[Options for remodeling of the right ventricular function during pneumonectomy].

UNLABELLED: The aim of the study---a comprehensive assessment of haemodynamic alterations during pneumonectomy using pulmonary arterial volumeter (PAV) opportunities. MATERIALS AND METHODS: 72 patients were included in the study, (the average age - 51 +/- 3,8 years, body weight - 68 +/- 7 kg), who underwent pneumonectomy about lung tumors under general anesthesia with separate ventilation (on indications - jet high-frequency ventilaton).

[The role of an objective assessment of the heart right vientricle function for the anesthesiological maintenance and intensive therapy of surgical patients].

Latent dysfunction of the heart right ventricle and hypovolemia were assessed in 50 patients divided into 4 groups, operated on the heart, abdominal aorta and lungs. It was found that after revascularization of the myocardium the diastolic disorders prevailed. In patients operated for the heart valve (mitral and aortal) diseases prevailing were the systolic and pump dysfunction of the right ventricle. Insufficiency of the right ventricle in these groups was 13% and 22% respectively. After operations on the abdominal aorta a combination of the systolic and diastolic impairments of the right ventricle were observed. After extended resections of the lungs there was a characteristic combination of systolic, diastolic and pump dysfunctions. When the operation was followed by a decreased minute volume of circulation, its cause was hypovolemia in 29% of cases in the examined surgical patients. The investigation of the right ventricle functions with the help of pulmonary arterial volumetry can reveal their latent dysfunctions as well as hypovolemia in a considerable part of surgical patients.

[Cardiac right ventricular function and hemodynamics during resection of the lungs]. / Funktsiia pravogo zheludochka serdtsa i gemodinamiki vo vremia rezektsii legkikh.

Right-ventricular function and hemodynamics were studied in 48 patients during resections of the lungs (lobectomy and pneumonectomy) under total noninhalation anesthesia. Approaches to compensation of circulation in resection of different volume of lung tissue were determined. The leading role of the diastolic function of the right heart ventricle in realization of hemodynamic response in pneumonectomy is revealed. Volumetric monitoring of right-ventricular function during extensive lung resections is highly informative.

[Transcranial electric stimulation in anesthesiological support in emergency operations in patients with hypovolemia]. / Primenenie transkranial'noi élektrostimuliatsii pri anesteziologicheskom obespechenii ékstrennykh khirurgicheskikh operatsii u bol'nykh s gipovolemiei.

Hemodynamics was studied in 60 patients with pronounced initial hypovolemia, urgently operated on for acute gastrointestinal disease under conditions of 4 anesthesia. In contrast to traditional anesthesia, transcranial electric stimulation (TCES) as a component of anesthesia stabilized hemodynamics without increasing the rate and volume of intraoperative infusion therapy. This makes total anesthesia with TCES preferable in urgent operations, particularly in cases when hypovolemia cannot be properly corrected before surgery.

[Postoperative pain syndrome and its relationship with individual psychological features of personality]. / Posleoperatsionnyi bolevoi sindrom i ego sviaz' s individual'nymi osobennostiami psikhologicheskogo statusa lichnosti.

A total of 120 patients subjected to planned operations for diseases of thoracic and abdominal organs and main vessels were examined for an objective evaluation of the postoperative pain syndrome. The psychological status of patients and its relationship with the painful syndrome and narcotic doses needed for pain arrest were studied. In the control (100 pts) the initial depression and postoperative pain were in direct correlation. Tetracycline antidepressant lerivone was used to confirm the results. Depression and the severity of postoperative pain decreased significantly in 20 patients.

[Postpneumonectomy syndrome: several new anesthesiological and pathophysiological aspects]. / Postpnevmonéktomicheskii sindrom: nekotorye novye anesteziologicheskie i patofiziologicheskie aspekty problemy.

As a result of 10-year investigations a concept of postpneumonectomy syndrome (PPS) has been defined as a combination of acute respiratory disturbances due to alteration of filtration and absorption functions of the lungs along with systolic and diastolic right heart dysfunction. The aim of the study was to identify the details of PPS pathogenesis dependent on the initial right chamber pressure levels and a search for probable approaches to PPS correction. The study was carried out on 26 patients subject to pneumonectomy. Central hemodynamics along with filtration and absorption lung functions and changes in extravascular lung water (EVLW) have been studied. According to the data obtained, initial pulmonary hypertension definitely plays a certain part in PPS pathogenesis; upon the administration of a Ca-blocker finoptin, the right heart condition was characterized by a significant increase in EF and EDV, followed by an increase in blood flow and a drop an PCWP; all the patients have experienced an increase in EVLW up to 7-8 ml/kg. Though altered right heart diastolic function may play a key role in hemodynamic and gas exchange disturbances, the application of Ca-blockers is believed to be a possible approach to the correction of the above deviations.

[Effect of the operation and general anesthesia on transcapillary exchange of fluid in the lungs during thoracic surgery]. / Vliianie operatsii i obshchei anestezii na transkapilliarnyi obmen zhidkosti v legkikh pri torakal'nykh vmeshatel'stvakh.

The influence of operation factors and general anesthesia on transcapillary exchange of liquid in the lungs was studied in 48 patients after thoracal interventions, and in 8 patients after general surgical treatment. It was found that operations on the lungs unlike general surgical procedures are characterized by the accumulation of liquid in the pulmonary interstitial tissue especially after extensive resections of lung tissue and during massive infusion-transfusion therapy. This process is influenced by the kind of general anesthesia: transcranial electroanalgesia is followed by less shifts of the transcapillary pulmonary exchange of liquid than fluoroxene narcosis.

[Evaluation of extravascular lung fluid]. / K voprosu ob otsenke vnesosudistoi zhidkosti legkikh.

The possibility of using the thermodilution technique for diagnosis of pulmonary oedema was studied in theoretical model of thermodilution between intra- and extravascular fluid spaces of pulmonary tissue as well as in acute experiments on anesthetized and immobilized dogs with hydrostatic pulmonary oedema. The intensity of thermoindicator diffusion at the "left atrium--aorta" stretch was found to depend on the degree of oedema. The following equation is suggested for calculating the pulmonary extravascular fluid volume: Vev = tev (Qao--Qpa). The thermodilution technique may be used as an independent method for diagnosis of pulmonary oedema.

[Morphofunctional assessment of the respiratory tract of rabbits in the subacute form of oxygen poisoning]. / Morfofunktsional'naia otsenka sistemy vneshnego dykhaniia u krolikov pri podostroi forme otravleniia kislorodom.

Rabbits were exposed to hyperoxic experiments (2.5--3.0 kg/cm2 O2 for 3--4 h and 2.0 kg/cm2 O2 for 16--22 h until death) to study changes in their respiratory and cardiovascular systems. After exposure one lung was used for histological examinations under light microscope and the other to determine the surfactant stability index. It was found that serious changes in the respiratory and cardiovascular systems in all animals (including those who died during exposure) were not followed by histological changes of the lungs. Therefore, the pathogenetic mechanisms of subacute (pulmonary) oxygen intoxication are associated with disorders in the central regulation of autonomic functions rather than with direct lesions of the pulmonary tissue.

[Relation between artificial respiration and blood circulation in lung surgery]. / Vzaimootnoshenie iskusstvennoi ventiliatsii i krovoobrashcheniia pri operatsiiakh na legkikh.

The investigation of parameters of the artificial pulmonary ventilation and hemodynamics of the greater and lesser circulation circles during operation on the lungs has shown these parameters to be most greatly changed at the stages of separation of the pulmonary root and dissection of the vessels and bronchi. Changes in the ventilatory regimen were not followed by changes in the pulmonary hemodynamics and gas composition of the blood.

[The state of the surfactant system and postoperative lung complications]. / Sostoianie surfaktantnoi sistemy i posleoperatsionnye legochnye oslozhneniia.

The article deals with the question of the influence of the surfactant system state determined during the operation upon the postoperative pulmonary complications. For the assessment of the surfactant the clinical material (pieces of the lungs taken from 182 patients during operations) was used. It has been shown that a reduced amount of surfactant can be established in cases of hypoventilation, atelectasis and pneumonia developing as early as during the operation. The stability index which is the quantitative criterion of the method may be considered to be a certain prognostic test relative to postoperative pulmonary complications.