[Special aspects of anesthesiology and intensive care in oncological operations with microsurgical autoplasty]. / Spetsial'nye aspekty anesteziologicheskogo posobiia i intensivnoi terapii pri onkologicheskikh operatsiiakh s mikrokhirurgicheskoi autoplastikoi.

The efficiency of the most rational antithrombotic, rheological, and antiischemic agents was evaluated: low-molecular heparin fraxiparin, nonsteroid antiinflammatory drug ketoprofene (ketonal), perfluorane, and antikininogen contrycal. Twenty-eight patients divided into 3 groups were examined before, during, and after extensive interventions with simultaneous microsurgical plastic repair by complex autotissue grafts. Results of treatment of 17 patients, in whom therapeutic and prophylactic complex including fraxiparin, perfluorane, and contrycal was used, deserve special attention. Use of this drug complex according to the proposed protocol creates optimal conditions for maintaining blood supply and oxygenation of the transplant at the expense of deceleration of blood clotting, decrease of blood viscosity, and decrease of erythrocyte and platelet aggregation. Complete healing of transplants was attained in all patients, who were discharged with good plastic results.

[General anesthesia and ventilation of the lungs in endoscopic surgery of tumors of the larynx, trachea and bronchi]. / Obshchaia anesteziia i ventiliatsiia legkikh pri éndoskopicheskikh operatsiiakh po povodu opukholei gortani, trakhei i bronkhov.

Clinical study was carried out during 116 total anesthesias for endoscopic operations on the larynx, trachea, and bronchi. Multicomponent total anesthesia was based on fentanyl, calypsol, diprivane, and dormicum microdoses in combination with local lidocaine anesthesia of the airways and premedication with nonsteroid antiinflammatory drugs. Interventions on the larynx and proximal part of the trachea were carried out with the patients' spontaneous respiration retained; during interventions on the middle part of the trachea, forced ventilation of the lungs (FVL) was carried out through an intubation bronchoscope; and during total anesthesia for operations on the tracheal bifurcation, high-frequency FVL of the intact lung was carried out. Stable hemodynamics and gas exchange, hypercapnia, and moderate respiratory acidosis were observed in patients operated on under both types of FVL. No serious complications during and immediately after surgery and anesthesia were observed. Hence, the choice of the method of total anesthesia and ventilation of the lungs in endoscopic interventions on the airways depends on the level of lesions and degree of airway obstruction.

[General intravenous anesthesia with spontaneous respiration for noncavitary interventions in cancer]. / Vnutrivennaia obshchaia anesteziia s samostoiatel'nym dykhaniem patsientov pri nepolostnykh onkologicheskikh operatsiiakh.

Two new variants of total intravenous anesthesia with spontaneous respiration were used in 307 female patients subjected to noncavitary interventions for cancer and gynecological cancer. The patients were divided into 2 groups: 1) total anesthesia with midasolam, fentanyl, and calipsol and 2) the same + propofol. Preventive analgesia by preoperative injections of peripheral analgesics was carried out in both groups. Both methods proved to be effective, ensuring good protection from traumatic noncavitary oncological operations. Balanced anesthesia with two hypnotics midasolam and propofol should be preferred, as they mutually potentiate their effects and therefore can be used in the minimum doses, thus preventing the probable side effects, minimizing the use of central analgesics, and ruling out the probability of respiration depression.

[Preventive analgesia: a new trend in anesthesiology. An idea born and developed at the P.A. Herzen Institute of Oncology]. / Profilakticheskaia analgeziia--novoe napravlenie v anesteziologii. Rozhdenie i razvitie idei i rabotakh kollektiva MNIOI im. P.A. Gertsena.

The authors summarize positive experience gained in the use of preventive anesthesia in oncosurgery. The new trend in anesthesiology has been developed at P. A. Herzen Institute of Oncology since the end of the eighties. A peripheral analgesic (aspisol, ketoprofene, ketorolac, etc.) was added to traditional premedication and anesthesia protocols in 522 patients subjected to extensive cavitary and other than cavitary surgery. Hemodynamic and metabolic parameters, homeostasis, stress criteria (hydrocortisone and glucose), pain intensity according to the verbal evaluation scale were studied at all stages of anesthesia and postoperative period, and side effects of postoperative analgesia were analyzed. Use of nonsteroid antiinflammatory drugs before the intervention and in the postoperative period prevented the development of strong postoperative pain and notably decreased the need in opioid analgesics in the presence of stable homeostasis. No serious side effects of analgesics, including hemorrhagic complications, were observed.