[Anesthesia, changes in hemodynamics and metabolism in resection of abdominal aortic aneurysms]. / Anesteziia, izmeneniia gemodinamiki i metabolizma pri rezektsii anevrizm briushnoi aorty.

Changes in hemodynamics and some metabolic parameters were studied in 78 patients during anesthesia for resection of the abdominal aorta aneurysms. The steps of the operation associated with the most profound hemodynamic changes were distinguished and measures aimed at stabilization of hemodynamics, blood volume, and electrolyte balance considered. No appreciable changes in the hemodynamics or depression of the myocardium were observed at stages of anesthesia and operation. A correlation was traced between pressure changes in the pulmonary artery and central venous pressure. The suggested method of anesthesia and infusion therapy strategy are conducive to stabilization of the hemodynamics in the course of the whole operation, to maintenance of normal volume of circulating blood and adequate diuresis. Monitoring of central venous pressure is sufficient to control infusion therapy and hemodynamics.

[Effects of halothane on cerebral blood flow and its protective action in ischemia]. / Vliianie ftorotana na mozgovoi krovotok i ego zashchitnoe deistvie pri ishemii.

Halothane impact on cerebral blood flow, brain metabolism and its protective effect in ischemia have been assessed in 30 patients operated on for the occlusion of brachiocephalic arteries. The data obtained indicate that additional use of halothane in N2O:O2 anesthesia during reconstructive surgery on brachiocephalic arteries makes it possible to enhance collateral blood flow, increase retrograde pressure, and decrease O2 consumption by the brain, without considerable changes in systemic hemodynamics. In addition, the studies have shown that halothane decreases lipid peroxidation processes.

[Oxygen transport in patients with ischemic heart disease operated on under a program to preserve the patient's blood]. / Nekotorye aspekty transporta kisloroda u bol'nykh ishemicheskoi bolezn'iu serdtsa, operirovannykh v usloviiakh programmy po sokhraneniiu krovi bol'nogo.

The results of the studies performed in 112 patients operated on with preservation of the patient's blood are reviewed. This meant pre- and intraoperative blood taking, surgery under normovolemic hemodilution, blood taking and transfusion upon its neutralization with heparin, collection of the blood flowing from drainages. Acid-base balance, pO2, blood Hb level, the degree of Hb saturation with O2, free plasma Hb, platelet count, the level of 2,3-diphosphoglyceric acid have been determined and parameters of oxyhemoglobin dissociation curve have been calculated. Computer monitoring of O2 transport was performed before and after assisted circulation in 28 patients. During surgery it proved possible to collect and return to the patients 10% of the circulating blood. The blood collected during surgery had no negative effect on the hemostasis. The above technique makes it possible to reduce the amount of donor blood used during surgery and has no negative effect on O2 transport.

[The concentration of potassium in the blood and 2,3-diphosphoglyceric acid in the erythrocytes during surgery of the abdominal aorta accompanied by massive blood loss]. / Kontsentratsiia kaliia plazmy i 2,3-difosfoglitserinovoi kisloty v éritrotsitakh vo vremia operatsii na briushnoi aorte, soprovozhdaiushchikhsia bol'shoi krovopoterei.

It has been demonstrated that transfusions of large amounts of stabilized donor blood and prolonged ischemia due to clamping of the abdominal aorta during surgery were not accompanied by an increase in K+ plasma level thanks to therapy aimed at the correction of hypovolemia and hemodynamic stabilization. A decrease in K+ plasma level directly depended on the volume of the liquid transfused, the degree of hemodilution and to some extent on 2,3-DPG level. There was a drop in 2,3-DPG level intraoperatively, which was due to the use of stored donor blood for blood loss compensation and to mounting metabolic acidosis (lactate acidosis included) and gaseous acidosis.

[New parameters of the oxygen transport function of arterial blood]. / O novykh parametrakh kislorodtransportnoi funktsii arterial'noi krovi.

New criteria of the arterial blood oxygen transport function suggested by O. Siggaard-Andersen et al. are reviewed. The examples from clinical practice show the possibility to evaluate the capacity of the arterial blood to transport O2 during general anesthesia and intensive care.

[Characteristics of the changes in the concentration of 2,3-diphosphoglycerate in heart surgery patients]. / Osobennosti izmeneniia kontsentratsii 2,3-difosfoglitserata u kardiokhirurgicheskikh bol'nykh.

Changes in 2,3-DPG level have been studied in cardiosurgical patients. It has been shown that 2,3-DPG concentration increase, as a moderately fast mechanism in a common model of tissue pO2 regulation, is observed in almost half of patients with acquired heart valve defects. An increase in 2,3-DPG level and P50 value leading to a decrease in hemoglobin affinity to oxygen has been found in one third of patients. It has been established that 2,3-DPG level and P50 value are, as a rule, normal in patients with mitral stenosis, acyanotic congenital heart valve defects and ischemic heart disease. In a number of patients with mitral stenosis an increased Hb concentration, as a slow mechanism of hypoxia compensation in the model of tissue pO2 regulation, is a prevailing mechanism of adaptation to hypoxia.

[The 2,3-diphosphoglycerate content and its influence on hemoglobin-oxygen affinity in patients following open heart surgery]. / Soderzhanie 2,3-difosfoglitserata i ego vliianie na srodstvo gemoglobina k kislorodu u bol'nykh posle operatsii na otkrytom serdtse.

70 patients have been examined in the early postoperative period after aortocoronary bypass surgery and surgical correction of acquired heart valve defects. 2,3-diphosphoglycerate (DPG) concentration was shown to increase in acute postoperative disturbances. The increase was most pronounced in reduced oxygen transport to tissues. However, with 2,3-DPG synthesis and metabolism slowed down, its concentration did not always correspond to the real state of the cardio-respiratory system. Changes in H+ concentration played a certain role in the regulation of 2,3-DPG content. In patients with cardio-respiratory disturbances 2,3-DPG concentration increased by 0.55 mcM/ml on average, with plasma pH increased by 0.1. No such regularity has been observed in patients with uncomplicated postoperative period. A positive correlation has been established between changes in 2,3-DPG concentration and the position of oxyhemoglobin dissociation curve. Considerable fluctuations in P50 value standard in cardiorespiratory disturbances have been observed. However 2,3-DPG effect was not the only mechanism causing these fluctuations.

[Regulation of blood oxygen transport function in patients after open-heart surgery]. / Reguliatsiia kislorodtransportnoi funktsii krovi u bol'nykh posle operatsii na otkrytom serdtse.

The oxygen transport function of the blood was studied in 223 patients in the early postoperative period after open-heart surgery, which included correction of acquired cardiac valve defects and aortocoronary bypass. The studied parameters comprised central hemodynamics, pulmonary gas exchange, oxygen supply and utilization, acid-base status, blood gas and lactate content, as well as erythrocytic 2,3-diphosphoglycerate (DPG); Boehringer Mannheim reagents (FRG) were used. The venous blood P50 was calculated using a Severinghaus device. It was found, that the Bohr effect and temperature changes are the major factors controlling the Hb affinity to oxygen. No coefficient modifications in pH and T were detected. Patients with cardiac and pulmonary disorders showed, along with the Bohr effect and temperature influences, an additional shift of the oxyhemoglobin dissociation curve. A positive relationship was revealed between the 2,3-DPG level and standard P50 value. However, the coefficient was low (0.010) at 2,3-DPG and insufficiently stable. It is most probable, that 2,3-DPG mediates the buffer effect eliminating the drastic P50 deviations and is not completely responsible for additional ODC shifts in cardiopulmonary disorders. A quantitative relationship between hypoxia and Hb affinity to oxygen was revealed. The coefficient at SO2 Y varied from -0.0025 to -0.0030 by one percent of changes in the latter. Reduction in SO2 by 15 percent in cardiopulmonary patients was equivalent to the Bohr effect at a pH fall by 0.1 unit.

[Changes in homeostatic parameters during transportation of patients from the operating room to the resuscitation and intensive care unit]. / Izmenenie nekotorykh pokazatelei gomeostaza v period transportirovki bol'nykh iz operatsionnoi v otdelenie reanimatsii i intensivnoi terapii.

Oxygen balance, acid-base balance, systolic and diastolic blood pressure, heart rate, central and peripheral temperature have been investigated in patients after abdominal, thoracic and vascular surgery during transportation from the operation room into an intensive care unit, using different respiratory techniques and inhaled mixture composition. It has been shown that spontaneous respiration leads to the onset of arterial hypoxemia, which is more pronounced in patients after thoracic surgery. Inhalation of vapourized O2 through nasal catheters during transportation reduces the incidence and degree of arterial hypoxemia. Assisted lung ventilation with O2 prevents the onset of arterial hypoxemia during transportation.