Objective: to study impairments in the nanostructure of red blood cell membranes in acute blood loss and methods to correct the membrane structures with perfluorocarbon emulsion. Materials and methods. Experiments were carried out on Nembutal-anesthesized outbred rats. The model of a terminal state was 60-minute hypovolemic hypotension, followed by blood reinfusion and addition of perfluorane or Ringer’s solution. Images of fragments of the red blood cell membrane surface structure were obtained using a Femtoscan atomic force microscope (AFM). Twenty-seven experiments were performed; 186 cells were scanned on the AFM, which provided 720 images of three orders. Results. The paper shows the time course of changes in the index hi for different phases of an experiment. After 5-minute hypotension, h1 increased by more than 4.3 times and after 60-minute hypotension, this value decreased to 4.7 nm. The second-order height rose linearly at the stages: control — at 5 minutes — at 60 minutes of hypotension. At 60 minutes of hypotension, the first- and second-order heights were similar. At 5 minutes of hypotension, the third-order surface slightly changed — it increased by 1.5-fold. But at 60 minutes of hypotension, the changes in the fine structures of the membrane became great — h3 increased by 6.3 times. Conclusion. Blood loss has shown to induce impairments in the microstructure of red blood cell membranes at all levels of its organization: flick in the range of 600—1000 nm, spectrin matrix at 150—350 nm, proteins, band 3, at 30—80 nm. The per-fluorocarbon emulsion «Perftoran» exerts a pronounced modulatory effect on the red blood cell membrane nanostructure at all steps of its organization, by restoring the membrane nanostructure practically to the control level. Key words: blood loss, red blood cell membrane, nanostructure, atomic force microscopy.

Objective: to study the genetic polymorphism of the genes of phase I and II xenobiotic detoxification (GSTM1, GSTP1, GSTT1, CYP1A1), as well as ACE, CCR5, MTHFR, and those of the cytokines IL-6 and TNF-a to reveal hereditary predisposition to pneumonia of varying genesis and its complications. Materials and methods. The frequency of the allele variants of 7 genes was studied in the groups of patients with pneumonia (n=524) and healthy donors (a control group (n=178). Results. There were are genotypes associated with predisposition to community-acquired and nosocomial pneumonia (CAP and NP): GSTM I*, CYP1A1 606T/T, ACE D/D and those associated with a higher risk for complicated CAP. There were effects of the allelic variants of the ACE gene in developing complications, such as acute respiratory distress syndrome, multiple organ dysfunction, and sepsis: ACEI/I insertion homozygotes linked to survival and the alternative ACE D/D genotype to mortality. Conclusion: The study revealed an association of detoxification gene polymorphism with predisposition to CAP and NP and with the development of complications in CAP. Key words: xenobiotic detoxification genes, key ACE renin-angiotensin system gene, chemokine receptor 5 (CCR5) gene, pneumonia, acute respiratory distress syndrome, sepsis, multiple organ dysfunction.

Objective: to improve the results of surgical treatment, by ruling out the negative effects of mechanical ventilation (MV) via combined anesthesia without myoplegia during operations on the lower abdomen. Subjects and methods. One hundred and twenty-one patients aged 20 to 64 years were examined. The patients were divided into 2 groups: 1) inhalation anesthesia under total myoplegia and continuous MV; 2) inhalation anesthesia without myoplegia and with preserved spontaneous respiration or pressure-support MV (PSMV). Results. The procedure of the latter allows combined anesthesia with preserved spontaneous respiration during operations on the lower abdomen and great vessels to have inadequate transport of oxygen under its relatively increased uptake in 98% of patients without any risk. MV made to prosthelytize external respiration function under combined anesthesia and total myoplegia causes a decrease in cardiac index (CI) by 40% or more (p<0.05) and increases in total peripheral vascular resistance (TPVR) by 50% or more (p<0.05) and intrapulmonary shunt by 3 times (p<0.05). Combined anesthesia without myoplegia and MV prevent induced changes in CI, TPVR, and Qs/Qt. The differences are significant throughout the follow-up (an intraoperative step and 9 postoperative hours). Conclusion. To rule out myoplegia and MV during combined anesthesia prevents MV-induced changes in CI, TPVR, and Qs/Qt. Key words: combined anesthesia, spontaneous respiration, hemodynamics, blood oxygen-transport function.

Surgical intervention is associated with the development of endocrine, metabolic, and inflammatory changes that may give rise to postoperative complications. Objective: to evaluate the impact of regional anesthesia on the magnitude of these changes during and after abdominal surgery. Subjects and methods. One hundred and twenty patients were examined during elective lower abdominal operations. The patients were divided into groups according to the anesthetic modality: general anesthesia alone (n=40) and in combination with continuous epidural (n=40) and spinal anesthesia (n=40). Cortisol, glucose, lactate, interleukins 6, 8, and 10 concentrations and daily urinary nitrogen excretion were studied before, during, and after surgery. Results. The two regional anesthesia modalities lowered the degree of an increase in the concentrations of cortisol, glucose, and lactate in the perioperative period and restricted a rise in the concentrations of both proinflammatory and anti-inflammatory cytokines. Spinal and epidural anesthesia both reduced daily urinary nitrogen excretion. Epidural versus spinal anesthesia/analgesia assured better quality of postoperative analgesia and was attended by less significant hemodynamic disorders. Conclusion. Both spinal and epidural anesthesia restrict the perioperative rise in the concentrations of cortisol, glucose, lactate, and cytokines and suppress protein catabolism after abdominal surgery. Key words: regional anesthesia, abdominal surgery, cortisol, protein and carbohydrate metabolism, inflammatory response.

Objective: to study the blood levels of free fatty acids (FFA) and adenyl nucleotides in patients with acute acetic acid poisoning (AAAP) complicated with exotoxic shock (ES). Subjects and methods. The study enrolled 33 patients with severe AAAP (with (n=10) and without (n=23) ES), of them there were 5 deaths. The patients’ age was 31.6±11.6 years. A control group comprised 16 healthy individuals. The total level of FFA and the concentration of glycerol were measured in the plasma. Red blood cells were as an object for investigation of ATP, ADP, and AMP. Hearts were morphologically studied in 5 patients died from shock. The data were statistically processed using the Mann-Whitney rank nonparametric tests. The differences were regarded as statistically significant at the achieved significance level of pConclusion. Microscopic studies of the hearts from the deceased patients revealed multiple cardiomyocyte necroses. All the patients with severe AAAP showed a considerably elevated blood level of FFAs with their impaired myocardial utilization and decreased red blood cell ATP and ADP concentrations. The most pronounced changes were found in a group of patients with AAAP and ES. Key words: acetic acid poisoning, exotoxic shock, free fatty acids, energy-rich phosphates.

Objective: to evaluate the impact of intestinal lavage (IL) on the incidence of pneumonia in patients with poisonings by psychopharmacological agents (PPA). Subjects and methods. The incidence of pneumonia as a complication of acute oral poisonings by PPA was studied in 393 patients with moderate and severe poisonings. Of them, 112 patients underwent IL as a detoxification method; the other patients received standard blood detoxification methods in a package of remedial measures. The time course of changes in the blood levels of gram-negative intestinal bacterial lipopolysaccharide (LPS) and immune status were studied before and after IL. Results. Prior to treatment, 65% of the patients with PPA poisoning were found to have an 8—10-fold excess in the reference values for blood LPS. At the same time, there were suppressed immunogram readings. After IL, there was a 1.5-fold decrease in blood LPS levels, which remained during 3 days, and activation of immune processes. It was shown that the patients undergoing IL developed pneumonia as a complication of PPA poisoning 1.6 times less frequently and died of pneumonia 16 times less often. Conclusion. The better results of IL treatment are obviously associated with enteral detoxification, reduced enterogenic toxemia, and improved hemostatic parameters, which was accompanied by normalized neutrophil oxygen metabolism and lower exposure of lung tissue to reactive oxygen species. Key words: acute poisonings, endotoxins, enterohumoral barrier, pneumonia, intestinal lavage.

Objective: to evaluate the impact of acute normovolemic hemodilution (ANH) with autoplasma transfusion on hemostatic parameters during cesarean section. Subjects and methods. The study covered 119 patients in whom ANH was used during cesarean section. Group 1 included 62 women undergoing ANH with autoplasma transfusion; Group 2 (control) comprised 57 pregnant women receiving ANH only. Examination of the hemostatic system involved studies of the plasma link, thromboelastogram readings, vascular platelet hemostasis and evaluation of intravascular thrombogenesis. Results. Transfusion of stored autoplasma as a hemostatic component during ANH favored the development of moderate hypercoagulation due to a significant increase in fibrinogen concentrations by 8%, r+k shortening by 11%, and a rise in the thrombodynamic potential index by 12%. A statistically significant difference has been found in the results between the groups at a stage of surgical hemostasis, which proves the best hemostat-ic effect of ANH used with autoplasma transfusion. Conclusion. The study has demonstrated that the combined use of ANH and autoplasma transfusion contributes to the stabilization of the blood coagulation potential during cesarean section and extends the feasibilities of ANH when the volume of intraoperative blood loss is as high as 25% of the circulating blood volume. Key words: cesarean section, acute normovolemic hemodilution, autoplasma transfusion, coagulation potential.

Objective: to evaluate the effect of methylprednisolone on capillary leak syndrome at surgery under normothermic cardiopulmonary bypass. Subjects and methods. Twenty-one patients who received intravenous methylprednisolone in a dose of 20 mg/kg body weight after anesthesia induction (a study group) and 21 patients who were not given this agent (a control group) were examined. The investigators estimated the levels of creatinine, albumin, cystatin C, sE-selectin, endothe-lin-1, and glucose in blood, creatinine in urine, microalbuminuria, and blood gas composition and assessed perioperative outcomes. Results. There were statistically significant differences between both groups in microalbuminuria level and albumin/creatinine ratio. At the study stages, there were increases in inotropic support needs, blood venous shunt ratio, and the levels of glucose, endothelin-1, sE-selectin, interleukin-10, and cystatin C and decreases in glomerular filtration rate, PaO2/PAO2 and PaO2/FiO2, and IL-6 level in the methylprednisolone group as compared with the controls. Conclusion. The use of methylprednisolone was not ascertained to reduce the manifestations of capillary leak syndrome. The pulse-dose administration of glucocorticosteroids contributed to the worsening of the signs of endothelial dysfunction (such as an elevated endothelin and sE-selectin levels in the study steps) and negatively affected the recovery of pulmonary and renal functions after cardiopulmonary bypass. Key words: glucocorticosteroids, cardiopulmonary bypass, capillary leak syndrome, endothelial dysfunction.

Objective: to reveal the features of perioperative metabolic disturbances in patients with lung cancer after pulmonectomy and a possibility of their correction with perioperative «Standard» formula sipping and with postoperative intravenous cytoflavin. Subjects and methods. The paper presents the results of a prospective randomized study of the efficiency of correction of metabolic disturbances in patients with lung cancer with perioperative enteral «Standard» formula sipping (5 days before surgery and 12 days after surgery). The study was conducted in 326 men aged 36 to 68 years. Arterial blood metabolic parameters (glucose, lactate, and pyruvate) and daily urine urea were estimated. Results. There was an association of preoperative metabolic disturbances with body mass index (BMI). Inclusion of sipping into perioperative therapy did not exert a considerable impact on the cause of postoperative metabolic disturbances. Key words: lung cancer, pul-monectomy, body mass index, sipping, cytoflavin.

Objective: to estimate blood glucose levels during complete parenteral nutrition (CPN), by using the three-in-one system with a high glucose level. Subjects and methods. Thirty adult patients without diabetes mellitus (including 18 men) were examined. Twelve and 18 patients were operated on for colonic and gastric cancers, respectively. CPN (Oliclinomel No. 7 — 1000, 1500 ml; glucose, 240 g in 1500 ml, Baxter, Belgium) was carried out at the Surgery Department in the early postoperative period (3-5 postoperative days) with stable hemodynamics and no organ dysfunction (acute respiratory, renal, hepatic failure). The preparation was administered at a rate of about 83 ml/h over 18 hours. Insulin was not used. Serum glucose concentrations were measured before the study and then for 24 hours at an interval of 6 hours. Results. Glucose concentrations were not found to exceed the allowable values in the majority of patients during CPN at the given rate. In 5 (16.7%) patients, short-term glucose increases up to 13.3 mmol/l were corrected, by decreasing the infusion rate. There was no hypoglycemia or other complications during CPN. Conclusion. Our findings suggest that three-in-one parenteral feeding is safe and causes no metabolic disturbances if simple principles are followed, the basic ones of which are to observe the intake of an adequate total dose and the rate of administration of nutrients. Key words: parenteral feeding, hyperglycemia, metabolic disturbances.

Objective: to estimate the perfluorane adsorption capacity of the drugs belonging to different pharmacological groups. Materials and methods. The binding of perfluorane to 50 drugs at concentrations of 12.5 to 100 ^M was studied in vitro using equilibrium dialysis. Results. Interactions of ligands with the particles of perfluorane emulsion were found to be of three types. Type 1 substances were characterized by negative affinity to perfluorane; type 2 ligands acted indifferently with the emulsion; type 3 compounds were reversibly adsorbed with the particles of the blood substitute by the affinity constants ( Kaff) of 104 M-1. Conclusion. The perfluorane adsorption capacity is ambiguous and seems to depend on the properties of ligands. Type 3 interactions, which may lead to an increase in blood adsorption capacity and change in the pharmacokinet-ics of drugs used in combination with perfluorane, appear to be the most important. Key words: perfluorane, binding, drugs, drug interactions.

Objective: to study hemodynamic changes and the development rate of adaptive reactions in patients with hypokinetic circulation during lung resections varying in volumes. Subjects and methods. Thirty-eight patients with hypo-kinetic circulation, who had undergone sublobar resections, lobectomies, and pneumonectomies, were examined. The values of hemodynamics and gas exchange were recorded at the basic surgical stages and in the early postoperative period (on days 1, 3, 7, and 10). Results. When the patient is placed in the lateral position, the lung is switched off, or the surgical pneumothorax is less than 10—12%, cardiac index changes generally fail to give rise to the decompensation of adaptive processes in the cardiovascular system if the volume of a surgical intervention does not exceed that of sublobar resections or lobectomies. A 15% or more change in cardiac index during controlled lung collapse even with the minimum volume of surgery is indicative of the breakdown of physiological adaptation processes and may manifest itself through the symptoms of cardiorespiratory decompensation in both intra- and postoperative periods. Conclusion. The patients with baseline poor, hypokinetic circulation need not only adequate preoperative estimation of central hemodynamic values, but also continuous intraoperative monitoring of the basic parameters of central hemodynamics. The magnitude of a reduction in cardiac index is prognostically important at the stage of one-lung ventilation during surgical pneumothorax. Key words: hypokinetic circulation, thoracic cancer surgery, central hemodynamic monitoring.

The review of literature considers the historical aspects and state-of-the-art of burnout in anesthesiologists-reanimatolo-gists and the factors leading to its development. Burnout is a state of emotional, mental, and physical exhaustion caused by prolonged stress in a stepwise manner through the mechanism for development of stress. Key words: burnout, anesthesiol-ogists-reanimatologists.

Proceedings of the Russia-Spain Symposium on Life Support in Critical States