[Oxygen consumption in the lungs and systemic circulation--different methods of measurement of one data or different data?].

The article deals with calculation of oxygen consumption in the lungs by means of breathing gas mixture analysis and in parallel--in the systemic circulation by reverse Fick method; 32 paired measurements were performed in 8 patients after cardiac surgery with cardiopulmonary bypass. The mean pulmonary oxygen consumption was higher than the same value calculated by the reverse Fick principle--148.4 +/- 39.9 ml x min(-1) x m(-2) and 120 +/- 35.1 ml x min(-1) x m(-2), respectively, the mean difference between two methods was 28.4 +/- 18.4 ml x min(-1) x m(-2). However, in two observations the interrelation was inversed. While analyzing physiological and methodological reasons for these differences, the authors concluded that, despite both methods can be used in monitoring systemic oxygen transport in the critically ill, they are not interchangeable, and valuable additional data could be derived from fast changes in lungs oxygen uptake.

[Modern diagnostic approaches to malignant hyperthermia susceptibility].

Malignant hyperthermia is a well-known rare life-threatening autosomal-dominant pharmacogenetic disease, The arti- cle deals with a halothane-caffeine contracture test. The test is a model of muscle reaction to triggers in-vitro and it is the "golden standard" for malignant hyperthermia susceptibility (MHS) diagnosis. Genetic analysis is less invasive, but its sensitivity is significantly lower. The review discusses both the methods which are essential to be completely reproduced in Russia, and their role in modern approach to MHS diagnosis.

[Prediction of postoperative pain on the basis of the psychological characteristics of patients and standard pain stimuli].

Practical physicians do not have instruments for objective pain assessment despite recent advances of neurophysiology and pain pharmacology. The article deals with the study of relations between preoperative pain sensitivity (finger prick and venipuncture) and pain level after surgery. 60 patients involved in the study were divided into two groups. Pain sensitivity was assessed in all patients by visual analogue scale before surgery, after awaking, in 1 hour and in 3 hours after awaking and in 1 day after the surgery. Psychological status of patients was assessed by integration anxious test, neurotic disorders questionnaire and type of attitude to the disease questionnaire. All patients were assessed by 70 criteria (54 psychological). Results of the study show that postoperative pain syndrome is affected by different psychophysiological factors. Therefore it is difficult to forecast the level of postoperative pain syndrome.

[Options for remodeling of the right ventricular function during pneumonectomy].

UNLABELLED: The aim of the study---a comprehensive assessment of haemodynamic alterations during pneumonectomy using pulmonary arterial volumeter (PAV) opportunities. MATERIALS AND METHODS: 72 patients were included in the study, (the average age - 51 +/- 3,8 years, body weight - 68 +/- 7 kg), who underwent pneumonectomy about lung tumors under general anesthesia with separate ventilation (on indications - jet high-frequency ventilaton).

[Esophagoplasty in non-standard situations: an analysis of 130 observations].

An experience with 130 esophagoplastics in non-standard situations has been analyzed. In all patients there was defectiveness of one or several organs--potential donors, in 48 observations the operation being repeated. Decision on the plastic material had to be individual and required systematized approach: in 87 patients the jejunum was used, in 26 patients--stomach, in 9--colon and in 8--ileum. In 69 cases plasty was followed by surgical reconstruction and different variants of revascularization of the shifted or free intestinal transplant with using microsurgical technique. The transplant was located in the posterior mediastinum (56), antethoracally (40), retrosternally (23) or on the neck (11). Complete clinical effect was obtained in 125 patients (96.1%), plasty was not completed in 2 (1.6%), 3 patients died (2.3%). The authors are discussing the ways of achieving and conditions of success of plasty of the esophagus in non-standard situations.

[Rheography of extracorporeal circulation: verification of method and calibration of the monitor]. / Reografiia iskusstvennogo krovoobrashcheniia: proverka metoda i kalibrovka monitora.

Cardiopulmonary bypass as a reference flow model for impedance cardiography monitoring is described in 34 children during open-heart surgery. Such an approach not only proved the accuracy and precision of impedance cardiac output measurement, but also gave a possibility to make intra-operative calibration of any cardiac output monitor which maintains its accuracy during the post-bypass period.

[Thermodilution and rheography: the coincidence and reproducibility of results]. / Termodiliutsiia i reografiia: sovpadenie i vosproizvodimost' rezul'tatov.

A comparison of the pulmonary artery thermodilution and tetrapolar impedance cardiography of cardiac output measurements based on 312 dual determinations has shown a good general coincidence, but better reproducibility of the impedance cardiography data and more evident character of the errors and artifacts. The authors' analysis of the mechanisms and causes of such phenomena is based both on their own conclusions and on a wide spectrum of the data of previous investigations.

[Clofelin-fentanyl analgesia in adrenalectomy]. / Klofelin-fentanilovaia analgeziia pri adrenaléktomiiakh.

Anesthesia for adrenalectomy as exemplified in 60 patients is discussed. Anesthesia was based on a combination of fentanyl with a central adrenoagonist clofelin. This method supplemented by accurate hemodynamic monitoring ensures adequate analgesia without side effects on the hemodynamics.

[The combined use of fentanyl and clofelin in the anesthesiological support of adrenalectomy]. / Sochetannoe ispol'zovanie fentanila i klofelina v anesteziologicheskom obespechenii adrenaléktomii.

The analgetic effect of a combination of phentanyl and clonidine was investigated in 68 cases of adrenalectomy as an analgetic component of anesthesia. The analgesic potency of the used combination and stability of the autonomous functions were proved to be sufficient in surgical interventions for various types of adrenal tumors. It was found that the mechanism of the clonidine effect was not associated with vasodilatation and was based on its antinociceptive properties. The role of hemodynamic monitoring in prevention of possible complications and adverse effects of the described anesthetic technique was stressed.

[Operability and resectability of esophageal cancer]. / Operabel'nost' i rezektabel'nost' pri rake pishchevoda.

An experience with treatment of 193 patients with carcinoma of the thoracic part of the esophagus during the recent 7 years is generalized. A characteristic of oncological and functional operability in patients of this group is given. More than half of them were elderly (41.9%) and senile (12.4%) patients. Radical operative interventions were thought to be possible in 161 patients (83.4%). Resections of the esophagus in combination with esophagogastro-or esophagoenteroplasty were performed in 146 of them. Resectability was 90.6%. Postoperative lethality was 9.9%. For the last 2 years resectability had increased up to 96%, while the postoperative lethality had decreased to 4%.

[Standards of examination, anesthesia and postoperative care of surgical patients with concomitant cardiovascular diseases]. / Standarty obsledovaniia, anestezii i posleoperatsionnogo vedeniia khirurgicheskikh bol'nykh s soputstvuiushchei serdechno-sosudistoi patologiei.

The authors present the standards for postoperative care of patients with concomitant cardiovascular diseases used at Medical Center No. 122 in St. Petersburg. Special attention is paid to detailed assessment of cardiac function, continuity of the pre-, intra-, and postoperative cardio- and vasotropic therapy, and adequacy of anesthesiological protection as the main guarantee of an uneventful postoperative course. The authors consider it important that preoperative examinations include echocardiography and daily ECG monitoring; preoperative treatment is to include antibiotic prevention of infective endocarditis and heparin prevention of pulmonary artery embolism in the risk group patients. Alternative methods for intraoperative hemodynamic monitoring are pulmonary artery catheterization and integral rheography with the real-time data processing. The importance of regional anesthesia and the hazards of hypercorrection of the globular volume are emphasized.

[The factors affecting patient survival after esophageal resection with single-stage intrathoracic esophagogastroplasty]. / Faktory, vliiaiushchie na vyzhivaemost' bol'nykh posle rezektsii pishchevoda s odnoétapnoi vnutrigrudnoi ézofagogastroplastikoi.

Factors influencing the survival after resection of the esophagus with a one-step intrathoracic esophagogastroplasty were studied in 94 patients. In addition to the standard set of clinical data, under study were the parameters of central hemodynamics and external respiration functions. Risk factors of lethality were found. It was shown that the patient's age did not substantially influence the postoperative survival. Among the absolute contraindications to the one-step operation on the esophagus is the decompensation of cardiorespiratory functions and cachexia. The investigation of factors of risk of postoperative complications considered in groups allowed to pass to purposeful prophylactics of most probable of them.

[Resection of the esophagus with single-stage intrathoracic esophagogastroplasty]. / Rezektsiia pishchevoda s odnoétapnoi vnutrigrudnoi ézofagogastroplastikoi.

An experience with treatment of 152 patients with diseases of the esophagus who were subjected to resection of the esophagus with a one-step esophagoplasty is analyzed. A principally new approach is presented to the method of forming the gastric transplant, to choice of the level of the esophagus resection and to preoperative examination of the patients. Postoperative lethality was 9.9% with the complete absence of the esophageal anastomosis incompetence.