ANAESTHESIA DURING OPERATIONS ON THE LOWER EXTREMITIES AT PATIENTS WITH COMPLICATED DIABETES MELLITUS.

Diabetes mellitus type 2 morbidity has increased signficantly in recent years. In spite of substantial advances in anesthesiology in past 25 years, there are no commonly used criteria in choosing anaesthetic techniques in these patients during lower limb surgery. The main risk factors in these patients are the most often complications of diabetes such as cardiovascular system diseases, polyneuropathia, nephropathia and retinopathia. Surgical stress-response is generally considered as a trigger of organ and systems dysfunctions and one of the main reasons of the postoperative complications high rate. The best anaesthetic techniques are those preventing or decreasing surgical stress response. The necessity of optimizing the approach to the choice ofperioperative anesthetic management of these patients determines the increasing interest in this issue. The objective of this review was to trace the evolution of the approach to the choice of perioperative analgesia methods in diabetic patients during lower limb surgery over the past 10-15 years.

[Prolonged pulmonary ventilation in critically ill patients].

Treatment results of 336 patients in critical state who had required prolonged (3-115 days) artificial pulmonary ventilation were analyzed. 3 groups were defined: 98 patients with complications after operations on thoracic and abdominal organs and organ failure development; 55 patients with surgical infection and sepsis; 183 patients with extensive burning injury III AB-IV degrees. Particular features of prolonged artificial pulmonary ventilation were studied. Optimum modes of respiratory therapy were determined. Frequency of complications was controlled.

[Central hemodynamics during conduction anesthesia in patients with pyonecrotic forms of the diabetic foot].

Conduction anesthesia-induced central hemodynamic changes were studied in 20 patients with pyonecrotic forms of the diabetic foot and coronary heart disease (CHD). There was a 19% reduction in cardiac output and a 25% increase in total peripheral vascular resistance, as compared with the baseline values, the level of blood pressure being unchanged. The authors proposed to include droperidole into premedication and intraoperative perlinganite infusion for postload reduction, which stabilized central hemodynamics during conduction anesthesia in patients with diabetes mellitus and CHD.

[Regional anesthesia and timely treatment for neuropathy in patients with pyonecrotic forms of the diabetic foot].

Regional anesthesia was studied for its impact on the functional status of a peripheral nerve in 20 patients with purulent diseases of the lower extremities in the presence of diabetes mellitus. The impact of conservative therapy on the peripheral nerve was also studied in these patients. There was no negative impact of regional methods of anesthesia on the function of the nerve, its improvement due to treatment with alpha-lipoic acid and serotonin adipinate.

[Nosocomial infection in a resuscitation and intensive care unit for patients with surgical infection].

The study was undertaken to define the main causes of nosocomial infection and the possible ways of its prevention in a resuscitation and intensive care unit (RICU). In 1999 to 2004, intensive therapy was performed in 408 patients (244 males and 163 females) aged 18 to 60 years (54%) and above 60 years (45%) who had severe surgical infection (severe sepsis). Most patients aged over 60 years had one concomitant disease or more. Wound biopsy specimens were bacteriologically tested for the microflora. If there were clinical indications, cavitary puncture specimens, urine and blood samples were also bacteriologically tested. Wound discharges were cultured on liquid and solid nutrient media. Microbial sensitivity to antibacterial agents was estimated by the agar diffusion method using standard paper disks. Bacteriological monitoring was made in 408 patients with surgical infection in RICU in 1999 to 2004. The task of this monitoring was to analyze changes in the microbial picture and to determine the antimicrobial activity of antibacterial agents, and to detect resistant strains of the microflora. Analysis of the results of the bacteriological monitoring makes it possible to develop effective starting and programmed antibacterial therapy and to prevent the development of nosocomial infection in patients in RICU.

[Central hemodynamics during epidural anesthesia in patients with pyonecrotic forms of diabetic foot]. / Tsentral'naia gemodinamika pri épidural'noi anestezii u bol'nykh s gnoino-nekroticheskimi formami diabeticheskoi stopy.

Central hemodynamics and physiological profiles were followed up during epidural anesthesia for surgical treatment of pyonecrotic forms of diabetic foot. Modification of epidural anesthesia is described. Hemodynamic stability and adequacy of anesthesia in patients with severe concomitant diseases and chronic specific complications of diabetes mellitus are demonstrated.

[Experience in the use of vessel due F (sulodexide) in patients with suppurative-necrotic forms of diabetic foot without critical ischemia]. / Opyt primeneniia Vessel dué F (sulodeksid) u bol'nykh s gnoino-nekroticheskimi formami diabeticheskoi stopy bez kriticheskoi ishemii.

AIM: To evaluate effectiveness of sulodexide in patients with pyonecrotic complications of diabetic foot. MATERIAL AND METHOD: Sulodexide was given to 15 patients which were examined for blood fibrinogen, foot tissues saturation with oxygen, microbic contamination of the wound tissue. In addition, ultrasound dopplerography of foot arteries, laser doppler flowmetry were performed. RESULTS: Fibrinogen in peripheral blood fell, arteriovenous shunting diminished, capillary blood flow and oxygen saturation of the tissues improved. CONCLUSION: Even early sulodexide treatment is effective at different stages of the pathological process in diabetic patients with severe pyonecrotic lesion of the lower limbs as it recovers microcirculatory blood flow.

[Choice of anesthesia in patients with suppurative surgical infections and diabetes mellitus]. / Vybor metoda anestezii u bol'nykh s gnoinoi khirurgicheskoi infektsiei na fonesakharnogo diabeta.

500 anesthesias were performed in patients with surgical diseases in the presence of diabetes millitus (90% of patients with II type diabetes). The methods of intravenous anesthesia are proposed for short-term procedures with preservation of spontaneous ventilation and stable hemodynamics. The method of epidural anesthesia with introduction of major dose of anesthetic in two stages was developed for the operation on the lower extermities, it provides for stable hemodynamics and adequate anesthesia. Factors, influencing the choice of anesthesia were determined. Basic principles of intensive care in patients with surgical infection in diabetes mellitus were established.

[Heart conduction system under conditions of general anesthesia. Results of a 15-year study]. / Provodiashchaia sistema serdtsa v usloviiakh obshchei anestezii. Itogi 15-letnego issledovaniia.

Effects of 14 anesthetics, narcotic analgesics, benzodiazepines, and their combinations on the cardiac conduction system (CCS) were studied in 470 surgical patients of a general profile during operation and narcosis by transesophageal electrocardiostimulation. Interactions between components of total anesthesia can improve or suppress the intracardiac conduction. The authors classified the data on the effects of agents used for narcosis on the sinus node function and atrioventricular and anteretrograde conduction. The results will help an anesthesiologist in a differentiated approach to the choice of anesthetics for surgical patients with initially disordered CCS and heart rhythm.

[Use of serotonin for treatment of patients with diabetic angiopathies]. / Primenenie serotonina dlia lecheniia bol'nykh s diabeticheskimi angiopatiiami.

In 26 patients (female 11, males--15) with diabetic angiopathy (necrosis of the foot or toes) local measurement of pO2 by transcutaneous mode was carried out before and during introduction of serotonine adipinate. Simultaneously with evaluation of pO2 in 14 patients electromyography (EMG) was made. Serotonine adipinate was introduced intravenously with a speed of 5.0-10.0 mg per hour. In this group mean age of the patients made up 57.4 years, mean values of initial pO2 25.6 mm Hg, and mean indices of pO2 at the moment of serotonine treatment 38.5 mm Hg. Average increase of pO2 during serotonine infusion was registered as 50.4% in comparison with mean initial data. In all 14 patients, who underwent simultaneous measurement of pO2 and registration of EMG, reinforcement of electrical activity of smooth muscles (SM) of various intensity and increase in tissue pO2 were detected. Improvement of microcirculation (increase of transcutaneous pO2, reinforcement of electrical activity of SM as a result of serotonine introduction) evidences that functional and morphological changes of serotonine receptors of SM are involead in genesis of diabetic angiopathy. The data obtained showed that in diabetes mellitus, besides insulin deficiency, insufficiency of such an endogenous factor as serotonine duclops. Thus, serotonin should be used for prophylaxis and treatment of diabetic angiopathies.

[Changes in central hemodynamics and the heart conduction system during total intravenous anesthesia using diprivan in extensive abdominal surgery]. / Izmeneniia tsentral'noi gemodinamiki i provodiashchei sistemy serdtsa pri total'noi vnutrivennoi anestezii s ispol'zovaniem diprivana vo vremia obshirnykh abdominal'nykh operatsii.

Diprivan was included in the multicomponent intravenous anesthesia during extensive prolonged and traumatic operations in abdominal surgery and gynecology. The investigations showed the minimal effect of anesthesia with diprivan, diazepam, and phentanyl on the central hemodynamics and conducting system of the heart. The suggested anesthetic scheme may be a method of choice in patients at a high risk of surgical anesthesiological injury.

[The effect of diprivan on the indices of central hemodynamics and the heart conduction system]. / Vliianie diprivana na pokazateli tsentralnoi gemodinamiki i provodiashchuiu sistemu serdtsa.

Using impedance tetrapolar plethysmography and transesophageal electrical stimulation of the left ventricle, changes in central hemodynamic parameters have been assessed in 46 women during brief (up to 10 min) anesthesias with diprivanum. Bolus injection of diprivanum at a dose of 2.5 mg per 1 kg body weight was used. It has been demonstrated that diprivanum administration decreased BP, which was associated with a drop in total peripheral resistance and stroke volume that led to the absence of compensatory tachycardia to an increase in the cardiac output. The absence of compensatory tachycardia upon diprivanum administration is accounted for by a combined effect of vagotonic diprivanum action and its ability to inhibit moderately the automatic function of the sinoatrial node.