Objective. To choose the optimum technique of general anesthesia in the surgical treatment of patients with postinfarct left ventricular aneurysms (PLVA).

Materials and methods. Fifty-four patients operated on for PLVA were examined. They were divided into 4 groups according to the basic technique of general anesthesia: 1) intravenous anesthesia based on propofol and fentanyl; 2) inhalation sevoflurane anesthesia with fentanyl enhancement of the analgesic component; 3) inhalation isoflurane anesthesia with fentanyl enhancement of the analgesic component; 4) general anesthesia in combination with epidural blockade. Central hemodynamics was investigated by the thermodilution technique and the perioperative period was also studied.

Results and discussion. None of the general anesthesia techniques affected the development of perioperative complications. However, with decreased myocardial reserves, high thoracic epidural anesthesia should be applied with caution as it causes a significant desympathization, which may lead to impairments of the autoregulatory mechanisms of coronary blood flow and aggravate existing contractile disorders. Intravenous and inhalation anesthesia techniques provide a fair hemodynamic stability at all stages of surgical treatment. Inhalation anesthesia has a number of advantages: less cost and the possibility of rapid activation of patients in the early postoperative period.

Early changes in the parameters of central hemodynamics and pulmonary extravascular fluid were studied in patients who had sustained a severe concomitant injury in combination with acute massive blood loss. Early postoperative monitoring of these parameters by a «Pulsion Picco Plus» invasive monitoring apparatus was ascertained to verify the early stages on non-cardiogenic pulmonary edema, to assess a risk for acute lung lesion and acute respiratory distress syndrome in the phase of reperfusion lesions, and to perform an adequate correction of therapy.

The purpose of the study was to examine the time course of changes in the cellular composition of bronchoalveolar lavage (BAL) fluid to assess the possibilities of using the values of an endopulmonary cytogram (EPC) for the prediction of the development of infectious pulmonary complications and death in victims with severe concomitant injury. Sixty-three victims divided into 2 groups by the injury severity scale (ISS) (Beaker et al., 1974) were examined. For BAL sampling, a BF-XT40 endoscope (Olympus, Japan) was applied to bronchofibroscopy. To study BAL, the authors used the routine cyto-logical techniques and compared the latter’s results with those of EPC. The data were statistically processed, by employing the Statistica 6.0 programs; p Kozlov I. A., Poptsov V. N. Combined Therapy with Nitric Oxide and Surfactant-BL for Acute Respiratory Distress Syndrome After Operations Using Extracorporeal Circulation ….15 Abstract Выбрать Показать< /> The present study was undertaken to comparatively evaluate the efficacy of inhalational nitric oxide alone and in combination with surfactant-BL in the complex therapy for acute respiratory distress syndrome (ARDS) after surgery under extracorporeal circulation (EC). The study included 53 patients aged 21 to 76 years. It has revealed that in ARDS that complicates operations under EC, the use of surfactant-BL during therapy with inhalational nitric oxide enhances the latter’s effects on arterial oxygenation, accelerates the regression of pulmonary oxygenizing dysfunction, and reduces the duration of artificial ventilation and the length of stay in an intensive care unit.

The paper presents the results of a clinical trial of Surfactant-BL in adult patients with acute respiratory distress syndrome. Pulmonary biomechanics and gas exchange are shown to improve, the duration of respiratory support and the length of stay at an intensive care unit decrease, and the frequency of pyoseptic pulmonary complications reduces with early endotracheal administration of Surfactant-BL under artificial ventilation in acute respiratory distress syndrome.

The outcomes of treatment of aspiration damages to the tracheobronchial tree, by performing the goal-oriented endobronchial perfluorane treatment were analyzed in victims with severe brain injury. The specific features of the time course of pathological tracheal and bronchial mucosal changes were defined during the therapy performed. The determinants of the efficiency of endobronchial perfluorane therapy were determined in the treatment of tracheal and bronchial damages of aspiration genesis.

The outcomes of treatment of aspiration damages to the tracheobronchial tree, by performing the goal3oriented endo3
bronchial perfluorane treatment were analyzed in victims with severe brain injury. The specific features of the time course of
pathological tracheal and bronchial mucosal changes were defined during the therapy performed. The determinants of the
efficiency of endobronchial perfluorane therapy were determined in the treatment of tracheal and bronchial damages of aspi3
ration genesis.

Objective. To comparatively analyze pressure controlled ventilation (PCV) and pressure controlled and guaranteed vol3 ume ventilation (VAPS) in the postoperative period. 26 neonatal infants with various surgical diseases treated at the intensive care unit, N. F. Filatov City Clinical Hospital 13, were examined. According to the type of artificial ventilation (AV), the patients were divided into 2 equal groups. Groups 1 and 2 infants received VAPS and PCV, respectively.

The results indicated that for normal gas exchange, less oxygen concentrations may be used during VAPS than during PCV. The mean airways pressure during VAPS that provides adequate ventilation and satisfactory gas exchange is noticeably less than that during PCV. 

The paper presents the results of a comparative study of different methods for preventing respiratory distress after laparoscopic cholecystectomy. It shows the advantages of use of noninvasive assisted ventilation that ensures excessive positive pressure in the respiratory contour, its impact on external respiratory function, arterial blood gases, oxygen transport and uptake. A scheme for the prevention of respiratory diseases applying noninvasive assisted ventilation is given.

The present study was undertaken to evaluate the informative value of the parameters reflecting the severity of endotoxi-cosis in the early postoperative period in diabetic patients with generalized purulent peritonitis. Sixty-six patients were examined and treated. A follow-up assessment of biochemical, immunological, and hemodynamic parameters has established that the serum level of procalcitonin, the level of leukocytosis, the immunoregulatory index, the content of circulating immune complexes, the scores of the SOFA scale, and minute circulatory volume are the most sensitive and specific markers of the severity of endotoxicosis. They show a low frequency of false-positive results, a high prognostic value of positive results, and a low prognostic value of negative ones.

The paper contains information on the currently available methods for intensive care for acute myocardial infarction (AMI), by using hyperbaric oxygenation (HBO), antihypoxants, and antioxidants. The presented information is based on the data available in the literature and on the results of the authors’ own studies made in 428 patients with AMI, in whom the time course of changes was determined in blood gas and in the biochemical parameters characterizing energy metabolism and free radical lipid peroxidation. Along with the conventional treatment (thrombolysis, restriction of a necrotic area, myocardial hemodynamic unloading, Labori mixture, anticoagulants, disaggregants, etc.), multimodality therapy for AMI used HBO sessions and antioxidants. The studies have provided evidence that it is possible and expedient to effectively and safely use HBO in AMI. Criteria for selecting the patients to undergo HBO, the time of its use, the choice of barotherapy regimes, and the nature of concomitant therapy are given. The application of the currently available methods for intensive care for hypoxia in AMI (HBO in combination with antihypoxants and antioxidants) can reduce the length of stay at hospital and in resuscitative and intensive care units and considerably decrease mortality rates.

Objective: to determine the sensitivity and specificity of combined stress echocardiography (EchoCG) using dipyri-damole and dobutamine in diagnosing and defining the extent of stenotic coronary lesions in coronary heart disease (CHD) in a group of critically ill patients who are unable to perform a physical exercise.

Materials and methods: the study included 57 male patients with suspected acute coronary syndrome who underwent stress EchoCG using dipyridamole in high doses in combination with dobutamine, as well as coronary angiography.

Results: stress EchoCG could bring up to the diagnostic criteria in all the patients, of whom 9 patients were found at coronary angiography to have no coronary lesion, 34 and 14 patients had one- and many-vessel lesions, respectively. The sensitivity and specificity of combined stress EchoCG were significantly higher than those of EchoCG used in the diagnosis of CHD.

Conclusion: stress EchoCG using dipyridamole in combination with dobutamine is a highly informative safe noninvasive technique for diagnosing CHD, its helps to identify patients with atypical acute coronary syndrome and to form a group of patients to be subject to urgent coronarography and angiosurgical intervention. The pattern of segmental contractile disorders at the height of exercise during combined stress Echo-CG makes it possible to define the site of stenotic coronary atherosclerosis with 97.3% sensitivity and to diagnose many-vessel lesion with 100% sensitivity and 100%specificity.

Objective. To present currently available information on the use of transpulmonary thermodilution, a new type of volumetric monitoring of hemodynamics.

Materials and methods. The data available in the Russian and foreign medical literature on this problem are analyzed.

Results. In the past recent years, transpulmonary thermodilution has come into wide use in modern anesthesiology and reanimatology, including during aortocoronary bypass surgery, correction of cardiac defects, and cardiac transplantation. The values obtained by transpulmonary thermodilution correlate with the results of other monitoring methods and can extend the capabilities of diagnosis of systemic and pulmonary hemodynamic disorders. The introduction of therapeutic algorithms based on the results of volumetric monitoring makes it possible to perform intensive therapy of cardio-surgical patients purposefully (infusion load, inotropic and vasopressor support, use of diuretics), which can improve a clinical outcome.

Conclusion. The use of transpulmonary thermodilution-based volumetric monitoring during cardiosurgical interventions assures adequate control of the values of preload, myocardial contractility, pulmonary circulation, and vascular tone, which allows one to develop a differential approach to correcting hemodynamics in the perioperative period.