[Haemostasis disturbances as the component of the surgical stress-response and possibilities of their correction].

OBJECTIVE: An estimation of haemostasis parameters in the major abdominal surgery in comparision with surgical stress-response markers depending on anaesthesia and analgesia technique. METHODS: 120 patients scheduled to undergo elective low-abdominal surgery were allocated to receive either general anaesthesia (n=40) or combined (general + epidural (n=40) or general + spinal (n=40)) anaesthesia. Postoperative analgesia, glucose, cortisol and cytokine levels, as well as coagulation, fibrinolysis, thrombocyte aggregation parameters were estimated. RESULTS: The epidural anaesthesia provided better postoperative analgesia. However both spinal and epidural anaesthesia show comparable correction of surgical stress-response markers. Also both types of regional anaesthesia reduced hypercoagulation expression and prevented fibrinolysis activation. This resulted in a reduction in the hemotransfusion frequency CONCLUSION: Hemostasis changes can be considered as a component of the surgical stress-response. The role of intraoperative regional anaesthesia is much more significant, than postoperative analgesia.

[Use of hypertonic sodium chloride solution for correction of arterial hypotension in patients with endogenous intoxication]. / Primenenie gipertonicheskogo rastvora khlorida natriia v korrektsii arterial'noi gipotenzii u bol'nykh s éndogennoi intoksikatsiei.

Reaction to infusion of 7.5% sodium chloride solution was studied in 81 patients with endogenous intoxication during development of critical arterial hypotension which could not be prevented or arrested by routine high-dose therapy. The reaction was considered adequate on condition that arterial pressure increased no higher than the safe level, subsequent maintenance of hemodynamics was effective, toxin binding with plasma albumin was increased, diuresis increased, and hypernatriemia was transitory in the presence of general improvement of patient's status. Such a reaction was observed in 83% patients. The efficiency of this method is determined by indications for low-dose therapy and probability of adequate reaction to infusion.