Perioperative management of patients with adrenal insufficiency

P.V. Dunts1,2, O.E. Li2, V.B. Shumatov1

1 Pacific State Medical University, Vladivostok

2 Regional Clinical Hospital, Vladivostok

For correspondence: Pavel V. Dunts, PhD, Chief of the Department of Anesthesiology and Reanimatology of the Regional Clinical Hospital № 2, Assistant Professor of the Department of Anesthesiology and Reanimatology, Pacific State Medical University; e-mail: dpv@bk.ru

For citation: Dunts PV, Li OE, Shumatov VB. Perioperative management of patients with adrenal insufficiency. Alexander Saltanov Intensive Care Herald. 2019;1:58–65.

DOI: 10.21320/1818-474X-2019-1-58-65


The article is a review of modern publications covering the issues of adrenal insufficiency in patients in the periopreparative period. The article covers the issues of epidemiology, etiology and pathogenesis, presents algorithms for examining patients with adrenal insufficiency. Topical issues such as the perioperative management of patients receiving steroid hormone replacement therapy, depending on the incidence of the operation and the problems of the hypoadrenal crisis are considered.

Keywords: adrenal insufficiency, perioperative management, anesthesia, hypoadrenal crisis

Received: 24.12.2019


References

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Perioperative Management of Patients with Bradyarrhythmias Undergoing Noncardiac Surgery

V.V. Myasnikova1,2, N.B. Karakhalis3,2, T.S. Musaeva2

1 The Academician S.N. Fyodorov IRTC “Eye Microsurgery” of the Ministry of Public Health of the Russian Federation, Krasnodar

2 Kuban State Medical University of the Ministry of Public Health of the Russian Federation, Krasnodar

3 Scientific Research Institute Krasnodar Regional Clinical Hospital № 1 named after prof. S.V. Ochapovski, Krasnodar

For correspondence: Victoria V. Myasnikova — Dr. Sci. Med., head of the department of anaesthesiology and resuscitation the academician S.N. Fyodorov IRTC “Eye Microsurgery”, Krasnodar; e-mail: vivlad7@rambler.ru

For citation: Myasnikova VV, Karakhalis NB, Musaeva TS. Perioperative Management of Patients with Bradyarrhythmias Undergoing Noncardiac Surgery. Intensive Care Herald. 2017;3:5–18.


The relevance of the problem of prophylaxis and treatment of perioperative arrhythmias is due to the fact that a widening range of surgical interventions is performed, including elderly patients, burdened with concomitant cardiac pathology. The article reviews Russian and foreign clinical guidelines and handbooks for managing patients with bradyarrhythmias in non-cardiac surgery. Key in- formation about the physiology of electrical impulse in the myocardium, the formation of a normal ECG, as well as the main signs of cardiac rhythm pathology is given; “safe” and potentially dangerous bradyarrhythmias are indicated. The mechanism of development of intraoperative reflex bradycardia, which is a specific complication of some ophthalmic, maxillofacial and laparoscopic operations, is con- sidered. The review presents managing patients with certain types of bradyarrhythmias in the perioperative period: sinus bradycardia, sinus node weakness syndrome, conduction disorders. Separately the questions of implantable antiarrhythmic devices, anesthesia during arrhythmic operations are described. The analysis of recommendations on the choice of the method of anesthesia, monitoring, used drugs in patients with concomitant cardiac arrhythmias, the algorithm of emergency therapy in the perioperative period for potentially dangerous forms of bradyarrhythmia was conducted.

Keywords: bradyarrhythmia, perioperative management, non-cardiac surgical patients, anesthesia maintenance

Received: 21.06.2017


References

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Perioperative Management of Patients with Tachyarrhythmias in Non-cardiac Surgery

V.V. Myasnikova1, 2, N.B. Karakhalis3, 2, T.S. Musaeva2, I.B. Zabolotskikh2

1 The Academician S.N. Fyodorov IRTC «Eye Microsurgery» of the Ministry of Public Health of the Russian Federation, Krasnodar

2 Kuban State Medical University of the Ministry of Public Health of the Russian Federation, Krasnodar

3 Scientific Research Institute Krasnodar Regional Clinical Hospital № 1 named after prof. S.V. Ochapovski, Krasnodar

For correspondence: Myasnikova Victoria Vladimirovna — Dr. Sci. Med., head of the department of anaesthesiology and resuscitation the academician S.N. Fyodorov IRTC «Eye Microsurgery», Krasnodar; e-mail: vivlad7@rambler.ru

For citation: Myasnikova VV, Karakhalis NB, Musaeva TS, Zabolotskikh IB. Perioperative Management of Patients with Tachyarrhythmias in Non-cardiac Surgery. Intensive Care Herald. 2017;1:37–55.


Treatment of patients with cardiovascular diseases has dramatically changed over past decades. Accompanied by an incredible increase in pathophysiological understanding and availability of treatment options, surgical and anesthetic technics have rapidly evolved. The understanding of electrophysiological basics of arrhythmia, pharmacological and non- pharmacological approaches its treatment, in many respects determines clinical efficacy of perioperative management patients with comorbidities by anesthesiologists. This article reviewed Russian and international guidelines and recommendations on tachyarrhythmia’s management in non-cardiac surgery patients. The arrhythmia classifications in respect to potential danger have pointed out with special emphasis on life-threatening ones. It has been shown information about preoperative examination, medication choice in accordance with pro-arrhyhmogenic activity. All arrhythmia issues have presented according to their prevalence in population: supraventricular extrasystole and tachycardia, atrial fibrillation/flutter, ventricular beats, ventricular tachycardia, ventricular fibrillation. Review included the information about such life-threatening rhythm disorders as WPW syndrome and Torsades des pointes. We analyzed perioperative assessment, risk stratification, choice the anesthesia methods, and monitoring settings in arrhythmic patients. The management algorithms of different kinds of tachyarrhythmias have been shown both chronic and acute perioperative cases.

Keywords: tachyarrhythmia, perioperative management, non-cardiac patients, anti-arrhythmic drugs

Received: 15.11.2016


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Perioperative Management of Patients with Valvular Heart Disease

I.B. Zabolotskikh1, A.Zh. Bayalieva2, S.V. Grigor’ev1, M.Yu. Kirov3, K.M. Lebedinskiy4

1 Federal State Budgetary educational institution of higher education Kuban State Medical University of the Ministry of

Healthcare of the Russian Federation, Krasnodar

2 Kazan State Medical University, Kazan

3 Northern State Medical University, Arkhangelsk

4 Ilya I. Mechinkov North-Western State Medical University, Saint-Petersburg

For correspondence: Igor B. Zabolotskikh — MD, PhD, DSc, professor, head of the Department of Anaesthesiology, Reanimatology and Transfusiology of Kuban State Medical University; e-mail: pobeda_zib@mail.ru

For citation: Zabolotskikh IB, Bayalieva AZh, Grigor’ev SV, Kirov MYu, Lebedinskiy KM. Perioperative Management of Patients with Valvular Heart Disease. Intensive Care Herald. 2016;3:55–69.


Perioperative management of patients with valvular heart disease is a serious problem, considering different hemodynamic changes depend on lesion of valves. Features of clinical and instrumental preoperative assessment of those patients reviewed. Recommendations on thrombosis prophylaxis, infectious endocarditis, intraoperative monitoring are given. Details on perioperative management of different frequent valvular diseases was described, include preoperative preparation, main anesthesia goals, choice of optimal anesthesia technique and drug.

Keywords: valvular heart disease, perioperative management, anesthesia


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Perioperative management of patients with schizophrenia

V.V. Myasnikova1, 2, A.E. Muronov2

1 The Academician S.N. Fyodorov ISTC “Eye Microsurgery”, Krasnodar

2 Kuban State Medical University, Krasnodar

For correspondence: Victoria V. Myasnikova — Dr. Sci. Med., head of the department of anesthesiology and resuscitation of the Academician S.N. Fyodorov ISTC “Eye Microsurgery”, Krasnodar; e-mail: vivlad7@rambler.ru

For citation: Myasnikova VV, Muronov AE. Perioperative management of patients with schizophrenia. Alexander Saltanov Intensive Care Herald. 2018;2:24–30.

DOI: 10.21320/1818-474X-2018-2-24-30


This article is a review of publications on clinical research and recommendations for managing patients with schizophrenia in the perioperative period in surgical interventions not associated with psychopathology. An anesthesiologist may face behavioral, cognitive and emotional problems in patients with schizophrenia at all stages of the perioperative period. When anesthetizing such patients, it is necessary to take into account the undesirable side effects of antipsychotics, as well as the risk of their interaction with anesthetics. It is also known that schizophrenia often combines with cardiovascular and endocrine diseases, which further increases the risk of anesthesia. The article gives a description of the main groups of drugs for the treatment of schizophrenia — typical and atypical antipsychotics, a tactic of withdrawal or continuation of their admission during the perioperative period. The problem of neuroleptic malignant syndrome is considered — a potentially lethal complication of therapy with these drugs.

Keywords: schizophrenia, perioperative management, antipsychotics, neuroleptic malignant syndrome

Received: 07.02.2018


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Perioperative management of patients with depression

V.V. Myasnikova1, 2, A.E. Muronov2

1 The Academician S.N. Fyodorov ISTC “Eye Microsurgery”, Krasnodar

2 Kuban State Medical University of the Ministry of Public Health of the Russian Federation, Krasnodar

For correspondence: Victoria V. Myasnikova — Dr. Sci. Med., head of the department of anesthesiology and resuscitation of the Academician S.N. Fyodorov ISTC “Eye Microsurgery”, Krasnodar; e-mail: vivlad7@rambler.ru

For citation: Myasnikova VV, Muronov AE. Perioperative Management of Patients with depression. Alexander Saltanov Intensive Care Herald. 2018;1:16–26.

DOI: 10.21320/1818-474X-2018-1-16-26


One of the most common mental illnesses, occurring in more than 5 % of the adult population, is depression. In the management of patients with this concomitant pathology in the perioperative period, the anesthesiologist must take into account a number of characteristics. These may be possible difficulties in communication due to patient closure, the risk of developing a “withdrawal syndrome” of antidepressants, side effects, as well as undesirable interactions of these drugs with anesthetics. The article reviews the publications of Russian and foreign articles and manuals on the perioperative management of patients with depression. The characteristics of the main groups of modern drugs for the treatment of depression, the tactics of their withdrawal or continuation of admission before the operation, the features of anesthesia against the background of long-term intake of various groups of antidepressants are presented. The problem of such complication of therapy with these drugs, such as serotonin syndrome, its differential diagnosis is considered. The review also includes non-pharmacological treatments for depression, their complications and anesthesia in electroconvulsive therapy.

Keywords: depression, perioperative management, antidepressants, electroconvulsive therapy

Received: 07.12.2017


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