlled hemodilution with radical intervention on the hip joint. Substantial energy deficit in patients without HS on traumatic phase of the operation reveals that the high probability of occurrence of cardiovascular complications.

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Influence of anaesthesia on energy metabolism in surgery

Year: 2013, volume 9 Issue: №1 Pages: 47-49
Heading: Anaesthesiology and Reanimatology Article type: Original article
Authors: Prigorodov М.V., Tashkaev I.V., Pominova I.V., Noskova I.L, virsta A.M.
Organization: Clinical hospital n.a. S. R. Mirotvortsev SSMU, Saratov State Medical University
Summary:

The purpose of the article is to establish adequacy of protection of energy metabolism in a patient under anaes-thesiology in cholecystectomy from mini-access. Material et methods: 122 patients subjected to cholecystectomy from mini access have been surveyed. Among them 92 patients have got intravenous general anaesthesia with AVL, 30 patients have got prolonged epidural anaesthesia on spontaneous breath with insufflations of oxygen through an obverse mask with sedatations. Monitoring of energy-plastic metabolism has been carried out in all patients. Results: Groups of patients have been compared by anthropometrical data, traumatic interventions. In both groups of patients loss of energy to traumatic to an operation stage has insignificantly increased, but after the anaesthesia termination in the group of patients with intravenous anaesthesia loss of energy continued to rise, and in the group of patients with prolonged epidural blockade it has returned to the initial level. After the anaesthesia termination the energy metabolism became essential higher in the first group of patients in comparison with the second one (p

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Gestosis pathogenesis (review)

Year: 2011, volume 7 Issue: №4 Pages: 813-816
Heading: Anaesthesiology and Reanimatology Article type: Review
Authors: Agapov l.A., Sadchikov D.V., Prigorodov M.V.
Organization: Saratov State Medical University
Summary:

Literature review contains the analysis of information concerning disturbances in hemostasis system in case of arterial hypertension, frequency rate, risk factors, causes and mechanisms of occurrence. The review states the causes of complications, inadequate treatment effects and arterial hypertension pathogenesis

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Diagnostics in critical conditions

Year: 2011, volume 7 Issue: №3 Pages: 601-606
Heading: Anaesthesiology and Reanimatology Article type: Original article
Authors: SadchikovD.V., PrigorodovM.V., IvanovR.V.
Organization: Saratov State Medical University
Summary:

The purpose of research: improvement of quality of diagnostics at the patients in a critical condition in intensive care unit. Material and methods. In total have analyzed 1957 medical cards of the patients who have died in ICU»s. At the first stage studied the factors influencing on diagnostics of critically ill patients (medical cards of 1557 patients); at the second stage investigated influence of the diagnostic standards in ICU»s practice on improvement of quality of diag-
nostics of critically ill patients (400 medical cards of the patients who have died). Entry criterions were standards and algorithm of diagnostics. Techniques of research: average bed-day in groups, first-day lethality, quantity of the carried out laboratory tests and tool methods of research, level of consciousness of the patients (Glasgow come score), severity of disease by ICU»s patients (APACHE II scores). Results. Quality of diagnostics depend on carried out laboratory tests and tool methods of research, level of consciousness of the patients (Glasgow come score), severity of disease by ICU»s patients (APACHE II score). The conclusion. The laboratory tests and tool methods of research conforming to the standards of diagnostics are necessary for improvement of quality of diagnostics, it is necessary to take into account an altered level of consciousness (Glasgow come score) and severity of disease by ICU»s patients (APACHE II scores)

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Diagnostic specificity in reanimation (review)

Year: 2011, volume 7 Issue: №2 Pages: 404-409
Heading: Anaesthesiology and Reanimatology Article type: Review
Authors: Sadchikov D.V., Prigorodov М.V., Ivanov R.V.
Organization: Saratov State Medical University
Summary:

The literature review presents the specificity of diagnostic aid given to patients of reanimation departments. It points out the most common difficulties that physicians face in such conditions

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Perioperative complications at patients with high anesthesiologic-operational risk (literature review, part I)

Year: 2010, volume 6 Issue: №3 Pages: 561-565
Heading: Anaesthesiology and Reanimatology Article type: Review
Authors: Sadchikov D.M., Prigorodov M.V., Vartanjan T.S.
Organization: Saratov State Medical University, Saratov Perinatal Centre, Saratov Military Medical Institute
Summary:

In the literary review frequency, risk factors, reasons and mechanisms of perioperative complications occurrence are submitted at thorax and abdominal interventions, including common data, cardiovascular complications, data about massive blood loss, condition of respiratory system, hemostasiologic complications; reasons of complications development are specified, consequences of inadequate anesthesia are named, mechanisms of perioperative complications development and consequence of a protein-power failure are considered

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Use Exercise Testing for an Estimation of a Oxygen-Power Exchange at Patients of High Anesthesiology-Operational Risk

Year: 2009, volume 5 Issue: №3 Pages: 333-336
Heading: Anaesthesiology and Reanimatology Article type: Original article
Authors: M.V. Prigorodov, DM. Sadchikov
Organization: Saratov Military Medical Institute, Saratov State Medical University
Summary:

It is lead randomized prospective research with the double "blind" control over 228 patients of high risk (ASA>III), undergone long and traumatic to operations on bodies of a breast and a stomach. Have excluded from research 133 patients. The staying 95 patients have divided into groups without complications and with complications (accordingly 51 and 44 patients) which one day prior to operation have carried out exercise testing. Investigated: ADP, CPRV, SI, a arterio-ve-nous difference on oxygen, delivery of oxygen to fabrics, consumption of oxygen in fabrics, factor extraction oxygen in tissue, a power exchange. In reply to exercise testing in both groups growth of SI is marked due to a tachycardia and falling CPRV which in group of complication remained above norm. In group without complications it was normalized FEO, 6-v the difference on О became higher than norm, in other group — FEO and б-v a difference on 02 began to exceed norm, and consumption of oxygen has grown almost in 2 times. After exercise testing б-v a difference on 02 and consumption of oxygen were essentially higher in group with complications. The total of complications made — 53, respiratory — 16, inflammatory — 23 and purulent — septic complications — 14. Clinically important connection (p=0,06939) perioperative complications with growth a-v differences on oxygen and a power exchange is received

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