[A case of adenovirus infection complicated by gram-negative polymicrobial sepsis: A clinical and morphological observation].

Among respiratory infections, adenovirus infection (ADVI), in the presence of which there may be severe pneumonia that frequently results in a fatal outcome, occupies particular attention. ADVI in patients without immunodeficiency is usually mild and shows a limited extent of injury. At the same time the disease in immunocompromised individuals may be severe, presenting with viremia, evolving sepsis, and high death rates. The paper gives a characteristic example of severe ADVI and its fatal outcome.

[Bilateral massive pulmonary embolism: clinical observation and literature review].

The description of successful surgical treatment of a patient with bilateral massive pulmonary embolism (with the defeat of the equity and segmental branches), thrombosis of the right atrium and patent foramen ovale is given. The authors emphasize that determining predictors of successful surgical treatment of bilateral pulmonary embolism in a patient with high risk of death are the following: a) operational emergency diagnosis of disease; b) time from the beginning of clinical manifestations till embolectomy (within 1 hour); c) the maximum total removal of blood clots from the pulmonary artery and its branches. Dynamic 12 months observation showed a significant decrease of pulmonary perfusion deficiency, improvement of functional parameters of right heart chambers, absence of thromboembolism relapses.

[Epidural anesthesia during operations on the heart in patients with obesity].

The paper estimates an anesthetic appliance using an epidural block during cardiac operations in obese patients. It shows the advantage of this type of anesthesia in reducing the dose of used narcotic analgesics, in early activating patients, and decreasing the length of stay in a cardiac intensive care unit.

[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.

[Correction of cardiorespiratory disorders in laparoscopic cholecystectomy]. / Korrektsiia kardiorespiratornykh narushenii pri laparoskopicheskoi kholetsistéktomii.

Carboxyperitoneum and traditional forced ventilation of the lungs have a negative impact on external respiration function during laparoscopic operations, leading to impairment of the ventilation device, pressure rise in airways, and decrease in oxygen diffusion and carbon dioxide release. This leads to accumulation of carbon dioxide in the blood and tissue with a trend to development of acidosis of mixed origin. Cardiovascular changes during laparoscopic cholecystectomy manifest by hypertension and tachicardia in the presence of increased central venous pressure and total peripheral vascular resistance, decreased stroke and cardiac indexes, decreased right-ventricular diastolic function, increased pressure in the pulmonary artery, and deceleration of venous bloodflow in the inferior and superior venae cavae. The most rational variant of forced ventilation of the lungs in laparoscopic cholecystectomy is high-frequency injection ventilation, which appreciably attenuates the negative effect of carboxyperitoneum on central hemodynamics, gas exchange, and external respiration function. The optimal variant of total anesthesia in laparoscopic cholecystectmy is endotracheal combined narcosis with diprivane and fentanide. The key factor in the choice of forced ventilation protocols is the maintenance of adequate gas exchange in the lungs in the presence of the lowest possible mean pressure in the airways.

[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.

[The intensive therapy of acute heart failure directly after heart operations performed under artificial circulation conditions]. / Intensivnaia terapiia ostroi serdechnoi nedostatochnosti neposredstvenno posle operatsii na serdtse, osushchestvliaemykh v usloviiakh iskusstvennogo krovoobrashcheniia.

The efficacy of dopamine infusions in doses of 2 to 10 micrograms/kg/min and combinations thereof with prolonged epidural lidocaine anesthesia (3.7 +/- 0.7 micrograms/kg/day) was assessed in 47 cardiosurgical patients with acute cardiac failure in the immediate postperfusion period. Dopamine increased cardiac output by boosting heart rate and directly increasing the pumping function of the myocardium. High epidural blocking (ThIV-ThV) decreased the chronotropic effect of dopamine, increased the cardiac output by 48.7%, the left ventricular pumping coefficient by 37.9% and the right ventricular by 38.1% and decreased the total peripheral vascular resistance by 36.4% and pulmonary vascular resistance by 52.1%. Epidural anesthesia used in intensive care of cardiac failure in cardiosurgical patients is believed to potentiate the inotropic effect of dopamine.

[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.

[Transesophageal echocardiography in cardiac anesthesiology]. / Chrespishchevodnaia ékhokardiografiia v kardioanesteziologii.

Starting from 1995 in the 3rd Military Central Clinic Hospital by A. A. Vishnevskii the staff specialists apply transesophageal echocardiography as intraoperative monitor when operating on heart. On their personal experience and literature information the authors prove that the method of intraoperative application of echocardiography in heart surgery is very effective. When operating on revascularization of myocardium, on correction or replacement of heart valve or foreign body removal, this method makes it possible to receive all necessary information on the functional and morphological changes in the heart right on the operation table. Transesophageal echocardiography proved itself as highly valuable for noninvasive evaluation of cardiovascular patients.