[Prevention of postoperative venous thromboembolic complications]. / Profilaktika posleoperatsionnykh venoznykh tromboémbolicheskikh oslozhnenii.

Venous thromboembolic complications (VTEC) occurring during the postoperative period notably increase the mortality. Prevention of this complications requires detection of risk factors in order to evaluate the risk for every patient. Based on the risk factors described in this paper, all patients can be divided into categories at a high, moderate, and low risk of complications. Preventive measures corresponding to the risk are to be taken. These measures are to include measures improving venous flow and anticoagulant therapy (low-molecular heparins should be preferred). Though these measures do not 100% prevent thromboembolic complications, they notably decrease the risk of VTEC.

[Abdominal sepsis: the integral assessment of the severity of patient condition and of multiple organ dysfunction]. / Abdominal'nyi sepsis: integral'naia otsenka tiazhesti sostoianiia bol'nykh i poliorgannoi disfunktsii.

Results of examinations of 247 patients with diffuse peritonitis and symptoms of abdominal sepsis are analyzed. Systemic inflammatory reaction in peritonitis patients can manifest by sepsis, severe sepsis, and infectious toxic (septic) shock. The severity of systemic inflammatory reaction syndromes can be evaluated by objective scores for evaluation of clinical states (APACHE II, SAPS) and the degree of multiple organ dysfunction/failure (MODS, SOFA). Application of objective scores for evaluation of clinical states provides clinical stratification of abdominal sepsis, helps predict the disease course and outcome, and improve treatment strategy.

[Prevention of hemodynamic disorders during anesthesia in middle-aged and elderly patients with essential hypertension. Components of anesthesia. II]. / Profilaktika gemodinamicheskikh narushenii vo vremia anestezii u bol'nykh pozhilogo i starcheskogo vozrasta s soputstvuiushchei gipertonicheskoi bolezn'iu v svete komponentnosti anestezii (Chast' II).

Hemodynamic parameters were evaluated during various stages of anesthesia in two groups of patients aged 60-85 years with mild essential hypertension. In group 1, routine preoperative treatment with hypotensive drugs was carried out and in group 2 differentiated preoperative treatment with calcium antagonists was carried out with consideration for a hemodynamic type. Group I patients were operated on under traditional neuroleptic analgesia (NLA), group 2 under NLA with 40% lower drug doses than in group 1 and with addition of calcium antagonists. To patients with hypo- and eukinetic hemodynamics, nifedipine was injected (bolus injection) in a dose of 14.2 micrograms/kg before induction and then was infused in a dose of 6.0-14.2 micrograms/kg/min. Patients with hyperkinetic hemodynamics were injected verapamil in a dose of 70-140 micrograms/kg (bolus injection) and then the same dose every hour of the operation. Differentiated use of calcium antagonists during anesthesia helped transform the hyper- and hypokinetic types of hemodynamics into a more rational eukinetic type, which was associated with a decrease of MVO2. Calcium antagonists, exerting analgesic, automatic stabilizing, and antihypoxic effects, prevented the hyperdynamic reactions complicating NLA in 30% cases and precluded complications of concomitant ischemic diseases, which were observed in 40% of group 1 patients.

[Inflammatory reaction and sepsis in pancreatic necrosis]. / Sistemnaia vospalitel'naia reaktsiia i sepsis pri pankreonekroze.

Analysis of clinical data, results of treatment, and the development of systemic inflammatory reaction (SIR) in 100 patients with sterile or infective pancreonecrosis and pancreatogenic necrosis demonstrated a phase-wise pattern in the development of inflammatory and septic process in pancreonecrosis. The development of inflammation and sepsis in such patients is determined by the extent of involvement, infection of necrotic zone, and disease duration. SIR, shock, and polyorgan failure are the cardinal components in the pathogenesis of various phases of pancreonecrosis. Detection of signs of SIR and sepsis are needed for individual and urgent evaluation of patient's state. The scale for evaluating the severity of patient's physiological condition and index of involvement of abdominal and retroperitoneal organs are the most accurate, sensitive, and quantitative characteristics for evaluating the patient's condition and the course and outcome in pancreonecrosis.

[A strategy and procedure for the antibacterial therapy of abdominal sepsis]. / Strategiia i taktika antibakterial'noi terapii abdominal'nogo sepsisa.

Offers a protocol of antibacterial therapy of abdominal sepsis in surgical patients. Analyzes the principal etiological agents of abdominal septic complications. Presents optimal schemes of antibacterial therapy of abdominal sepsis. Pays special attention to choice of antibiotics in different clinical situations.

[Nosocomial infections in intensive care]. / Nozokomial'naia infektsiia v intensivnoi terapii.

Nosocomial infection remains a pressing problem of surgery and intensive care. The authors analyze the sources of infection, the factors predisposing to it, and the pathogenetic aspects. The strategy of nosocomial infection control is determined by the clinical and nosological structure and severity of patients' status. Microbiological and pharmacological studies helped the authors develop the protocols of the initial and alternative antibiotic therapy of various nosocomial complications of wound infection, abdominal sepsis, nosocomial pneumonia, and infectious toxic shock. Experience gained by the authors permitted them to recommend preventive measures decreasing the risk of exo- and endogenous infection and improving the mechanisms of patients' immunity.

[Clinical experience in the use of dormicum (midazolam) in anesthesiology and intensive care]. / Klinicheskii opyt primeneniia dormikuma (midazolama) v anesteziologii i intensivnoi terapii.

The authors analyze the efficacy of midazolam (dormicum, Egys, Hungary) used for induction anesthesia in 35 patients subjected to planned surgery for varicose disease of the lower limbs and on the abdominal organs and in 17 critical patients in intensive care units. To assess the hemodynamics, catheterization of the peripheral and pulmonary arteries was carried out, cardiac output, pressure in cardiac cavities, pulmonary capillary wedging pressure assessed, total peripheral and total pulmonary resistance, cardiac and stroke indexes estimated, gaseous composition of arterial and mixed venous blood analyzed. The drug had virtually no side effects on the function of vital systems of the body. Midazolam fully meets the requirements to drugs used for induction anesthesia and is compatible to such drugs as barbiturates, diazepam, ketamine. The drug can meet pharmacodynamic and pharmacokinetic requirements to sedative agents used in intensive care units, excepting analgesia. However, the need in analgesics and their doses are reduced during sedative therapy with midazolam. Midazolam effects on the lesser circulation hemodynamics permit its use as a sedative agent in patients with respiratory distress syndrome and pulmonary artery thromboembolism; it is also advisable for induction anesthesia in patients operated on for pulmonary artery thromboembolism and in other patients with lesser circulation hypertension.

[High-frequency jet ventilation of the lungs during intensive care of cardiogenic shock and pulmonary edema in patients with myocardial infarction]. / Vysokochastotnaia struinaia ventiliatsiia legkikh pri intensivnoi terapii kardiogennogo shoka i oteka legkikh u bol'nykh infarktom miokarda.

High-frequency (HF) jet ventilation through transtracheal catheter has been used for the therapy of acute respiratory failure in 30 patients ith myocardial infarction complicated by pulmonary edema and cardiogenic shock. Gas exchange and central hemodynamics have been assessed, using a Swan-Ganz catheter fixed in the pulmonary artery. HF ventilation led to a decrease of hypoxemia, pulmonary blood shunting and to a moderate increase in the cardiac output.

[Measurement of the pressure in pulmonary capillaries by an occlusion method in patients with adult respiratory distress syndrome]. / Izmerenie davleniia v legochnykh kapilliarakh okkliuzionnym metodom u bolnykh s respiratornym distress-sindromom vzroslykh.

The pulmonary artery was catheterized using a Swan-Ganz catheter (7F) in 16 patients with adult respiratory distress syndrome. Hydrostatic pressure in the pulmonary capillaries was determined by analyzing changes in pulmonary artery pressure during its occlusion with a balloon and by the formula suggested by Gaar. The results have been compared. A high and significant correlation between the parameters obtained by the two above techniques has been established. The determination of pressure in the pulmonary capillaries makes it possible to calculate precapillary and postcapillary resistance.

[Effects of infusion therapy during anesthesia on circulating blood volume, osmolality and colloid-osmotic pressure]. / Vliianie infuzionnoi terapii vo vremia anestezii na ob'em tsirkuliruiushchei krovi, osmolial'nost' i kolloidno-osmoticheskoe davlenie.

The problems of infusion therapy during anesthesia and surgery, relevant for clinical practice, have been reviewed. The changes in circulating blood volume, plasma osmolality and colloid-osmotic pressure have been studied depending on quantitative and qualitative structure of the infusion therapy as well as on the duration of surgical intervention. The dependence observed indicates that infusion therapy during anesthesia and surgery must not be considered a routine procedure. The data obtained will help practicing anesthesiologists to choose the right technique.

[Colloid-osmotic pressure and osmolality of infusion media]. / Kolloidno-osmoticheskoe davlenie i osmolial'nost' infuzionnykh sred.

The value of such important parameters as colloid-osmotic pressure and osmolality of infusion media and their potential effect on the patient's body have been studied. The importance and necessity of dynamic control over the values of colloid-osmotic pressure and plasma osmolality in the course of infusion therapy have been stated. The problems of the correct choice of the infusion media depending on the concrete clinical situation have been reviewed.

[The effect of a nitroglycerin infusion on the hemodynamics, extravascular lung water and gas exchange in patients with adult respiratory distress syndrome]. / Vliianie infuzii nitroglitserina na gemodinamiku, ob"em vnesosudistoi vodyv legkikh i gazoobmen u bol'nykh s respiratornym distress-sindromom vzroslykh.

Nine patients with adult respiratory distress syndrome, stage III, secondary to diffuse peritonitis have been examined. The patients were subject to pulmonary artery and aorta catheterization. Cardiac output, extravascular water in the lungs, the extent of pulmonary shunting were determined; pulmonary artery and aortic pressure were measured. O2 transport parameters, pulmonary capillary pressure (Pc), pressure gradient (Pc-COP) were calculated and arterial and venous blood gases as well as colloid-osmotic pressure (COP) were analysed. Selective hypotension in the pulmonary circulation was performed using an infusion of nitroglycerin solution. Despite differences in the response of patients with ARDS to nitroglycerin, when the drug was injected with optimal positive end-expiratory pressure, it promoted an increase in O2 delivery, normalization of pulmonary hemodynamics and a decrease in extravascular pulmonary water.

[Change in the metabolic functions of the lungs and the content of biologically active substances in the blood of patients with the adult respiratory distress syndrome]. / Izmenenie metabolicheskikh funktsii legkikh i soderzhanie biologicheski aktivnykh veshchestv v krovi bol'nykh respiratornym distress-sindromom vzroslykh.

In 48 patients operated on for peritonitis of different etiology the postoperative period was complicated by the onset of adult respiratory distress syndrome. A considerable increase in the blood level of biologically active compounds (adrenalin, noradrenalin, histamine, serotonin) and the activation of kinin system have been observed. Marked humoral shifts trigger a sequence of reactions manifested in microcirculation disturbances and the onset of tissue hypoxia, thus inducing the damage of metabolic lung functions and the development of adult respiratory distress syndrome.

[Antibacterial prophylaxis in heart surgery interventions with extracorporeal circulation]. / Antibakterial'naia profilaktika pri kardiokhirurgicheskikh vmeshatel'stvakh v usloviiakh iskusstvennogo krovoobrashcheniia.

Clinico-laboratory studies were conducted in 30 patients who underwent operations for heart diseases and thromboembolism of the pulmonary artery under extracorporeal circulation. Gentamicin and tobramycin were used for antibacterial prophylaxis. Study of the pharmacokinetics of the agents disclosed essential changes of the distribution volume and clearance of the antibiotics in the patients of the studied group, which made the routine regimen of their administration modified. Analysis of the results of administration of the agents according to a modulatory regimen showed its high prophylactic efficacy in the absence of side effects.