[Hemodynamic features during coronary bypass surgery on the working heart].

Changes in hemodynamics and blood oxygen transport function were studied during coronary bypass surgery (CBS) on the working heart under anesthesia with propofol and fentanyl. In patients operated on the working heart, the course of the basic stage of an operation was characterized by a moderate reduction in cardiac index and stroke volume due to the cardiac changes and immobilization, which resulted in cardiac compression and venous return deterioration. These impairments did not lead to worse oxygen-transportfunction and they were completely eliminated in the rehabilitative period. Analyzing the results of studies of troponin-T and creatinine kinase-MB showed that the procedure of coronary bypass surgery without using EKK had a less damaging effect on the myocardium. Analyzing the course of an early postoperative period indicated that the use of perfusionless technology substantially reduced needs for inotropic support, the time of artificial ventilation, and the length of stay at an intensive care unit.

[Criteria of functional operability and indications for intraoperative volumetric monitoring of patients during extensive surgical procedures on the lung]. / Kriterii funktsional'noi operabel'nosti i pokazaniia k intraoperatsionnomu voliumetricheskomu monitoringu u bol'nykh pri obshirnykh operativnykh vmeshatel'stvakh na legkikh.

The investigation included 32 patients after extensive operative interventions on the lungs: pneumonectomy with circular resection of the trachea bifurcation and different kinds of combined pneumonectomies. Methods of Doppler echocardiography and thermal dilution were used for studying the parameters of lesser circulation before, during and after operation. Patients with the initially impaired hemodynamics had more pronounced functional changes after surgical procedures. The shift limits of the main ultrasonic indices of the right ventricle function were determined in order to form a group of the higher prognostic risk.

[Cardiac right ventricular function and hemodynamics during resection of the lungs]. / Funktsiia pravogo zheludochka serdtsa i gemodinamiki vo vremia rezektsii legkikh.

Right-ventricular function and hemodynamics were studied in 48 patients during resections of the lungs (lobectomy and pneumonectomy) under total noninhalation anesthesia. Approaches to compensation of circulation in resection of different volume of lung tissue were determined. The leading role of the diastolic function of the right heart ventricle in realization of hemodynamic response in pneumonectomy is revealed. Volumetric monitoring of right-ventricular function during extensive lung resections is highly informative.

[Postpneumonectomy syndrome: several new anesthesiological and pathophysiological aspects]. / Postpnevmonéktomicheskii sindrom: nekotorye novye anesteziologicheskie i patofiziologicheskie aspekty problemy.

As a result of 10-year investigations a concept of postpneumonectomy syndrome (PPS) has been defined as a combination of acute respiratory disturbances due to alteration of filtration and absorption functions of the lungs along with systolic and diastolic right heart dysfunction. The aim of the study was to identify the details of PPS pathogenesis dependent on the initial right chamber pressure levels and a search for probable approaches to PPS correction. The study was carried out on 26 patients subject to pneumonectomy. Central hemodynamics along with filtration and absorption lung functions and changes in extravascular lung water (EVLW) have been studied. According to the data obtained, initial pulmonary hypertension definitely plays a certain part in PPS pathogenesis; upon the administration of a Ca-blocker finoptin, the right heart condition was characterized by a significant increase in EF and EDV, followed by an increase in blood flow and a drop an PCWP; all the patients have experienced an increase in EVLW up to 7-8 ml/kg. Though altered right heart diastolic function may play a key role in hemodynamic and gas exchange disturbances, the application of Ca-blockers is believed to be a possible approach to the correction of the above deviations.