[Primary (idiopathic) pulmonary hypertension (Ayerza-Arrillaga syndrome) and pregnancy - intensive care and anesthesia management].

The lecture deals with detailed information about the etiology, pathogenesis and clinical manifestations of primary (idiopathic) pulmonaiy hypertension, intensive treatment and anesthesia in pregnancy.

[Dexmedetomidine use for postoperative adrenergic analgesia and sedation in abdominal surgery].

Comparative study of postoperative analgesia and sedation with trimeperidine and dexmedetomidine and their effects on haemodynamics and vegetative nervous system was performed. Assessment of analgesia and sedation during vagotonia (first part of the study) and hypokinetic type of haemodynamics (second part of the study) was carried out with visual analogue scale (VAS) and Richmond scale. Results of the study showed that dexmedetomidine is more effective and safer than trimeperidine for analgesia and sedation in patients with spontaneous breathing after abdominal surgery. Dexmedetomidine use allows keeping optimal type of haemodynamics and vegetative nervous system parameters on first day of postoperative period.

[Comparative assessment of prolonged femoral nerve blockade and epidural analgesia for postoperative pain in total knee joint arthroplasty].

The study deals with two mostly discussed techniques of postoperative analgesia for total knee joint arthroplasty. Surgeries were performed under subarachnoid anaesthesia with intravenous sedation. 9 patients of first group in received prolonged femoral nerve blockade as a component of multimodal analgesia. 8 patients of second group received epidural infusion of naropine. If basic technique of analgesia was not effective patients received trimeperidine 20 mg intramuscular. Patients of second group had less pain syndrome (in order to visual analogue scale) and did not need additional administration of opioids.

[Heparin-induced thrombocytopenia: theory and practice].

The article deals with detailed information about etiology, pathogenesis, clinical signs, prophylactics and treatment of a heparin-induced thrombocytopenia.

[The autonomous nervous system and blood circulation system--homeostasis and homeokinesis during spine surgery].

In 30-surgical patients, operated for degenerative-dystrophic changes of the spine (microdiscectomy), with due regard for initial condition of the ANS (differentiated by Kerdo index), homeokinesis state has been studied. The circulatory system function was controlled with the use of a standard monitoring and central hemodynamics indices, that has allowed to mark out Hyper-and Hypo - eukinetic circulation types. Microdiscectomy performed under combined anesthesia (N2O/ O2 - 0.5) with fentanyl and sevorane. It was found that 68% of the surveyed patients directly before the surgery had a lack of homeokinesis (vagotonia). Comparison of the reaction of the autonomous nervous system and the circulatory system to premedication revealed that the change in the number of vagotonic patients and patients with hypokinetic type of hemodynamics had a direct linear dependence, and the number of sympathotonic patients and patients with hypokinetic type of hemodynamics -- the reverse one. Surgery, intraoperative pharmacological load, change of the body in sympathotonic patients accompanied with changes in Central hemodynamics (low afterload, eukinetic HI values), characteristic for physiological homeokinesis, which was not observed in vagotonic patients, which have remained unsuccessful (dysadaptative) hypokinetic type of blood circulation.

[Neuro-autonomic inhibition and haemodynamics management optimization during cesarean section under spinal anaesthesia in pregnant women with gestosis].

Results showed that autonomic nervous system (ANS) and blood circulation system (BCS) dysfunction in 3rd trimester pregnant women with gestosis are more pronounced, than in healthy pregnant women, despite the prescribed treatment. The most significant disturbances were vagotonia and hypokinetic haemodynamics type (often iatrogenic). Spinal anaesthesia (SA) during Cesarean section in pregnant women is accompanied by blood pressure decrease to the level demanding on vasopressors use. Considering normal indicators of SI, CI, oxygen transportation and electrocardiogram vasopressor was not introduced Apgar score assessment of newborns was within normal. However, vagotonia and hypokinetic haemodynamics type during anaesthesia that certifies autoregulation reserves insufficiency. Atropine introduction in pregnant women with vagotonia and hypokinetic haemodynamics type (often iatrogenic, owing to irrational therapy) before SA beginning of promoted neurovegetative inhibition optimization and haemodynamics stabilization in eukinetic range. Vagus blockade (elimination of ANS dysfunction) was accompanied by more physiologic sympathicotonia development with smaller decrease of blood pressure (without stroke index reduction!), absence of bradycardia and vomiting. Research showed that the blood pressure cannot be the only objective criterion of vasopressors use.

[Difficult tracheal intubation: comparative assessment of the value of prognostic indices in using Macintosh and Truview laryngoscopes].

The paper describes the experience in using three predictive criteria, such as Mallampati test, Patila test, and ULBT test, to evaluate tracheal intubation and compares their predictive validity. The experience in applying Macintosh and Truview laryngoscopes to patients with predicted difficult tracheal intubation (DTI) is also depicted. A combination of three above predictive procedures is a reliable predictor of DTI (r = 0.5; p < 0.05). Therefore their combination may be recommended for clinical use to predict DTI. No significant correlation was obtained between the other criteria of DTI and the difficulties during intubation at the first attempt (p > 0.05). There was no statistical significant correlation between the used type of a laryngoscope and the rate of effective/ineffective intubations at the first attempt (r = 0.34; p > 0.05).

[Preoperative preparation of pregnant with hypertension according to state of the autonomic nervous system and circulatory system].

Pregnancy in patients with hypertension is considered in the spotlight of creation of general adaptation syndrome. According to evidence, when a stable hypertension in pregnant patients with hyper- and eukinetic types of haemodynamics is observed, the response of circulatory system and body fluid compartments has a moderate difference with normal. In pregnant patients with hypertension and a hypokinetic type of haemodynamics and pregnant patients with gestosis developed against the background of eukinetic type of hypertension, a physiological decrease of total peripheral resistance (TPR) is absent, which contributes into interstitial hyperhydration. In pregnant patients with gestosis developed against the background of hypokinetic type of haemodynamics, a pathological rise of TPR occurs, which is followed with a more significant interstitial hyperhydration. A differentiated preoperative preparation of pregnant with hypertension with the calcium antagonists and hydroxyethyl starch solution (130/0,4) favours the conversion of hyper- and hypokinetic types of haemodynamics to eukinetic, forms a physiological type of sympathicotonia and improves the water-salt metabolism.

[Optimization of the neuroautonomic inhibition and regulation of hemodynamics during subarachnoid anesthesia in abdominal delivery].

Pregnancy is considered in the spotlight of creation of general adaptation syndrome. It was revealed that 85% and 58% of healthy non-pregnant women had an inadequate autonomous nervous system (ANS) and circulatory system response respectively. This favoured the labour activity malfunction in 20% of women in childbirth when an abdominal delivery was needed. A traditional subarachnoid anesthesia (SA) in control group was accompanied by decrease of blood pressure (BP) to the numbers requiring a medicamentous correction (as by literature data). However, the central haemodynamics measures has shown a normal blood flow and the blood pressure correction was not performed. During surgery and in early post-operative period in all women in this group a parasympathetic tone has prevailed over, and the cardiac output was at the lower limit of the hypokinetic type of haemodynamics, which was accompanied with nausea and vomiting in 30% of women. Including the atropine administration into the traditional protocol of SA in cesarean section in pregnant patients with eu- and parasympathotonia (research group) has favoured the optimization of the neurovegetative inhibition of reflexes and stabilization of haemodynamics within the physiological ranges. Vagosympathetic block has been accompanied by sympathotonia with a lesser BP decrease compared to control group, absence of bradycardia, nausea and vomiting. Thus the BP can not serve as a criterion of the perfusion of essential organs, including uteroplacental haemodynamics, especially non-invasibe BP. Including the control of ANS tone dynamics, central haemodynamics and oxygen transport into monitoring guidelines in neuroaxial anaesthesia in abdominal delivery is necessary.

[Anaesthesia in abdominal delivery in pregnant patients with hypertension].

A differentiated administration of calcium antagonists in preoperative preparation of pregnant patients with hypertension enabled the conversion of circulatory system state to "normal pregnancy range": a conversion of hypokinetic (including the HES solution infusion) and hyperkinetic types of haemodynamics to eukinetic one, with the decrease of total peripheral resistance and myocardium need for oxygen, autonomous nervous system state to physiological sympathicotonia. Evidence shows that continued intra-operative treatment including tranexamic acid enables to maintain those results during the surgery. In postoperational period, the clinical manifestations of SIRS in patients who has received the mentioned therapy were marked less then in control group, and the newborns have a higher Apgar score.

[Experimental investigations of the analgesic activity of fentanyl and the non-opiodal agents -clonidine and isradipine, and protease inhibitors].

The analgesic activity of clonidine, isradipine, antagosane (aprotinine), transamine, and their combinations with fentanyl in subanalgesic doses was experimentally studied on mice, by using the tail-flick test. Analgesic activity was found in clonidine, antagosane, and transamine. A combination of fentanyl used in subanalgesic doses and clonidine, isradipine, antagosane, or transamine had supertotal analgesic activity. The findings serve as a basis for effectively making up a component of analgesia during anesthetic support at surgery made in patients with baseline sympathicotonia, ischemia/reperfusion syndrome, and a systemic inflammatory reaction.

[Hemodynamics, the autonomic nervous system and water metabolism as criteria for developing the general adaptation syndrome in pregnant women].

By taking into account the fact that the autonomic nervous and cardiovascular systems (ANS and CVS) are the major links of development of the general adaptation syndrome in pregnancy, which are affected by all the processes involved in the development of the syndrome, the author analyzed the state of these systems in healthy non-pregnant and pregnant women (HNPW and HPW) and in pregnant women with gestosis. HNPW were found to have already a prerequisite for impairing pregnancy adaptive processes as ANS and CVS dysfunction. In HPW, these impairments were more pronounced. In the pregnant women, impaired adaptive processes manifested themselves as excess sympathicotonia in 72% and parasympathicotonia in 23% of cases despite the treatment performed, which was accompanied by hypokinetic hemodynamics in 53 and 50%, respectively. In hyper- and eukinetic hemodynamics, there were no physiologically required decreases in total peripheral vascular resistance while in hypokinetic hemodynamics, there was its pathological increase. Such disorders enhance the significance of abdominal compartment syndrome, aortocaval compression, ischemia-reperfusion, hydrodynamic and membranogenic (capillary leakage) factors of impaired water metabolism, which contributes to adaptation derangement. Based on the findings, the authors have created a developmental modulation algorithm for the general adaptation syndrome by completed pregnancy and surgical delivery.

[Optimization of anesthetic service during abdominal delivery of pregnant women with gestosis].

Differential preoperative preparation of pregnant women with gestosis, by using calcium antagonists is an effective preventive measure against a circulatory hyperdynamic response to transportation to the operating suite. In pregnant women who had all hemodynamic types at baseline, the eukinetic type achieved during the preparation is retained. The patients with gestosis who did not receive calcium antagonists were found to have a circulatory hyperdynamic response with increased myocardial oxygen uptake (during surgery in particular). The use of calcium antagonists, ketonal, tranexamic acid, and hydroxyethyl starch-130/04 solution in the anesthetic appliance promoted the preservation of eukinetic hemodynamics in all those operated on, without increasing myocardial oxygen demands. The better reaction of the circulatory system and myocardial oxygen demands to surgical injury (the second mediatory wave of the systemic inflammatory response syndrome) correlated with higher neonatal Apgar scores in this category of puerperas with gestosis.

[Pregnancy in the context of general adaptation syndrome].

Based on their own findings and the data available in the literature on pregnancy including that complicated by gestosis, the authors consider these conditions in the context of Selye's general adaptation syndrome. They identify its basic links (the autonomic nervous and cardiovascular systems) the function of which is affected by all the physiological and pathophysiological processes involved in its development. There is a high likelihood of baseline impaired adaption processes in these links, which may lead to an inability to accommodate (dysadaptation) by the moment of delivery. The paper gives the current interpretation of functional disorders, called Zangemeister'a triad in 1913, from the present-day points of view of the evaluation of pregnancy as the systemic inflammatory response syndrome and, probably, adaptation disease. Based on the results of analyzing the data available in the literature, the authors indicate physiologically the basic trends in the modulation of impaired development processes of the general adaptation syndrome towards the completion of pregnancy and surgical delivery.

[Calcium antagonists in the preoperative preparation of pregnant women with gestosis].

Differential preoperative preparation of pregnant women with gestosis, which is aimed at eliminating dysfunction of the universal secondary calcium messenger and preventing further disorders caused by calcium antagonists, is accompanied by positive changes in the basic links of development of the general adaptation syndrome--the autonomic nervous and cardiovascular systems. A physiologically required reduction in total peripheral vascular resistance (TPVE) is achieved in pregnant women with hyper- and eukinetic hemodynamics. In pregnant women with hypokinetic type, who receive hydroxyethyl starch-130/04 solution in the infusion therapy protocol, there is elimination of its pathological increase and there is a tendency for its physiological reduction. Obviating the discrepancy between cardiac index and TPVE causes a change of the hyper- and hypokinetic hemodynamic types to the eukinetic one, which is attended by development of physiological sympathicotonia and by almost complete normalization of water metabolic parameters in pregnant women with gestosis.

[General anesthesia components during abdominal surgeries in patients with abdominal sepsis].

Results of optimization of general anesthesia during abdominal surgeries in patients with abdominal sepsis are analyzed. Inhibitors of proteases (transamin and antagozan) were used as non-opiate component in transduction stage. Central hemodynamics, gaseous metabolism and heart rate were analyzed in two groups of patients: group 1 -- anesthesia was carried out with inhibitors of proteases (32 patients), group 2 -- without it (30 patients). High efficacy of the inhibitors was demonstrated. Inhibitors of proteases are indicated for anesthesia in patients with severe metabolic disorders associated with tissues hypoxia. Analgesic activity of transamin permits one to decrease doses of anesthetic medication with a cardiodepressive effect.

[Optimization of anesthetic management in blepharoplasty]. / Optimizatsiia anesteziologicheskogo obespecheniia operatsii blefaroplastiki.

The anesthetic management in cosmetic surgery must be as much controllable, safe and comfortable for a patient as possible, i.e. it must be in line with all requirements of outpatient surgery. Fifty-two patients were added, to the anesthetic-management scheme in blepharoplasty, the following: ketoralak - 0.4-0.6 mg/kg, transamine - 13.5-15 mg/kg, analgetics with non-opiate effect and antiemetic tropisetron - 0.05-0.08 mg/kg. It ensured an adequate analgesic action without suppression of the breathing function and a more comfortable postoperative course with a lesser postoperative syndrome of nausea and vomiting - by 3-4 times less versus the controls.