[The monitoring of application of dabigatran as a remedy of prevention of thromboembolic complications after hip joint arthroplasty].

The analysis was applied to the indicators of hemostasis system under application of new anticoagulant, dabigatran etexilat, after hip joint arthroplasty. It is established that among the coagulation methods analysis the most specific to the effect of dabigatran is the testing of thrombin and echitox time of coagulation. Considering low sensitivity of the echitox to anticoagulation effect of D-dimer the echitox test is optimal for laboratory monitoring of application of dabigatran after orthopedic intervention.

[Characteristics of central hemodynamics and cerebrovascular circulation during various anesthesia modes in reconstructive surgeries for the extracranial vessels].

The purpose of the study was to choose an optimal anesthetic method to ensure adequate cerebral blood flow and to reduce the number of perioperative complications during carotid endarterectomy. Total intravenous anesthesia with diprivan, combined cervical plexus block anesthesia, and inhaled sevoflurane anesthesia were assessed in 190 patients undergoing carotid endarterectomy. The study of cerebral blood flow and central hemodynamic parameters indicated that deprivan anesthesia suppressed the major hemodynamic parameters, causing associated cerebral circulation depression. The use of cervical plexus block as a major component of anesthesia after Pashchuk stabilized the mean blood pressure and cardiac index, causing the optimization of cerebral blood flow parameters with a considerable postload increase. During sevoflurane anesthesia, the most physiological conditions for the performance of the circulatory system were found at all stages of surgical treatment, which predetermined the stable parameters of central hemodynamics and cerebral blood flow. The studies revealed that deprivan anesthesia was followed by a considerable number of both cardiac and neurological complications. The patients with cervical plexus block had fewer neurological disorders, but the increased postload accompanying these changes caused an increase in the number of cardiac complications. The most optimal parameters of cerebral blood flow and central hemodynamics during sevoflurane anesthesia induced a statistically significant reduction in the number of cardiac and neurological complications.

[Renal protective function in surgical treatment for chronic infrarenal aortic aneurysms].

The authors analyzed different modes of prevention of acute renal failure (ARF) in the planned surgical treatment of abdominal aortic aneurysms. A hundred patients randomly divided into 4 groups were examined. In patients from a control group, prevention of renal failure included no use of aminoglycosides, prevention of hyperglycemia, and provision of steady-state hemodynamics. In Group 2 patients, the reperfusion syndrome was prevented through a preventive load and early administration of antioxidants, for which they were enterally fed with Berlamine-modular for 5 days before surgery and in the postoperative period. The authors made efforts for Group 3 patients to have high oxygen supply values at all stages of surgical treatment. For this, they optimized infusion therapy and compensated for intraoperative blood loss by preoperatively prepared autoblood and through reinfusion of the blood collected from an operation wound with "Cell saver" apparatus. In Group 4 patients, the prevention of ischemia and reperfusion were simultaneously made and blood oxygen-transporting function was optimized. Renal function was evaluated from the activity of urinary enzymes and from nitrogen metabolic parameters. The studies have indicated that activation of free radical lipid peroxidation in the presence of ischemia/reperfusion and blood oxygen-transporting dysfunction plays an important role in the genesis of renal failure during surgical treatment for infrarenal aortic aneurysms. According to the data on changes occurring in urinary enzymatic activities, the preventive load with antioxidants and their early postoperative use ameliorate renal lesion. The similar effect is achieved by the provision of high tissue oxygen supply and uptake at all the stages of surgical treatment. The best effect shown, in addition to enzymuria diminution, by a clinical reduction in the frequency of renal dysfunction is achieved by applying a comprehensive approach to preventing ARF.

[A risk of myocardial ischemia and the nature of infusion-transfusion therapy in scheduled surgical treatment of infrarenal aneurisms of the aorta]. / Risk razvitiia ishemii miokarda i kharakter infuzionno-transfuzionnoi terapii pri planovom operativnom lechenii infrarenal'nykh anevrizm aorty.

The authors analyzed effects produced by different variations of the infusion-transfusion therapy on the risk of cardiovascular complications that can develop in the scheduled surgical treatment of the aorta abdominal part. The patients were randomized in 2 groups. Intraoperative hemodilution was made in group-1 patients (n = 50) before aorta clipping. Hemodynamics was stabilized by colloids and crystacolloids during clip removal; donor packed red blood cells were used at the hemoglobin level below 80 g/l. Group 2 comprised 66 patients for whom autoblood was prepared preoperatively. The infusion volume was limited before aorta clipping; blood losses were compensated for by autoblood and autoerythrocytes collected from surgical blood by "Cell Saver". The below results were obtained on the basis of conducted research: preventive infusion load aggravates, before aorta clipping, the risk of cardiac complications. Maintenance of Hb below the level of 90 g/l is accompanied by an impaired transport of oxygen to tissues; it speeds up the heart beat and provokes an increased cardiac need in oxygen, which enhances the risk of myocardium ischemia. Preparation of autoblood and hardware-based reinfusion of autoerythrocytes provide for an adequate compensation of blood losses and diminish the risk of cardiac complications in the scheduled surgical treatment of infrarenal aneurisms of the aorta.

[Blood loss compensation during surgery of abdominal aortic aneurysms]. / Vozmeshchenie krovopoteri vo vremia operatsii po povodu anevrizm briushnogo otdela aorty.

Two methods of intraoperative compensation of blood loss in patients with aortic aneurysm are compared in 30 patients: transfusion of donor blood preparations and reinfusion of washed autoerythrocytes. Changes in hemostasis system, central hemodynamics, and oxygen transport were analyzed. Reinfusion of washed autoerythrocytes proved to be more safe and involved no serious complications.

[Improvement of epidural anesthesia in reconstructive surgery of the aorta in Leriche's syndrome]. / Optimizatsiia épidural'noi anestezii pri rekonstruktivnykh operatsiiakh na aorte po povodu sindroma Lerisha.

Fifty-six patients subjected to aortofemoral bilateral shunting under prolonged epidural anesthesia are examined. Swan-Gans catheter was used to evaluate central and pulmonary hemodynamics. Ganglionic blocking with pentamine for taxiphylaxis was carried out in 31 patients prior to catheterization of the epidural space. Epidural anesthesia with ganglional blocking is associated with reduced vasodilation and hypotension and attenuates the hemodynamic reactions during clamping and unclamping of the aorta, thus decreasing the incidence of intra- and postoperative complications.

[Comparative assessment of the efficacy of selective and discrete plasmapheresis in combined preoperative preparation of patients with diffuse toxic goiter]. / Sravnitel'naia otsenka éffektivnosti selektivnogo i diskretnogo plazmafereza v kompleksnoi predoperatsionnoi podgotovke bol'nykh diffuzno-toksicheskim zobom.

The paper is concerned with comparative assessment of two methods of plasmapheresis (discrete and selective), employed for preoperative preparation of patients with a severe type of thyrotoxicosis. Selective plasmapheresis by its effect on immunity indices, hormonal status, central hemodynamics and clinical symptomatology was shown to be no inferior to the discrete method. At the same time selective plasmapheresis was not accompanied by allergic reactions, excluding the danger of infection and making preoperative preparation cheaper.

[The choice of a program of discrete plasmapheresis in the preoperative preparation of patients with diffuse toxic goiter]. / Vybor programmy diskretnogo plazmafereza pri provedenii predoperatsionnoi podgotovki bol'nykh diffuznym toksicheskim zobom.

The state of circulation and its impact on the nature of hemodynamic response during discrete plasmapheresis has been studied in 91 patients with hyperthyroidism. It has been established that the nature of cardio- and hemodynamics depends on the severity of the disease and the cardiac rhythm. In patients with mild hyperthyroidism the volume of single blood exfusion (BE) should not exceed 800 ml of blood and plasma should be replaced by colloid and crystalloid preparations in the ratio of 1:1. In patients with severe hyperthyroidism and normal cardiac rhythm the volume of single exfusion should not exceed 600 ml and plasma should be replaced by cryoplasma. In patients with severe hyperthyroidism and atrial fibrillation blood exfusion should be limited to 400 ml of blood. Simultaneously with blood exfusion it is expedient to perform cryoplasma infusion. Glycerol trinitrate and calcium antagonists may be used to prevent pulmonary hypertension.