[General anesthesia components during abdominal surgeries in patients with abdominal sepsis].

Results of optimization of general anesthesia during abdominal surgeries in patients with abdominal sepsis are analyzed. Inhibitors of proteases (transamin and antagozan) were used as non-opiate component in transduction stage. Central hemodynamics, gaseous metabolism and heart rate were analyzed in two groups of patients: group 1 -- anesthesia was carried out with inhibitors of proteases (32 patients), group 2 -- without it (30 patients). High efficacy of the inhibitors was demonstrated. Inhibitors of proteases are indicated for anesthesia in patients with severe metabolic disorders associated with tissues hypoxia. Analgesic activity of transamin permits one to decrease doses of anesthetic medication with a cardiodepressive effect.

[Choice of components of general anesthesia in patients with concomitant fibrillation arrhythmia in surgery on organs of the abdominal cavity]. / Vybor komponentov obshchei anestezii u bol'nykh s soputstvuiushchei mertsiatel'noi aritmiei pri operatsiiakh na organakh briushnoi polosti.

The central hemodynamic parameters were studied in 45 patients with ciliary arrhythmia operated on the abdominal and pelvic organs under different anesthesia. Epidural anesthesia as a component of total anesthesia had a favorable impact on the hemodynamics of such patients, decreasing the heart rate, mean arterial pressure, and oxygen consumption by the myocardium; the authors emphasize a high efficacy of blocking the pituitary-adrenal stressor stimulation in combined anesthesia.

[Indirect electrochemical oxidation of blood in multimodal intensive therapy of pneumonia in critical patients]. / Nepriamoe élektrokhimicheskoe okislenie krovi v kompleksnoi intensivnoi terapii pnevmonii u bol'nykh v kriticheskom sostoianie.

Seventy-five patients with severe pneumonia were treated with sodium hypochlorite solution (intravenous drip in concentration 600 mg/liter). Beneficial effect of the treatment manifested with lowering of body temperature, diminution of tachycardia, leukocytosis, leukocytic intoxication index. The patients recovered 5-7 days earlier, the mortality reduced by 11%. Better clinical parameters were due rather to stimulation of anti-infection defence than to direct detoxication action of sodium hypochlorite on the causative agent and toxic products. The solution is recommended for treatment of critical pneumonia as an effective modality with immunostimulating, antiinfectious and detoxication abilities.

[Anesthesia using clofelin in different types of arterial hypertension in middle-aged and elderly patients]. / Anesteziia s primeneniem klofelina pri razlichnykh tipakh arterial'noi gipertenzii u bol'nykh pozhilogo i starcheskogo vozrasta.

Clonidine in a dose of 2.5 to 3 mg/kg was used as a component of anesthesia in 150 patients aged 60 to 85. Essential hypertension of the second-third stages was diagnosed in 57% patients (group 1), systolic sclerotic arterial hypertension (SSAH) in 43% (group 2). Anesthesia was characterized by stable hemodynamics; however, analysis within the groups showed an increase of systolic and diastolic arterial pressure in 40% patients in group 2. There were no clinical signs of inadequacy of anesthesia. Remembering about the reduction of the reserve potential of the cardiovascular system in this cohort of patients, neurovegetative inhibition was supplemented by peripheral a-adrenoblocker droperidol, starting from the test dose of 1.25 and increasing it to 5 mg over the course of anesthesia; this led to stabilization of the peripheral and improvement of the central hemodynamics. Differences in the changes of central hemodynamics may be explained by specific features of circulation in patients with essential hypertension and SSAH, as well as by a higher tone of the sympathetic component of the CNS in SSAH patients.

[Neurophysiologic analysis of the effects of the centrally acting analgesics moradol, tramal and nubain]. / Neirofiziologicheskii analiz deistviia tsentral'nykh anal'getikov moradola, tramala i nubaina.

The analysis of measurements of early and late components of somatosensory (SSEP) and visual evoked potentials (VEP) in healthy examinees was used to compare the central mechanisms responsible for the analgesic action of moradol, tramal, and nubain. As compared to tramal and nubain, moradol was found to cause a more profound increase in the amplitude of early SSEP components. With this, all three agents were equal in suppressing the amplitude of late SSEP and VEP components. The effects of the drugs on SSEP and VEP, as well as on the sensory and psychoemotional components of human pain perception were also evaluated. The potential features of anesthesiological application of the drugs under study were discussed.

[Experience with the use of clopheline in geriatric anesthesiology]. / Opyt primeneniia klofelina v geriatricheskii anesteziologii.

The new aspects of the use of the central adrenopositive agent clopheline as a component of combined endotracheal anesthesia were studied. In distinction to the recommendation of some authors, clopheline was used in the preanesthesia period in an average dose of 2.5-3.0 mcg/kg (in debilitated patients in a dose of 1.8-2.2 mcg/kg). The authors examined 86 patients 60 to 85 years of age during planned and emergency operations on the biliary tract. All of them suffered from arterial hypertension: 70% had three and more concomitant diseases; 20% of patients were related to IB category of anesthesiological risk, 65% to IIB category, and 15% to IIIB category. The condition of peripheral and central hemodynamics, the stress index, and the excretion of the free forms of catecholamines (CA), their precursors, and metabolites were studied. During anesthesia with the use of clopheline by the suggested method, moderate activation of the sympathoadrenal system within the stress-norm occurs. During anesthesia as well as in the postanesthesia period the mechanisms of autoregulation, which contribute to rapid return of the activity of the sympathoadrenal system to the initial level and the control of the relationship of the synthesis and inactivation of CA, their precursors, and metabolites, are maintained. The method made it possible to reduce the doses of barbiturates to 2-3 mg/kg, and the doses of fentanyl by 3-4 times as compared with those in neuroleptanesthesia, which, in turn, facilitated rapid regaining of consciousness, adequate spontaneous breathing, a good cough reflex, and sufficient physical activity immediately after the operation. There were no complaints of pain hyperdynamic circulatory shift, trembling of muscles, suppressed respiration, and acrocyanosis.

[The use of xenogeneic splenic perfusates for treating suppurative-septic diseases]. / Ispol'zovanie ksenosplenoperfuzatov dlia lecheniia gnoino-septicheskikh zabolevanii.

It was shown in experiments on a model of fatal staphylococcal sepsis in 200 mice and 15 dogs that the perfusate of a pig's spleen obtained by perfusion of the isolated organ with a dextran solution (rheopolyglucin, polyglucin) is capable of preventing the animals' death. Intravenous infusion of 400-500 ml of a xenospleen perfusate at an interval of 1-3 days, which was included in the complex of postoperative treatment of 45 patients with destructive diseases of the abdominal organs complicated by peritonitis and sepsis, contributed to reduction of lethality and the terms of recovery. It is shown that the main effect, besides detoxification, is based on immunomodulation at the cost of biologically active substances produced by the cells of a xenospleen and contained in the perfusate. The best results were produced with the use of the perfusate of a xenospleen in the early periods after radical operation and thorough cleansing of the source of the infection.

[The effect of infusion therapy on the ventilation-gas exchange function of the lung during acute destructive pneumonia in young children]. / Vliianie infuzionnoi terapii na ventiliatsionno-gazobmennuiu funktsiiu legkikh pri ostroi destruktivnoi pnevmonii u detei rannego vozrasta.

It has been established that respiratory failure in young children with destructive acute pneumonia was enhanced upon intravenous correction of homeostasis disturbances with daily physiological volume repletion. Combined enteral-parenteral correction of homeostasis disturbances was an alternative technique.

[Clopheline as a component of general anesthesia during surgery in elderly and aged patients]. / Klofelin kak komponent obshchei anestezii pri operatsiiakh u bol'nykh pozhilogo i starcheskogo vozrasta.

Clopheline (2-3 micrograms/kg; 2-2.2 micrograms/kg in weak patients) as a component of premedication, for the induction to anesthesia, and in combined endotracheal anesthesia as an analgesic and vegetostabilizing agent has been used in 150 patients, aged 60 to 85 years during planned and emergency surgery. Reduced doses of barbiturates (3 mg/kg) and fentanyl (1.5-2.1 micrograms/kg for the induction to anesthesia and 0.5-0.67 micrograms/kg for analgesia maintenance) were used. At certain stages use was made of droperidol, beginning with a test dose 1.25 mg and not exceeding 5 mg during surgery. The use of clopheline in this category of patients ensures neurovegetative inhibition adequate to the operation stress. In 80% of patients favourable hemodynamic changes have been observed. 20% of patients require droperidol administration at a dose 1.25-5 mg during surgery. Due to low doses, the risk of complication associated with the use of narcotic analgesics in elderly and old patients is reduced considerably.

[Changes in lung function in the postoperative period during tube feeding]. / Izmenenie funktsii legkikh v posleoperatsionnom periode v usloviiakh zondovogo pitaniia.

39 patients after surgery for laryngeal cancer have been examined. It has been shown that enteral nutrition with high carbohydrate content is accompanied by an increase in O2 consumption, CO2 release, minute lung ventilation, disturbances in lipid metabolism, blood hypercoagulation and does not promote the recovery of the lung function. Diets with predominant fat content led to the normalization of gas exchange, correction of lipid metabolism and hemostasis and, therefore, were recommended in the postoperative period for patients with laryngeal cancer.