[New actual options in anesthesiological monitoring].

New aspects of rational monitoring in contemporary anesthesiology are discussed. Not only conventional pulsoximetric parameters of circulation and respiration disorders but also new noninvasive methods are suggested to determine blood losses (degree of its compensation), certain parameters of external respiration, gas exchange, and cardiac stroke volume (Fick's principle). Cardiac stroke volume is a cardinal parameter of oxygen transport and consumption. The level of monitoring implemented in the suggested system provides maximum patient safety during surgery. It also provides anesthesiologist with information about mechanisms of circulation and respiration dysfunction.

[Correction of arterial hypoxemia during early postoperative period]. / Metody korrektsii arterial'noi gipoksemii v rannem posleoperatsionnom periode.

The article is dedicated to investigating the reasons of development of hypoxemia during the early postoperative period when the patient is switched to an unassisted air breathing. It was established that hypoxemia develops, after abdominal operations with a multi-component total anesthesia, in 68% of patients, although there is a recovery of adequate ventilation of the lungs, and it is related with an insufficient anesthesia, which results in an increased volume of expiratory closure. Epidural anesthesia prevents an increase in the closure volume and development of hypoxemia.

[The prognosis and correction of circulation disorders following laparoscopic operations]. / Narusheniia krovoobrashcheniia pri laparoskopicheskikh vmeshatel'stvakh, ikh prognozirovanie i korrektsiia.

50 patients, suffering from accompanying cardio-vascular disorders (ischemic heart disease, arterial hypertension) were investigated in pre- and intraoperative period to carry out the analysis of influence of intraabdominal pressure on their hemodynamics. During preoperative period external abdominal cuff was used to imitate pressure elevation during operation. The data obtained showed the development of hypodynamic circulation disorders under abdominal hypertension. It permitted to use the technique of creating the external abdominal compression for prognosis of circulatory alterations during laparoscopic operative interventions. The method of pneumomassage of low extremities was suggested as a corrective therapy of circulatory disorders.

[Effect of hyperventilation on the cerebral blood flow and metabolism in patients with craniocerebral trauma]. / Tserebral'nyi krovotok i metabolizm vo vremia giperventiliatsii u bol'nykh s izolirovannoi cherepno-mozgovoi travmoi.

Cerebral blood flow and metabolism were studied in 44 patients with acute severe craniocerebral injuries (contusions of the brain and removal of intracranial hematomas) with consciousness depression (moderate coma), hospitalized in intensive neurological care wards. Oxygen supply to the brain was repeatedly evaluated (acid-base status of the jugular vein blood, oxygen arterio-venous difference, oxygen extraction coefficient), oxymetry of the brain was repeatedly carried out, and vital functions were monitored over the entire period of disease. Cerebral blood flow was monitored by rheoencephalography, which helped timely detect the changes in cerebral blood flow in patients with craniocerebral injuries during different ventilation protocols used in intensive care. All studies were carried out during three stages: 1) initial stage, when the patients were brought to intensive neurological care wards after surgical intervention, and during normoventilation (paCO2 36-40 mm Hg; 2) moderate hyperventilation (paCO2 35-26 mm Hg); and 3) pronounced hyperventilation (paCO2 25-20 mm Hg). Specific changes in the cerebral blood flow during the acute period of craniocerebral injury were detected during different ventilation regimens in 2 groups of patients: group 1 with lethal outcomes and group 2 with positive changes.

Pneumoperitoneum risk prognosis and correction of venous circulation disturbances in laparoscopic surgery. A pilot study.

BACKGROUND: This study was initiated to find a method of determining the prognosis for possible changes in hemodynamic and respiratory parameters in patients with pneumoperitoneum (PP). METHODS: We devised a model for a pseudopneumoperitoneum (PPP), which is created by encircling the wide pneumochamber on the entire abdomen and inflating it to a preset pressure. To verify the prognostic possibilities of the proposed model, we studied the pneumotachygraphy parameters, noninvasive and invasive monitoring parameters of PPP after induction of anaesthesia, and venous circulation disturbances, as well as the medical effect of the intermittent sequential compression device. RESULTS: In healthy patients, the restrictive lung syndrome did not approach the risky limit. In patients >/=60 years old, this syndrome was very close to the limit. In a number of patients with serious cardiovascular and pulmonary pathology, the pressure of >10 mmHg was considered to be intolerable. Lung compliance, which was the parameter most sensitive to the increased intraabdominal pressure, was 47 +/- 10 at baseline, and 29 +/- 4 (p > 0.05) at both PPP and real PP (14 mmHg). CONCLUSIONS: The PPP model is quite similar to the real PP and can be used for preoperative prognosis in laparoscopic surgery. The elevated intraabdominal pressure results in a significant disturbance of venous blood flow in the lower extremities. The use of the device for peristaltic pneumomassage of the lower limbs is effective in correcting negative changes in venous hemodynamics in laparoscopic surgery.

[The role of acoustic resonance in realizing the effect of high-frequency artificial ventilation of the lungs]. / Rol' akusticheskogo rezonansa v realizatsii éffekta vysokochastotnoi iskusstvennoi ventiliatsii legkikh.

A new explanation of improved oxygenation during high-frequency jet ventilation has been suggested. The mechanism is based on resonance oscillations generated by oscillation and injection high-frequency jet ventilation and promoting gas penetration into the alveoli, PaO2 elevation in perimembrane layer and O2 concentration gradient increase between the alveolar and convection zones. Alveolar and bronchial fluctuations facilitate their drainage and decrease pulmonary shunting. The suggested mechanism is explained, using facts known from the practical application of high frequency jet ventilation. The advantages of combined volumic-oscillation high-frequency jet ventilation over the jet one are established, except cases of lung ventilation in patients with open bronchus and in patients transmitted to spontaneous respiration after prolonged controlled lung ventilation.

[Controlled combination anesthesia]. / Upravliaemaia kombinirovannaia anesteziia.

The improvement of combined anesthesia is associated with the improvement of its control. The latter is possible only with continuous administration of anesthetics. 130 procedures of combined anesthesia were performed in patients subject to abdominal and other types of operations. With this in view fentanyl and calipsol were continuously injected, using modified dosators, to patients pretreated with N2O and total curarization. It has been found that with continuous administration adequate analgesia with stable blood pressure can be achieved provided that 1/3-2/3 of the total fentanyl dose is used as a loading dose at the beginning of anesthesia. The maintenance dose does not change considerably blood anesthetic concentration. If required, changes in the concentrations were achieved by additional fentanyl administration, using a dosator for 25-50 mukg. The technique described has advantages over bolus drug injection and continuous drug infusion. The technique may be considered a controlled one.

[Intensification of gas exchange in high-frequency artificial ventilation]. / K voprosu ob intensifikatsii gazoobmena pri vysokochastotnoi IVL.

Jet high-frequency artificial ventilation produces oscillations of some parts of the chest wall, which in its turn transmits oscillations to the lung parenchyma. It results in the mix-up of the gas in the alveolar space, which leads to the increase in the gradient of oxygen concentration on the alveolar membranes, thus, augmenting oxygen saturation of the blood. The effect is the same when oscillation artificial ventilation is performed, owing to the provocation of the oscillations amplified by the resonance in the natural acoustic circuit, formed by the adjacent parts of the chest and lung parenchyma. Derangement of the exudative adhesion to the bronchi epithelial tissue intensifies gas exchange, when the oscillations are generated in the lungs. It facilitates the removal of the exudate and lets the air into the previously obstructed parts of the lungs. Clinical studies confirm the effect of the increase in the blood oxygenation (by average 20%) at the feeding air column by pneumatic oscillations in the range of 65 Hz, when traditional artificial ventilation is performed.