[Clinical experience in the use of epidural blockade in complex anesthesia in cardiac surgical interventions]. / Klinicheskii opyt primeneniia épidural'noi blokady v komplekse anesteziologicheskogo obespecheniia kardiokhirurgicheskikh vmeshatel'stv.

A total of 326 patients were operated on the heart under total and combined epidural anesthesia. Multicomponent total anesthesia in combination with epidural blocking is indicated for patients with coronary disease, aortal and mitral valve failure, arterial and pulmonary hypertension. The dose of fentanyl is decreased 2.98 times, duration of forced ventilation of the lungs 2-fold, and the incidence of cardiovascular and pulmonary complications is reduced in patients subjected to cardiosurgical interventions under total anesthesia in combination with epidural blocking.

[Multicomponent intravenous and epidural anesthesia in aorto-coronary bypass surgery]. / Mnogokomponentnaia vnutrivennaia i épidural'naia anesteziia pri aortokoronarnom shuntirovanii.

The influence of epidural anesthesia (CEA) on clinical manifestations, cortisole and adrenocorticotropic hormone (ACTH) level, central hemodynamic values during aorto-coronary bypass surgery (ACBS) in 56 patients aged 42-68 years with preserved functional capacity of the myocardium was studied. Catheterisation of the epidural space was carried out in the evening before the operation according to the standard method at the level of T4-T5 with the use of disposable epidural set. During the procedure before perfusion 2% solution of lidocaine 3.8 +/- 0.2 mg/kg was introduced in epidural space (taking into account test-dose) as a bolus in 3-4 motions. The dose of local anesthetics for infusion was selected separately for each individual case with due regard for hemodynamic values. During artificial circulation additionally local anesthetic was introduced as a bolus, the dose being 4.7 +/- 0.8 mg/kg. At the end of the operation morphine (0.061 +/- 0.001 mg/kg) was introduced. It was established that combined application of intravenous and epidural anesthesia represents highly effective method of anesthesia in aorto-coronary bypass surgery. According to clinical course data, cortisone and ACTH blood contents and hemodynamic parameters, EA provides adequate anesthesia, promotes stabilization of hemodynamic values and creates functionally more advantageous conditions for the myocardium in patients with CHD during aorto-coronary bypass operation. Anesthesiologic aid with the use of EA promotes reduction of intravenous anesthetics expenditure, earlier waking up of the patients in postoperative period and decrease in duration of postoperative artificial lung ventilation.

[State of lipid peroxidation in patients with ischemic heart disease during aortocoronary bypass surgery using epidural anesthesia]. / Sostoianie perekisnogo okisleniia lipidov u bol'nykh IBS pri operatsiiakh aortokoronarnogo shuntirovaniia s ispol'zovaniem épidural'noi anestezii.

Effects of epidural anesthesia (EA) on free-radical lipid oxidation and the antioxidant system were studied in coronary patients during aortocoronary bypass operations and in the immediate postoperative period in comparison with patients operated on under common anesthesia (without EA). Thirty-six patients (men) aged 42.4 +/- 1.4 years were examined. EA as a component of total anesthesia in aortocoronary bypass surgery was conducive to a lesser activation of free-radical lipid oxidation. After surgery EA sooner normalized free-radical oxidation and the antioxidant system, which was observed at the end of the operation and during the first 24 h after it. During artificial circulation EA did not appreciably affect the degree of activation of free-radical oxidation.