[Mechanic reinfusion in emergency surgery].

The article highlights techniques and effects of intraoperative mechanic blood reinfusion in patients with trauma and intraabdominal bleeding in extend, exceeding the self circulating blood volume. The high efficacy of the self blood reinfusion during the emergency operation allowed the 2-fold decrease of the hospital and overall mortality. The mechanic blood reinfusion proved to be a safe and clinically effective method of the globular blood volume deficiency compensation, especially in emergency surgery.

[The intraoperative auto- and allohemotransfusion by massive bleeding in emergency abdominal surgery].

The results of intraoperative hemotransfusion of 112 patients with abdominal injuries, complicated with bleeding and the loss of more then 70% of the circulating blood. The aim of the study was to compare the efficacy of auto- and allohemotransfusion. The first method allowed to decrease both the overall lethality (p=0.039) and postoperative lethality (p=0.018). The odds ratio by the predominate autohemotransfusion was 1.385 (95% 1.101-1.741), where as the odds ratio by the predominate allohemotransfusion was 0.403 (95% 0.183-0.885; p=0.011).

[Effect of intraoperative infusion-transfusion therapy on mortality of patients with massive blood loss].

The aim of the research is to determine the influence of infusion-transfusion therapy of the volume and structure on intraoperation and hospital lethality in patients with injuries and diseases, complicated in blood loss, exceeding circulating blood volume (CBV). It was conducted a retrospective analysis of the anaesthesia flow, infusion-transfusion therapy and treatment results in 112 patients with injuries and diseases complicated in intra-abdominal bleeding, volume of more than 4 liters. It was found that the risk of death increases in low-volume infusion therapy (less than 1.5 volume of blood), use of the maximum permitted doses of colloids, high speed of infusion therapy. Adverse factors of intraoperative transfusion: the lack of intraoperative compensation erythrocytes(less than 50% of the lost), ones transfuse more than 2 standard doses of the donor's erythrocytes and large volumes of fresh frozen plasma (FFP).

[Optimization of preoperative preparation of patients with acute intestinal obstruction].

Water and electrolyte imbalance is considered to be the mainstay of preoperative treatment of patients with acute intestinal obstruction. The correct preoperative preparation defines the anaesthesia course, which requires the team work of surgeon and aneasthesiologist. The benefits of such an approach is confirmed by the retrospective analysis of 84 case histories, operated on the reason of the acute intestinal obstruction. The rational combination of colloid and crystalloid solutions was jointly selected, which allowed to decrease the need of vasopressor use and minimized the ICU and overall hospital stay.

[Automatic blood reinfusion in intraabdominal bleedings].

147 patients with polytrauma, complicated by acute large-volume intraabdominal bleeding, were included in the study. Anesthetic regimens and blood loss compensation were retrospectively analyzed. Thus, all patints were divided inti 3 groups: 1st group received only intraoperative blood reinfusion, 2nd group - got auto- and donor blood reinfusion, 3rd group had only donor blood transfusions. Intraoperative autoblood reinfusion allowed an adequate blood loss compensation. The method should be considered a method of choice by acute blood loss treatment during emergency operations in patients with polytrauma.

[Compensation for circulating blood volume in fatal blood loss].

Despite the extended potentials of modern medicine, noncompensated blood loss remains one of the leading causes of death in the able-bodied population all over the world. At present, there is no uniform policy of transfusion maintenance and intensive care in victims with severe decompensated blood loss. The purpose of the study was to assess the results of compensation for acute blood loss in victims with concomitant injury and wounds at various sites, which were attended by the loss of a circulating blood volume (CBV) with the use of new technologies. The authors retrospectively assessed the specific features of the course of anesthesia and compensation for blood loss in 66 male victims (mean age 37 +/- 1.5 years) with concomitant injury and various wounds complicated by acute CBV loss. CBV was compensated for by the currently available infusion media; globular blood volume deficit was restored via intraoperative instrumental reinfusion of autoblood and donor blood. The proposed procedure for infusion-transfusion therapy made it possible to stabilize the patient's condition and to perform emergency surgical treatment in victims with fatal blood loss. Total mortality in the chosen intensive care modality was 62.1%.

[Anesthetic provision of emergency surgical interventions].

Anesthetic provision of emergency surgery has a number of organizational and methodic features. The paper describes general principles in the organization of work of a team of emergency anesthetists. It also considers the problems of preoperative preparation, the choice of an anesthesiological procedure, and the tactics of intraoperative management of patients operated on, if there are emergency indications. Particular emphasis is laid on life-threatening stages of anesthesia.

[Role of starch preparations in the intraoperative correction of hypovolemia in patients with large-size uterine myomas].

The course of anesthesia during uterine extirpation for large and giant myomas depends on the efficiency of blood loss compensation and relative hypovolemia after rapid decompensation when a mass is removed. Thirty-five patients with a uterine myoma with the size corresponding to 18-40-week gestation were examined. Dextrans and voluven (hydroxyethylstarch 130/0.4) were used in Groups 1 (n = 20) and 2 (n = 15). The intraoperative administration of voluven reduced the volume of crystalloids and a need for sympathomimetics and maintained the normal amount of fluid and sectoral distribution.

[Cerebral metabolism and the exchange of biogenic amines in the brain of patients under various types of anesthesia in the surgery of intracranial aneurysms].

During intracranial surgical interventions, the major tasks of an anesthetic procedure are to maintain cerebral perfusion, adequate oxygen delivery, and brain tissue metabolism at all surgical stages. The authors have compared cerebral metabolism and the exchange of biogenic amines that regulate cerebral oxygen consumption and cerebral blood flow, by using neuroleptic anesthesia and balanced anesthesia on the basis of enflurane during operations on intracranial vessels. There is evidence for the equal efficiency of both types of anesthesias and for a unidirectional impact on the body's neurohumoral systems.

[Anesthetic support of operations on the hip joint in senile patients].

The impact of spinal anesthesia on a surgical stress response during prosthetic repair of the hip joint was studied in 56 senile patients (mean age 76 +/- 2.1 years). Hemodynamic changes, the time course of fluid distribution in different sectors, the activities of sympathoadrenal, cholinergic, serotoninergic, and histaminergic systems were analyzed. Studies were conducted in 4 steps: before a planned operation, before anesthesia, after the end of surgery, and 24 hours after intervention. The characteristic features of hemodynamic changes were elevated left ventricular filling pressure and high specific peripheral resistance, which was regarded as signs of latent heart failure and age-related vascular tone regulatory changes. Involutional tissue processes in senile patients appeared as decreased water levels in the cellular sector. The patients' sympathoadrenal and enterochromaffin systems were in a state of hypofunction. The adequacy of anesthesia supports no trend in the study neurohumoral regulatory parameters. The low level of hormones and mediators confirms the true depletion of the neurohumoral regulatory system.

[Cardiac arrhythmias during coronary bypass surgery without extracorporeal circulation].

Ventricular arrhythmias are recorded in most patients at coronary bypass surgery without extracorporeal circulation. The stages, such as the pulling of the sternal edges apart, the opening of the pericardium, the revision and dislocation of the heart, and revascularization of coronary arteries, are most dangerous due to the fact that they may lead to the development of arrhythmias. The major proarrhythmogenic factors at coronary bypass surgery without extracorporeal circulation are mechanical irritation of reflexogenic areas and myocardial ischemia, the mechanical factors playing the leading role in the development of ventricular arrhythmias.

[Noninvasive assisted lung ventilation during ambulatory laparoscopic cholecystectomy]. / Neinvazivnaia vspomogatel'naia ventiliatsiia legkikh posle laparoskopicheskoi kholetsistéktomii v usloviiakh otdeleniia khirurgii "odnogo dnia".

Both obstructive-restrictive respiratory disturbances along with hypercapnia and oxygen consumption rate and respiratory quotient increasing were proved to follow laparoscopic cholecystectomy. Non-invasive pressure assisted lung ventilation decreased the extent of both respiratory and metabolic deviations and provided the restoration of normal breathing pattern for 24 hours.

[Risk factors of atrial fibrillation after aortocoronary bypass surgery with extracorporeal blood circulation]. / Faktory riska fibrilliatsii predserdii posle operatsii aortokoronarnogo shuntirovaniia s iskusstvennym krovoobrashcheniem.

Fibrillation of the atriums is registered in 20-40% of cases after the surgery of direct revascularization of the myocardium and runs alongside with impairments that are life-menacing. Seventy-six (76) patients were examined after direct revascularization of the myocardium, including 20 subjects with paroxysms of atrium fibrillation. The arrhythmia-related risk was shown to be increasing in persons (older than 60) with an impaired left column of the left coronary artery, in unstable angina pectoris diagnosed before surgery, malfunction of the left ventricle and in case of a rapid warming-up of a patient after the artificial blood circulation with cold cardioplegia is over.