[Epidemiology and prevention of anaphylactoid reactions in heart surgery patients]. / Epidemiologiia i profilaktika anafilaktoidnykh reaktsii u kardiokhirurgicheskikh bol'nykh.

A retrospective analysis of the incidence, severity, and causes of anaphylactoid reactions (AR) in 1504 cardiosurgical patients operated on at Research Center of Surgery in 1995-1999 showed that AR occurred in 109 (7.4%) patients: 60% during aortocoronary bypass operations, 27.2% during correction of acquired heart diseases, and 12.8% during correction of congenital heart diseases. Skin symptoms predominated in the structure of AR (59.7%); cardiovascular episodes ranked second (38.5%), and the incidence of pulmonary reactions was lowest (1.8%). The causes of AR during anesthesia and surgery were platelet-rich plasma and fresh-frozen plasma (35.3%), antibiotics (12.1%), protamine (12.1%), myorelaxants (9.9%), colloid plasma substitutes (8.8%), dioxidine (3.3%), heparin (2.2%), aprotinin (1.1%), diazepam (2.2%), and other agents (7.6%). A history of AR and repeated interventions are risk factors of AR. The protocol of AR prevention in cardiosurgical patients includes determination of risk factors, selection of the least hazardous agents, strict adherence to the rate of infusion of histamine-releasing drugs, minimum utilization of donor blood components (platelets and plasma), use of H1 and H2 blockers, corticosteroids (celestone) during premedication and operation. Such treatment helped decrease the severity and incidence of AR in cardiosurgical patients to 4.7%.

[The effect of current methods of induction anesthesia on the systolic and diastolic functions of the left and right heart in patients with ischemic heart disease]. / Vliianie sovremennykh metodov vvodnoi anestezii na sistolicheskuiu i diastolicheskuiu funktsiiu levogo i pravogo serdtsa u bol'nykh ishemicheskoi bolezn'iu serdtsa.

Perioperative echocardiography and right ventricular volumic monitoring were used for more essential evaluation of different hypnotics in cardiosurgical patients. Our comparative study has shown that all the examined hypnotics induced no changes in systolic function of the left ventricle. Midazolam and propofol exerted minor depressive influence only on diastolic left ventricular function without significant fall of cardiac output. Etomidate moderately worsened diastolic and systolic right ventricular function with cardiac output decrease. The combined use of diazepam and ketamine provided excellent hemodynamic stability without negative effects on systolic and diastolic heart function.

[Oxygen transport function of blood in open heart surgery]. / Kislorodtransportnaia funktsiia krovi pri operatsiiakh na otkrytoi serdtse.

Complex intraoperative analysis of oxygen transporting function was performed in two groups of cardiosurgical patients operated on under ataralgesia (74 patients) and total intravenous anesthesia (49 patients). Heart performance, oxygen delivery (DO2) and O2 consumption (VO2) were the basic parameters reflecting O2 homeostasis at all stages of surgery. A decline in the cardiac output which is most frequent immediately before the beginning of cardiopulmonary bypass procedure leads to the disturbances in DO2. Metabolism maintenance in these conditions is due to increased O2 extraction from blood. According to the data of correlation analysis, a critical DO2 level, below which a decline of VO2, O2 debt and lactate accumulation are observed, is 350 ml/min/m2. Limited DO2 is more frequently encountered in patients operated on under ataralgesia using nitrous oxide. The use of drugs improving heart performance in the early postperfusion period is an effective technique of CPK damage correction in patients with decreased DO2, irrespective of the anesthesia technique. Dopamine administration at a dose of 5-7 micrograms/kg/min makes up for O2 debt, which is confirmed by positive changes in blood lactate.

[Disorders of the oxygenating function of the lungs during open-heart surgery]. / Narushenie oksigeniruiushchei funktsii legkikh vo vremia operatsii na otkrytom serdtse.

A retrospective analysis of arterial blood oxygenation during open-heart surgery in 463 patients revealed pulmonary oxygenation disorders in 23% prior to perfusion and in 49% in the post-perfusion period. The basic mechanism underlying the fall in arterial blood oxygenation is the increasing venous admixture in the lungs. A growth in the venous admixture in the post-perfusion period is brought about by a decreased total ventilation/perfusion ratio, increased alveolar shunting, and impaired diffusion. It was found, that the assisted ventilation regimen at +5+8 cm H2O in the post-perfusion period caused a 30% reduction in the venous admixture and improved the blood oxygenation. Additional use of diuretics to diminish the intrapulmonary water causes a 59% reduction in the venous admixture. A prophylactic pre-perfusion administration of corticosteroids, vitamin E, and protease inhibitors maintains the oxygenating function of the lungs, which is manifested in a higher blood oxygenation in these patients after assisted circulation compared to the controls.