[Mesenteric circulation evaluation during myocardial revascularization with different temperature modes of extracorporeal circulation].

The Mesenteric blood circulation during myocardium revasculization was investigated 40 patients were divided in 2 groups: 1st group - normothermia CPB, 2nd group hypothermia CPB. It was found that reduced mesenteric perfusion occurred in both groups, but it was more pronounced in hypothermia CPB group and was caused by a significant deterioration of the microcirculation.

[Efficiency and controllability of esmolol (breviblock)-induced adrenergic blockade during the heart and aorta surgery].

This article contains analysis of retrospective and prospective studies of use of selective ultrashort Beta-blocker esmolol during intraoperative period in cardiac surgery patients in recent years. The drug is highly effective and controlled the means for prevention and treatment of tachycardia, arising as a result of the sympathoadrenal system activation during anaesthesia induction (laryngoscopy, trachea intubation) and intraoperative period (during heart and aorta manipulations). It should be considered that the use of esmolol has dose-dependent effect. For the treatment of tachycardia against the background of hypertension is recommended dose of 0.6-1.0 mg/kg, with normal blood pressure it is recommended to decrease the esmolol dose up to 0.3-0.6 mg/kg. It is possible to use esmolol-infusion in the dose of 50-200 g/kg/min prolonging adrenergic blockade during heart and aorta surgery.

[Unintended cooling, active warming, and microcirculation in cardiosurgical patients].

The study was undertaken to compare various methods to maintain a patient's body temperature and to evaluate their impact on microcirculation during myocardial revascularization under normothermal extracorporeal circulation (NTEC). The study enrolled 50 patients with NYHA Functional Classes III-IV coronary heart disease, who underwent aortocoronary bypass surgery under NTEC. A HICO-AQUATHERM 660 water-warming unit (Hirtz, Germany) was used in Group 1 patients (n=30). A Bair Hugger air-warming unit (Arizant, U.S.A.) with a mattress located under a patient was employed in Group 2 (n=20). Intraoperative microcirculation monitoring was carried out by a laser analyzer (Lazma, Moscow).

[Role of entropy-based neuromonitoring during cardiac surgery].

The paper deals with a role of spectral entropy-based neuromonitoring at cardiac surgery. Eighty cardiosurgical patients were examined. The depth of entropy-based anesthesia was monitored in all the patients. The patients enrolled into the study were divided into 2 groups. Anesthesia was carried out in the study group (n=40), by taking into account entropic parameters, and in the control group (n=40) on clinical grounds. Information on entropic parameters in this group was accessible only to an investigator and inaccessible to an anesthesiologist who had made anesthesia. The results of the study indicated that entropy-based neuromonitoring permits more controllable and predictable anesthesia to be achieved, makes an individual adjustment of the doses of sedatives easier for each patient, at the induction of anesthesia particularly, enables hypo- and hyperhypnotic episodes to be timely revealed, thus reducing the frequency of hypo- and hyperdynamic reactions by 2.4 times.

[Changes in cerebral circulation in patients with coronary heart disease during myocardial revascularizing operations under combined xenon anesthesia].

Twenty-five patients with coronary heart disease were examined in the preperfusion stage of myocardial revascularing operations under extracorporeal circulation. All the patients received combined anesthesia with xenon (Xe) as minimum flow anesthesia with flow of gases: oxygen, 0.4 l/min; Xe, 0.9 to 0.4 l/min. Cerebral circulation was investigated by transcranial Doppler study. The following parameters of the circulation: maximum systolic and diastolic blood flow velocities and pulsatile index were bilaterally estimated, by insonating the middle cerebral artery (MCA). When the concentration of Xe was as high as 50-60%, systolic and diastolic blood flow velocities along the MCA increase and the pulsatile index decreased. Opposite results were obtained 8 minutes after Xe feed was stopped. The findings provide evidence that Xe increases cerebral circulation and has a significant hypnotic effect. The increased systolic and diastolic blood flow velocities with the decreased peripheral resistance index in the MCA suggest that Xe diminishes peripheral vascular resistance in the pial arteries of the brain.

[Surgical treatment of a patient with type I aortic dissection and occlusion of brachiocephalic branches by observation].

Presented herein is a clinical observation of a patient presenting with type I aortic dissection extending to the brachiocephalic trunk, closing down and occluding the ostium of the right subclavian artery, dissection with occlusion of the opening of the left common carotid artery, as well as dissection of the right iliac artery with the stenosing thereof. The patient was subjected to a two-stage surgical intervention: the first stage consisted in the subclavian-carotid prosthetic reconstruction on the left for revascularization of the brain; the second stage consisted in prosthetic reconstruction of the aortic valve, the ascending portion and the arch of the aorta, and the brachiocephalic trunk.

[Minimally invasive surgery of Leriche syndrome]. / Miniinvazivnaia khirurgiia sindroma Lerisha.

Successful treatment of 25 patients with Leriche syndrome with minilaparotomic approach is analyzed. This method promotes a decrease of postoperative complications and faster rehabilitation of patients compared with standard method. Mean time of surgery was 145+/-33,1 min, in one-stage carotid surgery - 182,1+/-27,4 min. Volume of infusion during surgery was 2500 ml, blood loss - 264,6+/-74,4 ml, time of aorta clamping - 24,6+/-5 min. There was no peripheral embolism after surgery. Postoperative lung ventilation lasted for 37,5+/-28,3 min. Mean stay in intensive care unit was 22,5+/-1,97 h. Patients could receive oral nutrition in 28,75+/-7,8 h. The proposed method may be used in the majority of cases as alternative to conventional surgery and doesn't require significant expenditures and expensive equipment.

[Anesthesia in surgical treatment of the ascending aorta-arch aneurysms]. / Anesteziologicheskoe obespechenie operatsii po povodu anevrizm voskhodiashchego otdela i dugi aorty.

The paper analyzes anesthesiological maintenance of infusion therapy, optimal criteria for effective brain protection, complications and mortality in 42 patients during operations on the ascending portion and arch of the aorta under deep hypothermic circulatory arrest. For this purpose, the patients were divided into 2 groups: Group 1 comprised 20 patients operated on before 1998; Group 2 included 22 patients operated on in 1998 to 2001. In both groups, circulatory arrest lasted 44 +/- 7 min. The patients were cooled to a temperature of 13.5 +/- 0.5 degrees C, to 15 +/- 0.6 degrees C in the nasopharynx. The duration of cooling was 58 +/- 5 and 73 +/- 6 min, respectively; that of warming-up was 70 +/- 8 and 83 +/- 6 min. Investigations have indicated that determination of the optimum brain cooling requires a complex assessment of central temperature values, electroencephalographic monitoring (visual estimation of a curve and quantitative characteristics), SjbO2 and cerebral metabolism. The investigations have shown that the procedure for anesthesiological maintenance and cerebral metabolism is safe and effective even in patients with arrested circulation lasting longer than 60 min. The operative mortality does not depend on the use of circulatory arrest under deep hypothermia and on its duration. Hemodynamic instability due to bleeding, as well as myocardial infarction, marked hemodilution during extracorporeal circulation are major factors that cause an increase in the rates of incidence of complications and mortality. The procedure used for anesthesiological maintenance and infusion therapy, decreased blood loss, and a reduction in the incidence of myocardial infarction could significantly reduce operative mortality. The fact that there were no neurological complications even during prolonged (80-min) circulatory arrest has shown that the brain-protective procedure including both general and regional cooling is reliable and to the extent of the indicated criteria. So is pharmacological protection.

[Anesthesiological aspects of early activation of patients after aortocoronary bypass surgery]. / Anesteziologicheskie aspekty rannei aktivizatsii bol'nykh posle operatsii aortokoronarnogo shuntirovaniia.

The specific features of the course of anesthesia and the time of extubation were studied in 142 patients suffering from coronary heart disease who had undergone myocardial revascularization. All the patients were divided into 3 groups in accordance with the type of anesthesia. Group 1 patients (n = 48) received routine anesthesia with ketamine, benzodiazepines, and large-dose fentanyl. Group 2 (n = 45) had combined anesthesia with inhalational and intravenous anesthetics having their better pharmacodynamics (such as isoflurane, diprivan, tracrium). In Group 3 (n = 49), the authors employed another developed modality of anesthesia using high thoracic (TII-TIV) epidural anesthesia as a basic component of anesthesiological maintenance. The two developed modalities of anesthesia almost halved the use of total dose opioids, which promoted patients' early postoperative recovery of consciousness and respiration. The time before extubation was 9.9 +/- 2.1, 4.5 +/- 1.1, and 1.5 +/- 1.2 hours in Groups 1, 2, and 3, respectively (p < 0.05). The developed anesthesia procedure using isoflurane, midazolam, propofol, and small-dose fentanyl ensures safe and early (up to 6-hour) extubation in 73% of the patients undergone aortocoronary bypass surgery. The developed anesthesiological protocol based on thoracic epidural anesthesia enables extubation to be carried out on the operating table within an hour in 75% of patients after aortocoronary bypass surgery. A comparative intraoperative analysis of hemodynamics, the incidence of myocardial ischemia, arrhythmias, glucose levels has indicated that the anesthesia techniques aimed at a patient's early activation are not inferior in the degree of protection to routine anesthesia using large doses of opioids, ketamine, and diazepam. When used in combination with thoracic epidural block, the methods are superior to the latter.

[Anesthesia, changes in hemodynamics and metabolism in surgical treatment of thoracic and abdominal aortic aneurysms]. / Anesteziia, izmeneniia gemodinamiki i metabolizma pri operatsiiakh po povodu anevrizm torakoabdominal'nogo otdela aorty.

45 patients aged 32-63 years operated on for dissecting aneurysm of the thoracoabdominal part of the aorta were divided into 2 groups. Group 1 patients (n = 36) were operated on with application of the bypass using centrifuge pump. Group 2 patients (n = 9) were operated on without the bypass. The results evidence that the employed anesthesia and infusion therapy in combination with the bypass maintained by the pump provide stable intraoperative hemodynamics and prevent renal failure. Usage of the bypass in combination with liquor drainage reliably protects spinal cord from ischemia, especially in patients with long-term aortic ligature.

[Autonomic reactivity and intraoperative arterial hypertension in patients with ischemic heart disease]. / Vegetativnaia reaktivnost' i intraoperatsionnaia arterial'naia gipertenziia u bol'nykh IBS.

As patients with ischemic heart disease (IHD) may develop intraoperative hypertensive and hyperdynamic reactions provoking myocardial ischemia, the authors estimated reactivity of the autonomic nervous system before giving anesthesia. This was made for prediction of intraoperative hypertensive reactions and choice of an optimal anesthesia variant. Combination of spectral analysis of variability of the heart rhythm and active orthostatic test was employed for this purpose in 50 IHD patients undergoing myocardial revascularization.

[Anesthesia, changes in hemodynamics and metabolism in resection of abdominal aortic aneurysms]. / Anesteziia, izmeneniia gemodinamiki i metabolizma pri rezektsii anevrizm briushnoi aorty.

Changes in hemodynamics and some metabolic parameters were studied in 78 patients during anesthesia for resection of the abdominal aorta aneurysms. The steps of the operation associated with the most profound hemodynamic changes were distinguished and measures aimed at stabilization of hemodynamics, blood volume, and electrolyte balance considered. No appreciable changes in the hemodynamics or depression of the myocardium were observed at stages of anesthesia and operation. A correlation was traced between pressure changes in the pulmonary artery and central venous pressure. The suggested method of anesthesia and infusion therapy strategy are conducive to stabilization of the hemodynamics in the course of the whole operation, to maintenance of normal volume of circulating blood and adequate diuresis. Monitoring of central venous pressure is sufficient to control infusion therapy and hemodynamics.

[Effects of halothane on cerebral blood flow and its protective action in ischemia]. / Vliianie ftorotana na mozgovoi krovotok i ego zashchitnoe deistvie pri ishemii.

Halothane impact on cerebral blood flow, brain metabolism and its protective effect in ischemia have been assessed in 30 patients operated on for the occlusion of brachiocephalic arteries. The data obtained indicate that additional use of halothane in N2O:O2 anesthesia during reconstructive surgery on brachiocephalic arteries makes it possible to enhance collateral blood flow, increase retrograde pressure, and decrease O2 consumption by the brain, without considerable changes in systemic hemodynamics. In addition, the studies have shown that halothane decreases lipid peroxidation processes.

[Anesthesia and brain protection in reconstructive surgery of brachiocephalic arteries]. / Anesteziia i zashchita mozga pri rekonstruktivnykh operatsiiakh na brakhitsefal'nykh arteriiakh.

Application of a shunt is not the principal factor preventing brain blood flow disorders in reconstructive surgery on the carotid arteries in conditions of general anesthesia with anesthetics of an antihypoxic action, reducing oxygen consumption by the brain, combined with adequate compensation of the circulating blood volume, moderate hemodilution, elevation of the systemic arterial pressure and heparin. The authors claim that even in patients with bilateral stenosis of the carotid arteries or with occlusion of one of these arteries surgery may be carried out without shunts or craniocerebral hypothermia. Still, they do not deny a bypass application, particularly by the surgeons who always use it, or in cases with a drastic inhibition of the brain electrical activity, evidenced by EEG, which they consider a sufficiently reliable indicator of the brain blood flow adequacy.