[Clinical, neurophysiological and hemodynamic effects of a new nondepolarizing myorelaxant mivacurium in heart surgery patients]. / Klinicheskie, neirofiziologicheskie i gemodinamicheskie éffekty novogo nedepoliarizuiushchego miorelaksanta mivakuriuma u kardiokhirurgicheskikh bol'nykh.

Thirty patients aged 23 to 65 years with ASA class III operated on the heart under total intravenous anesthesia were examined after the Good Clinical Practice protocol. Mivacurium in bolus dose of 0.2 mg/kg was injected for intubation of the trachea; neuromuscular blocking (NMB) was maintained by a repeated injection of the drug in a dose of 0.15 mg/kg, after which it was infused at a rate of 1 to 10 micrograms/kg/min. Accelerometric control of neuromuscular conduction was carried out by the Organon (Belgium) TOF-Guard device. Central and peripheral hemodynamics was monitored. Side effects of the drug were recorded. Bolus injection of mivacurium in a dose of 0.2 mg/kg caused T1 suppression (90%) after 2.6 +/- 0.7 min. Maximal (97.7 +/- 4.5%) suppression was observed after 4.17 +/- 2.5 min. The conditions of intubation of the trachea after 3.9 +/- 1.8 min in the presence of 78 to 100% T1 suppression (97.7 +/- 4.5%) were considered excellent or good in 96.6% of cases. Clinically and neurophysiologically sufficient muscle relaxation after the first injection of the drug persisted for 27.7 +/- 7.3 min. Minimal rate of infusion for maintaining the NMB at 95 +/- 4% level of T1 suppression was 6.3 +/- 1.7 micrograms/kg/min. Bolus injection of mivacurium in a dose of 0.2 mg/kg for 60 sec involved a 1-3-min drop of the mean arterial pressure by 10.5% and a 10.3% decrease of heart rate. Repeated bolus injection of the drug in a dose of 0.15 mg/kg and its infusion did not change the peripheral and central hemodynamics. The most typical side effect of the drug in a dose of 0.2 mg/kg is short-term reversible reddening of the skin of the face and neck, observed in 20% of patients. The results permit us to consider mivacurium as an effective, safe, and controllable agent, which can be used in cardiosurgical patients.

[Personal computer-based computer monitoring system of the anesthesiologist (2-year experience in development and use)]. / Monitorno-komp'iuternaia sistema anesteziologa na osnove personal'nogo komp'iutera (2-letnii opyt razrabotki i ékspluatatsii).

Creation of computer monitoring systems (CMS) for operating rooms is one of the most important spheres of personal computer employment in anesthesiology. The authors developed a PC RS/AT-based CMS and effectively used it for more than 2 years. This system permits comprehensive monitoring in cardiosurgical operations by real time processing the values of arterial and central venous pressure, pressure in the pulmonary artery, bioelectrical activity of the brain, and two temperature values. Use of this CMS helped appreciably improve patients' safety during surgery. The possibility to assess brain function by computer monitoring the EEF simultaneously with central hemodynamics and body temperature permit the anesthesiologist to objectively assess the depth of anesthesia and to diagnose cerebral hypoxia. Automated anesthesiological chart issued by the CMS after surgery reliably reflects the patient's status and the measures taken by the anesthesiologist.

[Use of a new ultra short-acting beta adrenoblocker esmolol in anesthesiological practice]. / Primenenie novogo ul'trakorotkovo beta-adrenoblokatora ésmolola v anesteziologicheskoi praktike.

The effect of a novel ultrashort acting beta-adrenoblocker esmolol on systemic and pulmonary hemodynamics has been studied intraoperatively in 81 cardiosurgical patients. All the patients were operated under ataralgesia. Esmolol is an effective controlled agent for the treatment and prevention of supraventricular tachycardia and hyperdynamic reaction developing in cardiothoracic patients during anesthesia and surgery. Bolus injection of 100 mg esmolol exerts a negative chronotropic effect with maximum heart rate decrease by 23.3% by minute 5 and a gradual attenuation of the effect by minute 20. A parallel drop in the cardiac output by 18.5% is caused predominantly by a decrease in the heart rate and accounts for BP reduction. The above esmolol dose does not have a considerable effect on pulmonary hemodynamics and does not enhance intrapulmonary venous shunting.

[A comparative study of five pulse oximeters]. / Sravnitel'noe issledovanie piati pul'sovykh oksimetrov.

The pulsed oximeters "Satlite" and Satlite Trans" (Datex, Finland), "Biox-3700' (Ohmeda, USA) "OXI" (Radiometer, Denmark), "Danamap-Oxytrak" (Critikon, Johnson & Johnson, USA) are essential and highly precise devices for controlling vital functions of the body during anesthesiologic techniques. The delay time of a response of the pulsed oximeters "Satlite Trans" and "Box-3700" in providing the values of the saturation of arterial blood hemoglobin with oxygen is 40 sec. The pulsed oximeter-personal computer system opens up new possibilities of increasing the quality of monitoring and safety of bronchoscopic studies and operations and allows a protocol of the intervention to be developed.

[The concentration of carbon dioxide at the end of expiration as an index of hemodynamic status in open-heart operations]. / Kontsentratsiia uglekisloty v kontse vykhoda kak pokazatel' sostoianiia gemodinamiki pri operatsiiakh na otkrytom serdtse.

The interrelationship of the cardiac index (CI) and carbon dioxide concentration measured at the end of respiration (CO2ER) was studied in 258 patients, aged from 5 to 71 years, during operations on the open heart. Statistical analysis of the stage of revision of the left ventricular posterior wall showed that CO2ER decreases from 29.9 +/- 0.7 mm Hg to 24.9 +/- 1.4 mm Hg in parallel with reduction of CI from 2.81 +/- 0.19 l/min/m2 to 1.62 +/- 0.13 l/min/m2. At the end of this manipulation the CI and CO2ER were restored to the initial level. Marked parallel dynamics of CO and CO2ER was revealed in continuous appraisal of the cardiac output (CO), determined by the method of catheter flow measurement, at the stage of parallel circulation and blood pumping from the extracorporeal circulation apparatus before CO2ER stabilization. The correlation coefficient of these parameters varied in this stage in various patients from +0.73 to +0.96. Analysis of the mass of data (n = 161) collected in 14 patients showed that the CI--CO2ER relation was exponential in character and could be expressed by the equation CI (l/min/m2) = e (-0.99 + 0.065 x CO2ER); standard determination error +/- 0.42 l/min/m2. Analysis of the "CO2ER-venous pressure" relation in these 14 patients showed it to be similar to the "cardiac index-venous pressure" relation. The coefficients of correlation between CVD and CO2ER at this stage ranged in various patients from +0.74 to +0.96 and those between VP and CI from +0.58 to +0.97. Transition of the relations to the plateau occurred at equal CVP values.