[Correction of cognitive dysfunction after laparoscopic cholecystectomy under inhalation anesthesia with sevoflurane]. / Korrektsiya kognitivnoi disfunktsii posle videolaparoskopicheskoi kholetsistektomii v usloviyakh ingalyatsionnoi anestezii sevofluranom.

OBJECTIVE: To study the dynamics of markers of brain damage, determine their role in postoperative cognitive dysfunction (POCD) and evaluate the effectiveness of therapeutic correction of POCD in patients undergoing laparoscopic cholecystectomy under inhalation anesthesia with sevoflurane. MATERIAL AND METHODS: We analyzed data of two representative groups of patients (aged 55 years and older) who underwent laparoscopic cholecystectomy under inhalation anesthesia with sevoflurane. Perioperative neuropsychological testing was performed for monitoring of higher mental functions (MoCA and FAB). In the 1st group (n=30), POCD was not corrected. In the 2nd group (n=30), Cellex 0.1 mg was subcutaneously injected once before surgery and then throughout 5 postoperative days to correct cognitive disorders. RESULTS: Neuropsychological testing revealed moderate POCD in the 1st group. In the 2nd group, Cellex provided a significantly lower level of brain-specific proteins compared to the 1st group. This limited brain damage and ensured no severe cognitive deficit in early postoperative period. CONCLUSION: Laparoscopic cholecystectomy under inhalation anesthesia with sevoflurane in patients aged 55 years and older is accompanied by moderate POCD in early postoperative period. Injections of Cellex 0.1 mg before surgery and then for 5 postoperative days prevent POCD and improve quality of life.

[Ischemia-reperfusion syndrome]. / Sindrom ishemii-reperfuzii.

The ischemia-reperfusion syndrome complicates the course of a number of emergency conditions in various fields of clinical medicine, determines the course, prognosis and outcome of the disease. This review examines various aspects of the etiology, pathogenesis, and clinical manifestations of this syndrome. Particular attention is paid to its prevention and treatment. It is indicated that most of the studies devoted to this problem are of an experimental nature. The use of preparations based on succinic acid in the clinic is seen as the most promising direction in solving this issue.

[Ways of improving the efficacy of preoperative preparation in patients with acute intestinal obstruction].

The comparative assessment of preoperative fluid therapy was made in 56 patients with acute intestinal obstruction. Parameters of central hemodynamics, the intra-abdominal pressure and water sectors of organism were investigated. The fluid therapy was conducted during 3 hours and included Tetraspan and Sterofundin on average 615 ml and 1585 ml, respectively. It was shown, that the fluid therapy facilitated to the elimination of water-electrolytic and hemodynamic shifts and to some extent it improved the outcomes of surgical treatment.

[Controlled myorelaxation in patients with aldosteroma].

Purpose of the study was to develop techniques of controlled myorelaxation during surgeries in patients with aldosteroma. 46 patients were involved in the study. Adrenalectomy was performed by videoendoscopy from retroperitoneal access. All patients were operated under general anaesthesia with sevoflurane with obligate monitoring of neuromuscular conduction (NMC). Patients were divided into 4 groups. Myorelaxation in patients of the group 1 (n = 14) was performed by continuous infusion of 0.4 mg/kg/hr rocuronium bromide (esmeron). Myorelaxation in patients of groups 2 (n = 11), 3 (n = 11) and 4 (n = 10) was performed by bolus administration of 0.15 mg/kg/hr esmeron. Patients of groups 1 and 2 were not decurarized. Decurarization in the group 3 was performed by proserin and in the group 4 by sugammadex. In patients of the group 1 esmeron consumption was minimal due to continuous infusion of the drug. Time of neuromuscular blockade recovery (TOF 0.9) was longer than 19 min. Worst data of neuromuscular blockade recovery accrued in the group 2. In patients of the group 3 time of neuromuscular blockade recovery (TOF 0.9) reduced 2.5-3 times in comparison with groups 1 and 2. The use of sugammadex in the group 4 provided almost 4.7 times faster neuromuscular blockade recovery than proserin administration. Controlled myorelaxation in patients with aldosteroma is possible when monitoring of neuromuscular conduction is provided. Infusion administration of esmeron provides decreasing of its consumption and high quality of myorelaxation. Sugammadex administration provides 4.7 times faster neuromuscular blockade recovery (TOF 0.9) than proserin administration without risk of neuromuscular block reverse.

[Prevention of cognitive disorders in postoperative period after carotid endarterectomy].

238 patients with atherosclerosis of carotid arteries after reconstructive operations under different types of anesthesia were enrolled in the study. Neuropsychological survey with Montreal cognitive assessment scale, frontal assessment battery and clock drawing test was performed in dynamics. Minimal cognitive dysfunction was mentioned in patients with symptomatic and asymptomatic stenosis after combined anesthesia with regional anesthesia. Postoperative cognitive dysfunction was developed after sevoflurane and propofol anesthesia in patients with asymptomatic stenosis. After inhalation anesthesia it was more severe. Prevention of postoperative cognitive dysfunction with ceraxon was clinically effective. This therapy can facilitate mental functions recovery and improve quality of life.

[The dynamics of the state of higher mental functions after surgical reconstruction of carotid stenosis using different types of anesthesia].

It was studied 238 patients after the reconstructive surgeries of atherosclerotic stenosing lesions of carotid arteries using different types of anesthesia. Neuropsychological testing included MMSE, the Frontal Assessment battery and the Clock drawing test. Regional anesthesia in the combination with reduced general anesthesia caused the less pronounced cognitive deficits in patients with symptomatic or asymptomatic stenoses. Inhalation anesthesia with sevofluorane led to the more pronounced cognitive impairment compared to total intravenous anesthesia with propofol. Ceraxon was used for the correction of cognitive impairments. This treatment increased the recovery of brain functions and quality of life of patients.

[Influence of various types of anesthesia in oncosurgical practice on immune parameters].

The aim of investigation is to reveal dependence of indicators of a phagocytes-macrophageal link and cytokine regulation at the operated patients with malignant new growths from a way of anesthesia. 274 patients with a gastroenteric cancer which was exposed to radical operative interventions with use of various ways of anesthesia (total intravenous, inhalation and intravenous-epidural) are surveyed. Existence of dependence of indicators of a phagocytes link of immunity and cytokine regulation from a way of surgical anesthesia at oncological patients is revealed. Most the imbalance of the studied phagocytes and cytokine mechanisms was shown at total intravenous, in the smallest--at combined intravenous epidural anesthesia that serves one of factors for the recommendation of its priority use in oncosurgical practice.

[Perioperative complications rate depending upon the method of anaesthesia in surgical management of an atherosclerotic lesion of the infrarenal aortic portion].

We examined a total of two hundred and thirty-seven 54-to-69-year-old patients subjected to aortofemoral bypass grafting for atherosclerosis of the aorta and its branches. Depending on the method of anaesthesia, the patients were subdivided into 3 groups: Group One patients received NLA with artificial lung ventilation (ALV), Group Two comprised the patients subjected to surgery in the setting of epidural anaesthesia at the level of ThXII-LI with ALV, and Group Three consisted of the patients who sustained the procedure of thoracic epidural anaesthesia at the level of ThX-Thl with ALV. The groups of patients were representative. The highest and most stable parameters of the coronary blood flow and central haemodynamics turned out to be in patients given thoracic epidural anaesthesia (ThX-Thl) with ALV due to low doses of a topical anaesthetic combined with a narcotic analgesic. The blockade of the sympathetic trunk ensured the highest and most stable parameters of the coronary circulation, stroke index, and ejection fraction as compared with those in the rest groups of patients.

[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.

[Comparative assessment of various general anesthesia methods during reconstructive operations on the carotid arteries].

Total intravenous anesthesia with diprivan and inhaled sevoflurane was assessed in 130 patients undergoing carotid endartectomy. The parameters of hemodynamics and cerebral circulation and the markers of brain lesion were studied. Sevoflurane anesthesia was shown to induce less depression of hemodynamic parameters and to maintain the more optimal level of cerebral circulation, limiting brain ischemic and reperfusion lesions and causing a fewer number of postoperative complications.

Selective brain cooling with endovascular intracarotid infusion of cold saline: a pilot feasibility study.

BACKGROUND AND PURPOSE: Endovascular brain cooling as a method for rapid and selective induction of hypothermic neuroprotection has not been systematically studied in humans. In this clinical pilot study we investigated the feasibility, safety, and physiologic responses of short-term brain cooling with IC-CSI. MATERIALS AND METHODS: We studied 18 patients (50 +/- 10 years old, 9 women) undergoing follow-up cerebral angiography after previous treatment of vascular malformations. Isotonic saline (4-17 degrees C) was infused into 1 internal carotid artery at 33 mL/min for 10 minutes. Brain (JVB) and bladder/esophageal temperature measurements (n = 9) were performed. Both MCAs were monitored with transcranial Doppler sonography (n = 13). Arterial and JV blood were sampled to estimate hemodilution and brain oxygen extraction. RESULTS: JVB temperature dropped approximately 0.84 +/- 0.13 degrees C and systemic temperature by 0.15 +/- 0.08 degrees C from baseline (JVB versus systemic temperature: P = .0006). Systolic MCA-flow velocities decreased from 101 +/- 27 to 73 +/- 18 cm/s on the infused side and from 83 +/- 24 to 78 +/- 21 cm/s on the contralateral side (relative changes, -26 +/- 8% versus -4 +/- 27%; P = .009). Changes in hematocrit (-1.2 +/- 1.1%) and cerebral arteriovenous oxygen difference (0.2 +/- 1.0 mL O(2)/100 mL) were not significant. Doppler data showed no signs of vascular spasm or microemboli. No focal neurologic deficits occurred. Pain was not reported. CONCLUSIONS: The results of this pilot study suggest that brain cooling can be achieved safely, rapidly, and selectively by means of IC-CSI, opening a new potential avenue for acute neuroprotection. Clinical investigations with control of infusion parameters and measurements of CBF, oxygen consumption, and brain temperature are warranted.

[Comparative assessment of efficacy of local thrombolysis with various fibrinolytics].

To avoid the characteristic for thrombolytic therapy of pulmonary embolism problems associated with low efficacy and elevated danger haemorrhagic complications may, in our opinion, be possible by means of the method of local thrombolysis worked out in our Clinic (RF Patent No 2376042). The present work was aimed at assessing efficacy of local thrombolysis in patients diagnosed as having pulmonary artery embolism with the drugs urokinase and actilyse. We examined a total of twenty patients. Ten Group One patients underwent local thrombolysis with Urokinase, and the remaining ten Group Two patients were treated with actilyse. We studied the parameters of central and pulmonary haemodynamics. Local thrombolysis with urokinase and actilyse in patients with pulmonary artery embolism turned out to equally efficiently reestablish blood flow in the pulmonary artery, which was confirmed by normalization of central haemodynamics maximally 2 hours after carrying out thrombolytic therapy with urokinase, with acktilyse accelerating this process to take 1 hour only. The proposed method makes it possible to decrease the dose of fibrinolytic agents twofold as compared with the recommended guidelines of the Pharmacopoeia, without losing their efficacy and ensures prevention of haemorrhagic complications.

[Use of current technical teaching aids in postgraduate training of anesthetists].

The paper describes the unique experience in using and introducing the elements of a virtual approach to teaching practical skills. The Department of Anesthesiology and Resuscitation has a large stock of various training mannequins at its disposal. They are suficiently accessible primarily to postgraduate educational program students (clinical residents). But in accordance with the continuing professional development system, the medical specialists trained at the Department have a good chance of working through elaborate technical manipulations on the mannequins, if they wish or the need arises. The mannequins have a broad spectrum of simulating the clinical situations, as well as a control system for the correctness of a trained physician's actions. The high professional training of the Department's students is also maintained by the application of a number of new technical training aids, including video materials and multimedia presentations.

[Comparative assessment of inhalation anesthesia with sevofluran and intravenous anesthesia with propofol for carotid endarterectomy].

Total intravenous anesthesia with propofol and inhalation sevofluran was assessed in 130 patients with carotid endarterectomy. The parameters of brain blood circulation, brain damage markers were studied. It was shown that sevofluran anesthesia caused less depression of the hemodynamic parameters, supported more optimum level of brain blood flow that limited ischemic and reperfusion damage of the brain and was accompanied by a fewer number of postoperative complications.

[Current approaches to the analgesia of spontaneous child birth].

The authors have compared various modes of spontaneous labor. Prolonged epidural infusion of naropine in combination with fentanyl has been found to cause a less motor block and therefore it may be used in the late first-to-second period of labor. Adequate analgesia ensures a smooth course of the second labor period and promotes the reduction in its duration and the correction of central hemodynamic and hormonal homeostastic disorders. The administration of moradol provides adequate analgesia of the first labor period, prevention, and elimination of abnormal labor activity, without exerting a depressive effect on maternal and neonatal respiration, which makes it possible to consider this procedure as an alternative mode of labor pain relief if there are contraindications to epidural analgesia.

[Effect of anesthesia and anticoagulant prophylaxis on the occurrence of postoperative thromboembolic complications in orthopedic patients].

Different prevention regimens of venous thromboembolism, by using the low molecular-weight heparin Fraxiparin, were studied in 152 patients who had undergone major orthopedic leg surgery under spinal and general anesthesia. The regimens differed in the time of Fraxiparin administration (before or after surgery). Fraxiparin and spinal anesthesia were found to promote the lower incidence of venous thromboembolism. The preoperative preventive treatment of venous thromboembolism, by using a low molecular-weight heparin in patients undergoing spinal anesthesia is unnecessary because of a high risk of epidural hematomas. If the risk for venous thromboembolism is higher before surgery and remains the same after it, thromboprophylaxis should be prolonged for at least one month.

[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.

[Total intravenous anesthesia with ketamine and the condition of the higher psychic function in the early and remote postoperative periods]. / Vliianie total'noi vnutrevennoi anestezii s primeneniem ketamina na sostoianie vysshikh psikhicheskikh funktsii v posleoperatsionnom periode.

Influence of total intravenous anesthesia with ketamine on the higher psychic function was studied, immediately after surgery and in the remote postoperative period, in 143 patients with different typological properties of the nervous system after a scheduled surgery--supravaginal uterectomy in fibromyoma of the uterine body. The authors defined 6 groups of patients with different typological properties of the nervous system. Persistent impairment of the higher nervous functions were established, immediately after surgery and in the remote postoperative period, in patients with a weak nervous system, biased nervous balance towards excitation, and with lability of nervous processes. Total intravenous anesthesia with ketamine, when used in patients with the robust nervous system, biased nervous balance towards excitation, and with lability of nervous processes, caused changes in the higher nervous functions and an intensified level of nervous-and-psychic loads, which were unstable and were arrested by the 30th postoperative day. The use of such anesthetic scheme was found to be inadvisable in the above groups of patients. The described impairments were not registered when total intravenous anesthesia was used in patients with a balanced nervous system irrespective of its type, a biased nervous balance towards inhibition and with inertness of nervous processes. The above anesthetic management is acceptable for such patients.