[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.

[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.

[The possibilities for the transcranial monitoring of the blood flow in the circle of Willis arteries during operations on the brachiocephalic arteries and in heart operations]. / Vozmozhnosti transkranial'nogo monitoringa krovotoka v arteriiakh villizieva kruga vo vremia operatsii na brakhitsefal'nykh arteriiakh i pri operatsiiakh na serdtse.

The paper gives the results of arterial blood flow monitoring in the circle of Willis via transcranial Doppler during 81 reparative operations on brachiocephalic arteries (including carotid endarterectomy from the internal carotid artery in 32 patients). Transcranial monitoring of blood flow supports the fact that there is a collateral reflow along the cerebral arteries during removal of the common carotid artery and that there is a relationship between the status of great arteries and arteries of Willis' circle. The paper also summaries the results of a comprehensive ultrasound study of 9 patients who have undergone reparative and plastic operations on the cardiac valves during extracorporeal circulation and general hypothermia. Blood flow was intraoperatively monitored in the arteries of the basis cerebri by using transcranial duplex scanning with colour Doppler flow mapping to evaluate not only hemodynamics, but also the embolic situation, as well as to check up how air was removed from the cardiac cavities by transesophageal echocardiography.