[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.

[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.

[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.

[Current anesthesia problems in minor proctological operations]. / Suvremenni problemii na obezboliavane pri niakoi malki po obem proktologichni operatsii.

Surgical interventions, performed routinely or on an emergency basis in the clinic of abdominal surgery are mostly proctologic. All patients operated in the clinic are analyzed with a special reference to the modern methods of analgesia used.

[Problems of postoperative drug analgesia in proctological surgery]. / Problemi na postoperativnoto medikamentozno obezboliavane v proktokhirurgiiata.

It is the purpose of this study to analyze all practical methods of analgesia in proctologic surgery. A new procedure of intravenous or subcutaneous fentanyl analgesia is proposed.

[The induction of lipid peroxidation in the serum of patients with acute peritonitis]. / Induktsiia na lipidna pereoksidatsiia v seruma na patsienti s ostur peritonit.

The level of lipid peroxidation products in the sera of patients with acute peritonitis and clinically healthy blood donors are studied. An increase in the level of TBA-reactive substances is documented in the acute peritonitis group--twice as high as compared to clinically healthy blood donors. Changes in the patients in toxic and terminal phases of peritonitis are rather significant. Following hemofiltration, the serum lipid peroxidation products are decreased in comparison with the pre-hemofiltration state.

[The level of lipid peroxidation products in the plasma of patients with acute pancreatitis]. / Nivo na produktite na lipidna peroksidatsiia v plazmata na patsienti s ostur pankreatit.

Plasma malondialdehyde level is studied in patients presenting acute pancreatitis. In those subjected to nonoperative treatment no statistically significant variations in MDA level, by comparison with the reference values, are registered. In patients undergoing surgery, a statistically significant increase in MDA, exceeding the uppermost limit of the reference values, is documented. The inference is reached that values above the reference ones (3.2 nmol/ml plasma) are usually interpreted as pointing to necrosis development in the pancreas.

[The determination of plasma malondialdehyde in patients with obstruction of the small intestine]. / Opredeliane na plazmeniia malondialdekhid pri patsienti s tunkochrevna obstruktsiia.

Plasma malonic dialdehyde (MDA) level is evaluated in 22 patients with small intestinal obstruction. Bowel strangulation is found in 14 cases-reversible in eight, and irreversible in six, and simple small-intestine obstruction-in eight. The plasma MDA level in this group of patients is compared with the one in a control group of twenty healthy individuals. In the control group MDA is 2.6 +/- 0.5 nmol/ml, in strangulation obstruction-6.9 +/- 1.5 nmol/ml, and in those with simple obstruction-2.8 +/- 0.4 nmol/ml. The difference in MDA level between strangulation cases and the other groups under study is statistically significant plasma MDA increase in patients with small intestinal strangulation may be successfully used for the purpose of diagnosis.

[The lipid peroxidation level and antioxidant status of the plasma in patients operated on under propofol (Diprivan) anesthesia]. / Nivo na lipidnata peroksidatsiia i antioksidanten status na plazmata na patsienti, operirani pod anesteziia s propofol (diprivan).

It has been investigated the level of lipid peroxidation and antioxidant status of blood plasma from patients operated under general anaesthesia with propofol (Diprivan). The following parameters have been registered: TBA-reactive substances (TBARS) and fluorescent lipofuscine-like lipid peroxidation products, before, directly after and 24 hours after anaesthesia. It was not shown statistically significant changes of TBARS before and after anaesthesia. The levels of TBARS were initially higher in comparison of referent levels. The fluorescent lipofuscine-like products were increased weakly after anaesthesia directly but the changes were not statistically significant, too. The antioxidant capacity of blood plasma was decreased weakly 24 hours after anaesthesia, in comparison of the levels, registered before anaesthesia. The good correlation between fluorescent products and antioxidant status of plasma was observed.

[Changes in the cell cycle of cultured lymphocytes from patients subjected to halothane anesthesia]. / Promeni v kletuchniia tsikul na kultivirani limfotsiti ot bolni, podlozheni na khalotanova anesteziia.

The effect of halothane anesthesia on the proliferative activity of peripheral blood lymphocytes was analyzed. Included in the study were 7 patients. Lymphocyte cultures were prepared by standard methods with blood samples obtained immediately before the operation, after the effect of halothane anesthesia was over and 24 hours later. 5-bromodeoxyuridine in concentration 10 micrograms/ml was used for labelling cells which had passed 1, 2 or more mitotic cycles within the cultivation time. Cell proliferation rate was evaluated by the proportion of metaphases from I, II and III mitotic cycle. Lymphocyte proliferation in the cultures was shown to be inhibited after halothane anesthesia. Inhibition was particularly strong in the first post-halothane sample, but kept on being strong also 24 hours later. The first mitotic cycle was markedly prolonged--to such a degree that subsequent cycles within the 72-hour cultivation period were fully absent. The results were discussed in the light of the overall effect of halothane in the process of its metabolism, its effect on DNA synthesis and eventual implication of additional immunologic mechanisms.

[The clastogenic effect of halothane on the lymphocytes from patients operated on under halothane anesthesia]. / Klastogenen efekt na khalotana vurkhu limfotsiti ot bolni, operirani pod khalotanova anesteziia.

The clastogenic effect of halothane anesthesia on peripheral blood lymphocytes from operated patients was studied. Chromosomal aberrations and sister chromatic exchanges in lymphocyte cultures of 7 patients were analyzed. Blood samples were obtained before the operative intervention, immediately after the effect of anesthesia was over and 24 hours later. To differentiate sister chromatids in the culture medium, on the 24th cultivation hour bromodeoxyuridine in final concentration 10 micrograms/ml was added. Increased incidence of structural chromosomal aberrations was recorded in lymphocyte cultures of patients after anesthesia--6.43 per cent cells with aberrations in the first post-halothane culture and 8.28 per cent in the second. Comparison of the cell affection index with the total number of affected cells revealed a continuous clastogenic effect pattern within the study period. Reliable evidence for induction of sister chromatid exchanges after the anesthesia was not found. The results were debated in the light of the possible mechanisms of clastogenicity of halothane anesthesia, the initial state of the patients and the consequences for them.

[The effect of general anesthesia and its components on free-radical processes]. / Vliianie na obshtata anesteziia i neinite komponenti na svobodnoradikalnite protsesi.

The problem of free-radical production in biological objects is discussed with emphasis laid on the influence exerted by general anesthesia and its components on free-radical processes. Free radicals are characterized by enhanced biological activity and potentiality to damage cellular structures and composition of the biological membranes, with changes in enzyme activity resulting in cell function and substance metabolism impairment. It is of interest to note the pro-oxidant effect of some anesthetics and drugs used in the course of general anesthesia. Contemporary multicomponent general anesthesia is accomplished with the aid of a large number of drugs, having different physico-chemical properties, and affecting directly or indirectly the processes of peroxide oxidation of lipids in the body. The role of antioxidants in eliminating the adverse sequels of lipid peroxide oxidation disorders id comprehensively discussed under a separate heading.

[The anesthesiological risk and treatment characteristics of patients with ischemic heart disease prepared preoperatively with beta-receptor blockers, calcium antagonists and nitro preparations]. / Anesteziologichen risk i osobenosti v lechenieto na patsienti s iskhemichna bolest na surtseto, podgotveni predoperativno s beta-retseptorni blokeri, kaltsievi antagonisti i nitropreparati.

The anesthesiologic risk in ischemic heart disease (IHD) patients undergoing noncardiac surgery is determined by the duration of myocardial infarction sustained in the past, and the degree (severity) of stenocardia manifestations. Such risk is estimated as minimal within six months after myocardial infarction in the presence of stenocardia stabilization. In this contingent of patients the anti-ischemic therapy is proceeded with in both pre- and postoperative period. The role of beta-adrenergic blocking agents (propranolol, acebutolol, esmolol, sotalol) and calcium antagonists (nifedipine, diltiazem) in the prophylaxis against intraoperative myocardial ischemia, rhythm disorders and pathologic arterial pressure rise is definitely proved.