[The content of beta-endorphin, met-enkephalin and ACTH in the blood plasma during electric and drug anesthesia]. / Soderzhanie beta-éndorfina, meténkefalina i AKTG v plazme krovi pri élektromedikamentoznoi anestezii.

Beta-endorphin, metenkephaline, and ACTH were radioimmunoassayed in the peripheral blood plasma of 4 groups of patients subjected to microsurgery by different techniques. In 3 groups electropulsed exposure of the CNS was a component of general combined ataralgesia. In group 1 (13 patients) two Lenar devices were employed, in group 2 (5 patients) Skat-202 device, in group 3 (7 patients) Elean device. Group 4 (17 patients) were controls administered drugs according to the same protocols as in the rest three groups. Anesthesia was considered adequate in all the groups. The hypoalgesic effect of electroexposure was the most expressed in group 1: fentanyl was not injected in 53% cases, and in 47% its dose, 0.74 microgram/kg/h, was 2.25 times lower than in controls (1.58 micrograms/kg/hm p < 0.05); the drug doses in groups 2 and 3 (0.82 and 0.8 microgram/kg/h) were 1.9 and 2 times lower than in controls, respectively, p < 0.05. The levels of ACTH and opioid peptides were measured at 6 stages: 1) several days before surgery; 2) after premedication, 10-15 min after the patient was brought into the operation room; 3) before discontinuing nitrogen oxide; 4) after discontinuing nitrogen oxide; 5) when the patient regained consciousness after the end of surgery; and 6) after extubation of the trachea. During surgery under electromedicamentous anesthesia the level of ACTH in the plasma was the same as initially or comparable to the level of this hormone at the same stages in the control group. The content of opioid peptides changed at stressogenic stages of anesthesia and surgery. In patients administered drug anesthesia beta-endorphin levels were shifted, in those operated on under electromedicamentous anesthesia the metenkephaline compound of the opiate system was altered. Activation of various components of endogenous opiate system in electromedicamentous and drug anesthesia may be due to differences in the mechanisms of this types of anesthesia at the given level of the antinociceptive system of the organism. No stable reaction of endorphin level on the electroexposure could be detected. There was no evident relationship between changes in the levels of opioid peptides and the decrease of fentanyl consumption. Besides, it is possible that the analgesic effect of electroexposure is mediated not only by the opioid, but by other mechanisms of endogenous antinociceptive system as well.

[Acupuncture analgesia and analgesic transcutaneous electroneurostimulation in the early postoperative period]. / Igloanalgeziia i protivobolevaia chreskozhnaia élektroneirostimuliatsiia v rannem posleoperatsionnom periode.

Efficacies of two methods of nondrug analgesia: acupuncture (1000 cases) and antipain transcutaneous electroneurostimulation (91 cases), as well as of narcotic analgesics omnopon and promedol (229 cases) were compared in the immediate and early postoperative period. In 229 cases acupuncture was used for the treatment of other functional complications of the postoperative period. The efficacies of the methods in question were assessed by formalized verbal estimation scales. Narcotic analgesics provided adequate analgesia in 75 to 79% of patients, electrostimulation in 61 to 64%, acupuncture in 50% of patients. Acupuncture, though less effective than narcotic analgesics, helped arrest or noticeably alleviate the severity of such postoperative complications as reflex retention of the urine, impairment of hte drainage function of the bronchi, intestinal paresis, bronchial asthma, vomiting, nausea, pain or itching in the stoma, chill, hyperthermia in 43 to 81% of cases. The authors come to a conclusion on the desirability of an integrative approach (combined use of drugs and nondrug methods of analgesia) in the management of postoperative pain.

[Central electroanalgesia as a component of combined anesthesia in reconstructive microsurgery]. / Tsentral'naia élektroanalgeziia kak komponent kombinirovannoi anestezii pri rekonstruktivnykh operatsiiakh s mikrokhirurgicheskoi tekhnikoi.

Efficacy of central analgesia and adequacy of anesthesiologic protection in operations making use of microsurgical techniques were analyzed by double blind method using the criterion 'requirement in narcotics' in 88 specially selected patients divided into 4 groups. Group 1 (n = 24) were patients operated on under electro-medicamentous anesthesia after Kastrubin-Kordyukov; group 2 (n = 21) were operated on under electro-medicamentous anesthesia after Limoges' technique modified by M.I. Kuzin et al.; group 3 consisted of 14 patients operated on under combined anesthesia based on NLA agents and simultaneous simulation of transcerebral electropulse exposure (placebo group); and group 4 (n = 29) were patients operated on under combined NLA anesthesia (controls). To assess the function of systems of adaptation to surgical trauma blood plasma levels of ACTH and cyclic nucleotides were measured at 7 stages of anesthesia.