[Anesthesiological problems in the surgical treatment of chronic obstructive pulmonary disease]. / Anesteziologicheskie problemy pri khirurgicjeskom lechenii khronicheskoi obstruktivnoi bolezni legkikh.

Maintenance of effective gas exchange made with respect to surgical comfort and lower risk of intraoperative lung damage is the main problem in the anesthetic management of surgical reduction of pulmonary volume (SRPV). Described in the paper is the experience of anesthetic management made in 10 patients in SPRV. The method of differential ALV (DALV) with continuous positive pressure in airways (CPPA) made for the ventilation support of the independent lung was found to be the only effective technique ensuring an adequate gas exchange in surgery for SPRV in patients with diffusive pulmonary emphysema (DPE). It accounts for the pathophysiological specificity of diffusive pulmonary lesion. At the same time, it provides for an optimal surgical comfort and for the most cautious manipulations on the lung. Such a combination improves the overall surgical results. The high-frequency respiratory support to the operated lung is contraindicated in such patients because of hyperinflation of the affected lung.

[Continuous positive airway pressure and high-frequency independent lung ventilation in patients with chronic obstructive lung diseases]. / Postoiannoe polozhitel'noe davlenie v dykhatel'nykh putiakh i vysokochastotnaia ventiliatsionnaia podderzhka nezavisimogo legkogo u patsientov s khronicheskimi obstruktivnymi zabolevaniiami legkikh.

The original hypoxemia, hypercapnia, high pulmonary hypertension, high resistance of microcirculation vessels, right volumetric ventricular overload, persistent sub-edema of pulmonary intersticium as well as disparity of ventilation and perfusion between both lungs are the main problems in patients with chronic obstructive disease of the lungs (CODL). Such patients are, as a rule, intolerant to the independent lung collaboration or artificial single-stage ventilation (ASV). Patients with respiratory insufficiency, stages 2 and 3, and with a pronounced impaired type of ventilation have originally a deranged blood gas composition, like hypoxemia or hypercapnia. The application of volume-controllable bi-pulmonary ASV in such patients maintains an adequate gas exchange hemodynamics. However, ASV is accompanied by a significantly reduced gas-exchange function of the single ventilated lung and by essentially worsened intrapulmonary hemodynamics. Therefore, what is needed is to use alternative methods of independent lung ventilation in order to eliminate the gas-exchange impairments and to enable surgical interventions at thoracic organs in such patients (who are intolerant to ASV). A choice of a method and means of oxygen supply to the independent lung is of great importance. The possibility to avoid a high pressure in the airways, while maintaining, simultaneously, an adequate gas exchange, makes the method related with maintaining a constant positive pressure in the airways (CPPA) a priority one in case of CODL patients. The use of constant high-frequency ventilation in the independent lung in patients with obstructive pulmonary lesions does not improve the gas exchange or hemodynamics. Simultaneously, a growing total pulmonary resistance and an increasing pressure in the pulmonary artery are observed. Consequently, the discussed method must not be used for the ventilation support of the independent lung in patients with the obstructive type of the impaired external breathing function.

[Anesthesia in obese patients]. / Osobennosti anesteziologicheskogo obespecheniia u bol'nykkh s izbytochnoi massoi tela.

Anesthesiological aids were analyzed in 70 obese patients undergone a total of 88 surgical interventions (in 1992 to 2002). This category of patients presented difficulties with tracheal intubation and gas exchange management at all stages of anesthesia and medication, which is associated with high chest rigidity, large distribution volume due to excess fatty tissue and serious comorbidity. The authors propose basic ways of solving the problems occurring with the use of fibrooptic equipment for tracheal intubation and suggest that short-acting agents with extraorgan elimination for induction and maintenance of anesthesia and special methods of artificial pulmonary ventilation (traditional volume-cyclic and jetwise high-frequency pulmonary ventilation) should be used to maintain effective gas exchange.

[Prevention of risk of cross-infection through the respiratory system during anesthesia]. / Predotvrashchenie riska perekrestnoi infektsii cherez dykhatel'nye sistemy vo vremia anestezii.

The authors present a modern concept of prevention of cross contamination during forced ventilation of the lungs in the course of total anesthesia and operation. The optimal complex of measures of individual protection of a patient includes hygienic measures, use of sterile respiratory systems (better disposable), obligatory use of respiratory filters between the intubation tube and T-piece of the narcosis and respiration device; hydrophobic folded membrane filters should be preferred. Studies carried out at Anesthesiology Department of Research Center of Surgery of Russian Academy of Medical Sciences indicate that BB 22-15 filters (Pall Corporation) reliably protect patients from cross-contamination realized through respiratory gases and biological fluids (blood, saliva, condensate) and save heat and humor. Hydrophobic folded membrane filter BB 22-15 is highly effective, which recommends it for wide use.

[Use of new respiratory technologies in solving problems of artificial one-lung ventilation in thoracic surgery in high-risk patients]. / Primenenie novykh respiratornykh tekhnologii dlia resheniia problemy iskusstvennoi odnolegochnoi ventiliatsii u patsientov vysokogo riska v torakal'noi khirurgii.

The authors proposed a separate independent (or differentiated) artificial lung ventilation as an appropriate alternative variant of artificial lung ventilation (ALV). This approach implies bulky ALV of the operated lung and high-frequency ventilation of the contralateral lung. In patients with associated respiratory diseases and stage II-III respiratory insufficiency, ALV initiates high pulmonary hypertension, intrapulmonary bypass of 50% cardiac output. The differentiated ALV on principal operation stage optimizes homeostatic parameters vs both one-lung and conventional ALV. For patients with stage II-III respiratory insufficiency and cardiovascular disease ALV is contraindicated. Differentiated ALV is the only alternative allowing surgical treatment of lung diseases in high risk patients.

[Differential artificial lung ventilation as an alternative to single lung ventilation in thoracic surgery]. / Differentsirovannaia IVL kak al'ternativa odnolegochnoi ventiliatsii v torakal'noi khirurgii.

The study was undertaken to develop and introduce a lung artificial ventilation (LAV) procedure that levels the pathophysiological changes associated with collapse of the lung operated on, which is based on comparison of the impact of one-lung and differential LAV on gas exchange and hemodynamics. It was found that under differential ventilation, ventilation-perfusion ratios became normal, pulmonary pressure dropped, resistance in all regions of the lung microcirculatory bed decreased, the volume of intrapulmonary shunting became smaller. Concomitantly, there were reductions in right cardiac preload and fluid filtration into the both parts of the extravascular lung space. This all shows that there is a significant increase in the efficiency of intrapulmonary gas exchange. Thus, differential ventilation is the most advisable alternative to collapse of the independent lung in thoracic surgery hemodynamics. It is the method of choice in pulmonary hypertension, right ventricular failure, oxygenation function of the lung.