[Oxidative stress in perioperative period of cesarean section].

OBJECTIVE: To assess a pro- and antioxidant status in pregnant women at the system level in the perioperative period of cesarean section under regional and general anaesthesia. MATERIAL AND METHODS: 62 pregnant women aged 21 to 37 years (30,9 ± 6,2 y,ears) undergone delivery by cesarean section under general (n = 33) and regional (29) anaesthesia (1-2 class ASA (American Society ofAnesthesiologists). Blood samples were collected immediately after placing patients on an operating table (T1), immediately after suturing the surgical wound (T2), and 12 (T3) and 24 (T4) hours after taking the first sample. We studied following parameters: superoxide dismutase (SOD), glutathione peroxidase (GP). reduced glutathione (RG), total antioxidant activity, active products that react with thiobarbituric acid (TBA-ap). RESULTS: In general anaesthesia cesarean critical period activation ofprooxidant and antlioxidant activity is the period T2. Activation prooxidant activity (TBA-ap) was stored at 12 and 24 hours after surgery. Increased antioxidant activity (SOD, GP) was observed in the period T2. which wass replaced by its inhibition to 24 hours. Reduced glutathione content (RG) was reduced during T2 remains at low values up to 24 hours. Regional anaesthesia did not change observed prooxidant (poorly marked increase antioxidant activity (SOD, GP), which persists up to 24 hours). Reduced glutathione content (RG) was reduced in the period T3. but recovered after 24 hours. CONCLUSION: The use of regional imnaesthesia and spontaneous breathing with atmospheric air during an elective caesarean section helps to avoid induction and manifestations of oxidative stress in pregnant women in the perioperative period and to fully implement the program early activation parturients after cesarean section.

[Angiogenic growth factors in the ceresbropinal liquid of pregnant women during planned cesarean section under combined spinal - epidural anaesthesia].

The content of soluble angiogenic growth factors in cerebrospinal liquid and blood serum in 33 pregnant women aged from 21 to 37 years (30.9 +/- 6.2 years) before spinal - epidural anaesthesia during Cesarean section was studied in observative, prospective, stratificative research. All patients without somatic pathology were divided into 2 groups -control and main. 12 pregnant women with high degree myopia as a main indication for Cesarean section were included in the 1st control group. 21 pregnant women were included in the 2nd main group. This group was divided into 2 subgroups: group 2a--with eukinetic haemodynamics type (12 patients), group 2b--with hyperkinetic haemodynamics type and moderate hypoxemia (9 patients). The indications for planned Cesarean section in patients of the 2nd group were uterine scar and/or pelvis bones pathology. The analysis of angiogenic growth factors content in cerebrospinal liquid revealed differences between group 2b and group 2a. Results of angiogenic growth factors content in cerebrospinal liquid testify hidden intracerebral hypoxemia and can be used for its assessment before anaesthesia and for the testifying of the haemodynamics status and system hypoxemia relationship.

[Pharmacogenetical aspects of clinical anaesthesiology].

This survey of literature highlights the issues of pharmacogenetics and pharmacogenomics, the nomenclature of polymorphisms and the major clinically significant polymorphisms for the classes of medications which are most widespread in clinical anaesthesia. 53 data sources has been analyzed, including the polymorphism data base of National Center for Biotechnological Information (USA). Nowadays, choosing a medication do not provide for a individual genetic variability. It is possible that some of the drugs are potent to cause severe adverse effects or ineffective in certain subclasses of population due to unfavourable effectiveness/toxicity ratio. As the technology is developing, it is possible in future to treat every genetic subpopulation with a specific medication in order to obtain a target effect. Perhaps, it is too early to expect some immediate results of pharmacogenetics for a daily practice in anaesthesia. Nevertheless, it is possible that progress in genomics will enable a better understanding of those single nucleotide polymorphisms (SNPs) and haplotypes which alter the response to a medication. Those future discoveries will enable the targeting of the anaesthesia medications and personalization of the anaesthesia strategy aimed at improving the surgery outcomes as well as treating the acute and chronic pain according to a genetic profile of the patient.