[Modern aspects of anesthesia for laparoscopic surgery: questions and answers].

Recently the endoscopic surgery enters widely in clinical practice. Laparoscopic surgery has gained rapid acceptance in the anaethesiological community, mainly due to its advantages to patients in postoperative period. Recognition of pathophysiological changes in hemodynamic, respiration associated with pneumoperitoneum helps to prevention of possibly fatal complication during surgery, general anaesthesia, and also during early postoperative period. The aim of present review is using our experience and available bibliographic data to introduce anaethesiologists and surgeons to recent trends of anaesthesia in laparoscopic surgery.

[Abdominal compartment syndrome].

BACKGROUND: Abdominal compartment syndrome (ACS) manifests with increase of intra abdominal pressure (IAP) and organ dysfunction resulting in multiple organ failure. ACS presents with respiratory failure, hemodynamic changes, and impaired renal function. ACS is most often observed in critically ill patients with peritonitis, gastric dilatation, intestinal obstruction intra abdominal abscesses, abdominal trauma, and sepsis. In the absence of complex treatment mortality can reach 100%. OBJECTIVE: Examine the IAP changes in the postoperative period in ICU patients with complicated abdominal surgery. METHODS: Ten patients after abdominal surgery on mechanical ventilation were examined. From the existing methods for measurement of IAP we chose to determine the pressure in the bladder. RESULTS: We observed IAP changes, hemodynamic instability, oliguria, and acid base balance impairment. In two patients IAP reached levels above 25 mmHg while the increase in the other eight patients was moderate between 8 and 17 mmHg. Two of the patients had an anastomotic leak which necessitated relaparotomy. CONCLUSIONS: IAP level above 25 mmHg is associated with impairment of the blood flow in the major abdominal vessels which can lead to respiratory, cardio circulatory, liver, and renal failure. Currently the surgical decompression is the only treatment leading to significant mortality reduction.

[Oxidative stress: unsolved problem in the complex therapy in critically ill patients].

BACKGROUND: Recent reports emphasize the important role of oxidative stress in the genesis of many syndromes and diseases. The ICU patients have prerequisites for activation of oxidative stress process: activation of the neutrophils, macrophages, and other cells which are capable of producing reactive oxygen species (ROS). The traditional opinion was that lipids are the primary target of the ROS but new data show also protein damage. The interaction between ROS and lipids is an indicator for oxidative stress. OBJECTIVE: Complex investigation of the parameters of oxidative stress in critically ill patients undergoing abdominal surgery. METHODS: Eight patients undergoing surgery for diffuse peritonitis or acute pancreatitis were examined. The intensity of the lipid peroxidation processes was defined by the TBA-RS plasma levels. The status of the plasma antioxidant system was assessed by desoxyribose method. Patients with malignant diseases were not included. RESULTS: Our results confirm the growth of oxidative stress in study patients. We observed consistent increase in MDA levels toward 3rd-5th day of postoperative period. CONCLUSIONS: Oxidative stress processes have an important role in the course and outcome of surgical ICU patients. Multiple organ failure in these patients correlates well with the oxidative damage of body's protein structures. It is advisable to monitor the parameters of oxidative stress and protein damage in the course of critical illnesses.

[Application of total intravenous anesthesia with propofol in laparoscopic cholecystectomy: specific properties of propofol as an antioxidant]. / Prilozhenie na totalna intravenozna anesteziia s propofol pri laparoskopska kholetsistektomiia: osobenosti i kachestva na propofola kato antioksidant.

The authors reveal the formation of free radicals in biologic objects stressing upon the influence of Propofol (Diprivan; Zeneca; London, UK) as an intravenous agent during laparoscopic cholecystectomy (LCCE) lipid peroxidation. Some LCCE surgical details help this process resulting in free radical synthesis. The antioxidant effect of Propofol in vitro constitutes a peculiar interest. This generates idea that Propofol may be used as an anesthetic or as a sedative in patients with disturbances in free radical formation.

[Risk of drug-induced acute pancreatitis following propofol anesthesia used in abdominal operations]. / Risk ot lekarstvenoindutsiran ostur pankreatit sled anesteziia s propofol po povod koremni operatsii.

The postoperative pancreatitis is a well-known complication. More than eighty-five drugs have been reported to have induced postoperative pancreatitis. Twenty-five cases of Propofol-induced pancreatitis have been reported till now. The relation of pancreatitis to Propofol (Diprivan; Zeneca; London, UK) is considered as a possible one, but has been proved. The goal of the authors is to reveal the plasma lipid and amylase level dynamics in patients after Propofol anaesthesia. The clinicians have to consider this possible relation, because of the growing use of Propofol recently.

[Bacterial translocation from the gastrointestinal tract: catalyst of multiple organ dysfunction syndrome]. / Bakterialna translokatsiia ot gastrointestinalniia trakt: katalizator na sindroma na multiplena organna disfunktsiia.

The abnormal colonization of gastrointestinal tract (GIT), the loss of the intestinal barrier function, the bacterial translocation (BT) are signs of intestinal insufficiency which are supposed to be involved in the pathogenesis of MODS. This worsens the condition or leads to lethal outcome in patients after major abdominal surgery in ICU. The goal of this investigation was to consider the scientific and clinical evidence for the BT role in the pathogenesis of MODS and to present evidence about the advantages and the efficiency of antibiotic combination Amikacin plus Clindamycin as a new therapeutic strategy for the improvement of the outcome in patients with MODS and sepsis. To that purpose patients with diffuse peritonitis of different origin were analyzed. After surgery some patients were left with laparostomy. This gave the possibility for revisions and lavages of the abdominal cavity and for taking material for microbiological analyses. The patients were grouped into two subgroups according to antibiotic treatment: 1st group--combination of usually used antibiotics; 2nd group--Amikacin plus Clindamycin. The second group patients showed good tolerance to this antibiotic combination and good therapeutic effect.

[The role of low molecular weight heparin (fragmin) in the prophylaxis and treatment of venous thromboembolism in major abdominal operations]. / Miastoto na inskomolekuliarnite kheparini (fragmin) v profilaktikata i lechenieto na venozniia tromboemboliz'm pri golemi koremni operatsii.

The goal of the authors was to prepare a thorough survey of the publications about the application of low molecular weight heparines in deep venous thromboses and pulmonary embolism after abdominal surgery. Several low molecular weight heparines have been introduced in clinical practice since 1980. Till then only standard heparin has been used for deep thromboses prevention. Both drugs have the same or similar anticoagulant or antithrombotic effect. Low molecular weight heparines are more widely used than standard heparin because of the possibility to be administered once daily subcutaneously. They don't require a strict laboratory control and can be used in outpatients or home conditions.

[Oxidative-reductive activity of the mycelium as a criterion for assessing inoculate quality in gentamycin biosynthesis]. / Okislitel'no-vosstanovitel'naia aktivnost' mitsellia kak kriterii otsenki kachestva inokuliata pri biosinteze gentamitsina.

The development of the seed mycelium at various stages and temperatures was studied with the method of methylene blue decolorization characterizing the respiration level of the culture and its oxidation-reduction (dehydrogenase) activity. Relationship between the time of methylene blue decolorization by the seed mycelium, the quantity of the inoculum transferred from one stage to the other and the temperature of cultivation was shown. The seed mycelium decolorizing methylene blue within 2 minutes was most productive at the biosynthetic stage irrespective of the growth period, biomass volume, cultivation temperature and volume of the inoculum transferred from one stage to the other.