[Perspective in the development and supply of equipment for xenon anesthesia].

Basic trends in development of methods and equipment for xenon-saving anesthesia are discussed. Brief description of specifications of equipment for xenon anesthesia is given. Unique models of domestic medical devices are briefly described together with methods of their adaptation to commercial equipment for anesthesia. Prospects in further upgrade of the equipment for xenon anesthesia are discussed.

[The method of low-flow xenon anesthesia]. / Metodika nizkopotochnoi ksenonovoi anestezii.

Two variants of low-flow xenon (Xe) anesthesia was used in 150 patients operated on in general surgery, gynecology, urology, and vascular surgery; 116 patients received a combined endotracheal variant of Xe anesthesia and 34 patients received mask-type mono-narcosis. Limited possibilities of Russian-made apparatuses ("Polinarkon-2P") were shown in the process of minimizing the Xe consumption. An average Xe consumption reached, in a 2-hour anesthetic session, 42 l ($210). When foreign-made narcosis apparatuses ("Medimorph", "Anemat-8" etc.) were used, it was possible to minimize the Xe consumption during the same time period to 22 l ($110). When the endotracheal variant was in use, the Xe consumption was 15-16 l ($75-80) during 2 hours. When Xe was recycled by the desorption processor and fine cleaning at "Akela-N" Ltd. production facility, the cost of 2-hour anesthesia went down five-fold ($16-20). The article contains some recommendations made by authors to improve the method of low-flow Xe anesthesia as a method reducing the cost of Xe anesthesia in the routine medical practice.

[Treatment of acute pain syndrome]. / Lechenie ostrogo bolevogo sindroma.

The article reviews modern concepts regarding stress response and its effects on various organs and systems of critical patients. Postoperative pain is regarded with emphasis on its pathophysiology and the prospects of using epidural anesthesia-analgesia for alleviating its injurious effects. Analgesia and sedation in patients with multiple injuries is discussed. The importance of adequate analgesia for alleviation of the injurious effects of nociceptive impulses in critical patients is emphasized. Analgesia should be regarded as one of the methods of intensive care of critical patients along with respiratory support, fluid replacement, and parenteral nutrition.

[Basic intensive care of ischemic cerebral stroke. Method of therapeutic hemodilution]. / Bazovaia intensivnaia terapiia ishemicheskogo tserebral'nogo insul'ta. Metod terapevticheskoi gemodiliutsii.

Ischemic cerebral stroke (ICS) ranks among the most frequent causes of disability. The incidence of untoward consequences of ICS can be decreased by early adequate use of intensive care methods restoring tissue oxygenation in the focus. The most important methods of intensive care of ICS are measures notably improving microcirculation and essentially decreasing subsequent incidence of disabling complications. The basic component of intensive care ensuring favorable results is therapeutic hemodilution making use of modern plasma substitutes--second-generation hydroxyethyl starch Infukoll HES 6 and 10% solutions. Currently used methods including use of dextran-based solutions cannot normalize microcirculation in ICS patients, particularly if used in long course. Prolonged infusions of dextran-based solutions inevitably increases plasma viscosity and impairs the hemostasis system. An essential increase of plasma viscosity involves the need in a complex of appropriate drug therapy aimed at compensation for untoward aftereffects of high dextran doses. Therapeutic doses of dextran-based solutions do not notably improve blood rheology. By contrast, therapeutic hemodilution with Infukoll HES notably improves the results of intensive care of ICS.

[Changes in hemodynamics during intermittent high-frequency ventilation of the lungs in patients with acute respiratory insufficiency]. / Izmeneniia gemodinamiki pri preryvistoi vysokochastotnoi ventiliatsii legkikh u bol'nykh s ostroi dykhatel'noi nedostatochnost'iu.

Hemodynamic changes have been studied in 19 patients (30 observations) with acute respiratory failure of various genesis during transition from conventional controlled lung ventilation, performed using PO-6 and Phase-3C devices, to intermittent high-frequency jet ventilation ("Spiron 601"). Impedance plethysmography and rheopulmonography have been used. It has been established that intermittent high-frequency jet ventilation during 1 hour can have both positive and negative effect on systemic and pulmonary hemodynamics in patients with lung damage. It has been demonstrated that the type of reaction depends on the initial values of stroke volume and cardiac output.

[High-frequency artificial ventilation of the lungs in the postoperative period of neurosurgical patients]. / Vysokochastotnaia iskusstvennaia ventiliatsiia legkikh v posleoperatsionnom periode u neirokhirurgicheskikh bol'nykh.

The authors examined 80 patients who underwent operation on the brain and upper parts of the spinal cord. The control group of patients who had been operated on in the same period of time did not differ essentially from the group studied in number, sex, age, character and severity of the operative interventions, and the principles of postoperative intensive therapy. All the patients had no concomitant pathological conditions of the organs of respiration and circulation and required prolonged postoperative artificial ventilation of the lungs (AVL). High-frequency artificial ventilation of the lungs (HF AVL) was conducted in 40-minute sessions in the first 2-3 postoperative days at a frequency of 120 respiratory cycles per minute. The values of pressure in the trachea and right parts of the heart, arterial pressure, and rate of heart contractions were recorded; the thoracic organs were regularly examined by X-ray, the results of postmortem examination were analysed. It is shown that HF AVL is attended by tension of the compensatory mechanisms of the cardiovascular system, but the sessions are tolerated by the patients well and create conditions for neurological appraisal of the person who is operated on, as a result of which neurosurgical correction can be conducted in good time. The application of the AVL method in sessions is an effective measure for the prevention of postoperative pulmonary complications.