[Total intravenous anesthesia based on propofol infusion with target concentration: a new procedural solution]. / Total'naia vnutrivennaia anesteziia na osnove infuzii propofola po tselevoi kontsentratsii: novoe takticheskoe reshenie.

Total intravenous propofol anesthesia with target control (TCI) infusion was used in 61 surgical patients (43 women, 18 men, ASAI-II). Propofol concentration in the central compartment at awakening was in high correlation with the effective concentration (Ce) at the moment of falling asleep (r = 0.64). A model investigation demonstrated the advantages of longer induction for minimization of the hemodynamic disorders. Propofol TCI in a dose of 2 micrograms/ml led to an increase in the EEG spectral potency in the 1-12 Hz range, appearance of biomodality, and a decrease in the right-side frequency. The studies helped determine the policy of intravenous propofol TCI anesthesia using the Ce values at the moment when the patient lost consciousness and the right-side frequency of EEG spectrum.

[Functional state of the right and left heart at different stages of anesthesia in patients with ischemic heart disease during myocardial revascularization surgery]. / Funktsional'noe sostoianie pravogo i levogo serdtsa na razlichnykh étapakh anestezii u bol'nykh IBS pri operatsiiakh revaskuliarizatsii miokarda.

57 ischemic heart disease (IHD) patients entered the study of right and left heart function at different stages of anesthesia and operation to reveal possible reasons of myocardial dysfunction and to propose effective prevention of this dysfunction. All the patients were operated on under multicomponent balanced anesthesia (relanium, fentanyl, arduan, nitric oxide with oxygen 1:1). Left ventricular function was assessed at Doppler echocardiography, right ventricular function--at catheterization of the lung artery with a Swan-Ganz catheter with low time constant. Hemodynamic monitoring was made with a domestic MX-04 monitor. It was found that in the preperfusion period diastolic function of the right and left ventricles is impaired much more than the systolic one. The conditions of anesthesia and operation affect right ventricular function more than the left one. Diastolic and systolic right ventricular dysfunctions were observed at all stages and three stages of the operation, respectively. Diastolic and systolic left ventricular dysfunction was observed at four and one stages, respectively. Basic causes of the above systolic and diastolic disorders in the preperfusion period may be tachycardia, arterial hypertension, reduction of the preloading and increased postloading (for the right ventricle) in artificial lung ventilation.

[Prevention of negative hemodynamic effects of protamine sulfate by simultaneous infusion of microdoses of adrenaline]. / Profilaktika otritsatel'nykh gemodinamicheskikh éffektov protamina sul'fata s pomoshch'iu odnovremennoi infuzii mikrodoz adrenalina.

Two groups of coronary patients subjected to revascularization of the myocardium were examined in order to detect the negative hemodynamic effects of protamine sulfate (PS) and the possibility of their correction by simultaneous infusion of adrenaline microdoses. In group 1 (27 pts.) heparin was neutralized by infusion of PS alone (6 mg/kg) and in group 2 (27 pts.) by simultaneous infusion of PS and adrenaline (15 ng/kg/min). The functions of the right and left ventricles were evaluated by catheterization of the pulmonary artery by a Swan-Ganz catheter and transesophageal Doppler echocardiography. These methods provided volume and velocity characteristics of the right and left compartments of the heart. PS deteriorated the systolic function of the right ventricle, particularly in patients with initial dysfunction of the right heart. Infusion of adrenaline simultaneously with PS leveled its negative effects, thus preventing myocardial dysfunction.

[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.

[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.

[First experience with clinical use of intravenous anesthetic recofol: effectiveness and safety]. / Pervyi opyt klinicheskogo ispol'zovaniia vnutrivennogo gipnotika rekofola: éffektivnost' i bezopasnost'.

Clinical trials of a new anesthetic Recofol were carried out. This analog of well-known drug diprivan is characterized by a predominantly hypnotic effect. The effect of recofol on hemodynamics, gas exchange, and EEG was studied in 30 clinical trials during anesthesia for bronchoscopic manipulations and operations on the abdominal and thoracic organs, microsurgery, and during peripheral vessel repair. The results indicate that recofol is virtually identical to diprivan (propofol). Clinical course of induction and anesthesia, hemodynamic reactions and effect on the respiratory system of patients were virtually the same. Recofol was well tolerated, its allergenic activity was relatively low, it was rapidly metabolized, there were virtually no side effects. Positive results of recofol trials carried out by Leiras Oy firm recommend the drug for wide use in anesthesiology.

[Clinical, neurophysiological and hemodynamic effects of a new nondepolarizing myorelaxant mivacurium in heart surgery patients]. / Klinicheskie, neirofiziologicheskie i gemodinamicheskie éffekty novogo nedepoliarizuiushchego miorelaksanta mivakuriuma u kardiokhirurgicheskikh bol'nykh.

Thirty patients aged 23 to 65 years with ASA class III operated on the heart under total intravenous anesthesia were examined after the Good Clinical Practice protocol. Mivacurium in bolus dose of 0.2 mg/kg was injected for intubation of the trachea; neuromuscular blocking (NMB) was maintained by a repeated injection of the drug in a dose of 0.15 mg/kg, after which it was infused at a rate of 1 to 10 micrograms/kg/min. Accelerometric control of neuromuscular conduction was carried out by the Organon (Belgium) TOF-Guard device. Central and peripheral hemodynamics was monitored. Side effects of the drug were recorded. Bolus injection of mivacurium in a dose of 0.2 mg/kg caused T1 suppression (90%) after 2.6 +/- 0.7 min. Maximal (97.7 +/- 4.5%) suppression was observed after 4.17 +/- 2.5 min. The conditions of intubation of the trachea after 3.9 +/- 1.8 min in the presence of 78 to 100% T1 suppression (97.7 +/- 4.5%) were considered excellent or good in 96.6% of cases. Clinically and neurophysiologically sufficient muscle relaxation after the first injection of the drug persisted for 27.7 +/- 7.3 min. Minimal rate of infusion for maintaining the NMB at 95 +/- 4% level of T1 suppression was 6.3 +/- 1.7 micrograms/kg/min. Bolus injection of mivacurium in a dose of 0.2 mg/kg for 60 sec involved a 1-3-min drop of the mean arterial pressure by 10.5% and a 10.3% decrease of heart rate. Repeated bolus injection of the drug in a dose of 0.15 mg/kg and its infusion did not change the peripheral and central hemodynamics. The most typical side effect of the drug in a dose of 0.2 mg/kg is short-term reversible reddening of the skin of the face and neck, observed in 20% of patients. The results permit us to consider mivacurium as an effective, safe, and controllable agent, which can be used in cardiosurgical patients.