[PERIOPERATIVE CARE FOR PATIENTS WITH UNDERLYING ARTERIAL HYPERTENSION (CLINICAL GUIDELINES)].

These clinical guidelines apply to the implementation of health care for all patients with concomitant hypertension in the perioperative period in a hospital. The guidelines specify the method of stratifying the risk of perioperative cardiac complications. We described methods for the treatment of urgent conditions with hypertension and hypertensive crises and identified the main features of the preoperative evaluation and preparation of patients with concomitant hypertension. The clinical guidelines contain recommendations on the management of intra- and postoperative period

[Reversion of sedation and general anaesthesia--agonist-antagonist technique].

OBJECTIVE: To study an expediency and efficacy of application of different reverses drugs (naloxone, flumazenil, neostigmine, galantamine, sugammadex) either their separate or combined using. METHODS: We studied 119 patients underwent endoluminal endoscopic procedures and surgeries on trachea-bronchial tree and intestines under sedation or general anaesthesia. RESULTS: The article deals with conceptual approaches to the reversal of residual effects of opioids, benzodiazepine sedation and neuromuscular block (the so-called agonist-antagonist technique). CONCLUSIONS: A reversion of neuromuscular block without using of antagonists' combination does not provide complete recovery of psychomotor and cognitive functions for rapid socialization of patients after anaesthesia.

[Intubating laryngeal mask efficacy in obese and overweight patients].

UNLABELLED: We evaluated the Intubating Laryngeal MAsk (ILMA Fastrach) efficacy for airway management, ventilation and blind intubation in obese and overweight patients. Methods. 50 adult patients (22 men and 28 women) with predicted difficult trachea intubation (PDTI), undergoing general anaesthesia with ILMA were included in this study. ILMA was selected according to gender: ILMA No 5 for men and No 4 for women. PREMEDICATION: diazepam and H,-blockers. Anaesthesia induction: midazolam 0. I - 0.15 mg/kg, propofol 1.6-2.5 mg/kg, fentanyl 0.1-0.15 microg/kg, rocuronii bromide or atracurii besilate 0.6 mg/kg. RESULTS: 21/2/3 patients had morbid obesity with BMI over 40/45/55 kg/m'. 5 and more difficult trachea intubation (TI) predictors were found in 48 patients. The ILMA was placed successfully at the first try for 7.2+/-2.9 sec in all patients. Ventilation was successful in 100% of cases; TI via ILMA - in 94% of cases (90% - at the first try). Total TI time was 7,5+/-4,8 sec, ILMA removal time - 9,2+1,5 sec. 2 patients had 2 or 3 DTI predictors, but conventional TI was unsuccessfild; TI via ILMA was performed at the first try. There was one "can't intubate, can't ventilate" case, TI via ILMA was made at the first try. TI via ILMA was unsuccessful in 3 patients, ILMA was replaced by Proseal LM or Supreme LM, TI was performed conventionally. There were no complications observed. CONCLUSION: ILMA Fastrach was used successfiully in obese patients with PDTI for both ventilation and TI. Technique is simple in training, but a preliminary experience is essential for ILMA use in difficult cases.

[Characteristics of perioperative period in Xenon-based combined general anaesthesia in neurosurgery].

Neuroprotection could be the aim to use Xenon for general anesthesia. However the experience of Xenon anesthesia in neurosurgery is quite limited. The appraisal of Xenon based anesthesia was accomplished in 12 patients during various brain surgery. Xe in concentration 65% was used to maintenance of anesthesia, other medication was avoided. As a resuIt there were 8 cases of arterial hypertension and 2 cases of superficial hypnotic state. Excitation (n = 3), hyperdynamic reaction (n = 8), PONV (n = 8) were detected in early postoperative period. An analysis of this study suggests a conclusion that studied method of Xenon-based anesthesia is inexpedient for neurosurgery.

[Successful anaesthesia for abdominal reconstructive surgery in a myasthenia gravis patient].

This article presents a clinical case of colon disease surgical treatment in a 34-year old patient with. generalized myasthenia. Perioperative management peculiarities in these patients are clarified. Different approaches to anaesthesia choice were discussed on a case study. The importance of tactics individualization, rational drugs selection, including neuromuscular block reversal agents as well as intraoperative neuromuscular transmission monitoring.

[Respiratory support in anaesthetic management for thoracic surgery and their comparative characteristics: over 2000 anaesthesia experience].

The article deals with the first comparative study of haemodynamics, gas exchange, and metabolic lung finction in patients with underlying respiratory and cardiovascular diseases. Different anaesthesia and ventilation (conventional AVL, OLV differentiated ALV) techniques were used. Respiratory support methodology with the use of HFV or CPAP during the main phase of thoracic surgery in patients with severe associated cardio-respiratory diseases was developed. Indications for differentiated AL V in thoracic surgery were developed.

[Paracetamol (perfalgane) as analgesic component of medicinal sedation].

This article reviews the possibility of the use of paracetamol (perfalgane) as an analgesic component of medical sedation. The actuality of the problem is the choice effective pharmacological means of protection from peri-operative pain. The theoretical advantages of paracetamol in the scheme of sedoanalgesia are exquisite. We describe a personal experience of efficacy assessment and safety of paracetamol as an analgesic component of the methodology of drug sedation for bronchoscopy in the early postoperative period. We compare analgesia by the means of paracetamol 1000 mg (IV) and tramadol 100 mg (IV). The sedative agent in both groups was midazolam. It turned out, that despite the high efficacy of tramadol as a component of sedoanalgesia, the quality of anialgesia when using perfalagane is almost 5 times higher, both due to the significant number of good results, and to reduced number of adverse events. Use of paracetamol (Perfalgane) instead of tramadol for medical sedation during fibrotracheoscopy in patients in the early postoperative period leads to better quality of analgesia, thus avoiding such undesirable phenomena as hypersedation, respiratory depression, dizziness, and nausea.

[Nutritional status, anesthesia and early postoperative complications in patients with radical operations on the esophagus].

The material of the research were 63 patients operated on benign strictures and esophageal cancer in the RSCS after B.V. Petrovsky. We studied the occurrence and the character of postoperative complications, dependence on initial nutritive (alimentary) status and anesthesia techniques. The main postoperative complications were of respiratory system and cardiovascular insufficiency and mainly depended on the initial degree of nutritive and used anesthesia techniques. No significant difference in the structure of postoperative complications for the patients with benign and malignant diseases of esophagus has been identified.

[Cholinesterase blockers in anesthesiology: a replenishment of former arsenal].

Cholinesterase blockers are widely used in various fields of clinical medicine. In anesthesiology they are used for the means of decurarisation, as well as for performance of central segmental blockades. In recent years, along with the most frequently used neostigmine again an opportunity arose to use the well-known galantamine. A brief overview of the pharmacological properties of galantamine is completed by the study of its efficacy and safety in 30 patients (first group) who underwent general anesthesia with total myoplegia at a range of abdominal surgeries. The comparison group (second group) included 30 patients who were applied neostigmine. The method of clinical functional evaluation, the accelerometry and frontal electromyography confirmed that galantamine although inferior to neostigmine in efficiency, has a higher safety threshold.

[Problem of neuromuscular block reversion: neostigmine and sugammadex].

The review covers the history of neuromuscular block reversal. It states that indications for decurarization have been changed due to the extremely high rate of residual curarization even after the use of average-acting myorelaxants. The paper provides the pharmacological characteristics of sugammadex, a new selective relaxant-binding agent for aminosteroids (rocuronium and vecuronium) with the unique mechanism of action. It also gives data on the efficacy and safety of sugammadex versus anticholinesterase agents and estimates the prospects for its clinical application.

[Effect of propofol-based combined anesthesia on the development of adaptive mechanisms to the prolonged one-lung artificial ventilation].

The paper deals with the assessment of the adequacy and safety of multicomponent anesthesia based on propofol at lung surgery requiring one-lung ventilation (OLV) in patients with chronic respiratory diseases and with the evaluation of the effect of propofol on the development of adaptive mechanisms in various ventilation modalities in thoracic surgery. The pressor, resistive, and volume characteristics of pulmonary blood flow, systemic and intracardiac hemodynamics under artificial ventilation (AV) and OLV of a duration of up to 1.5 hours by a combination of pulmonal and transpulmonal thermodilution on a PiCCO plus device with a VOLEF attachment were compared. Multicomponent balanced anesthesia based on continuous graduated propofol infusion provides adequate protection of patients during thoracic operations, including those with concomitant respiratory abnormality.

[Drug sedation during digestive tract endoscopy: current trends].

The paper considers whether ketofol, a mixture of ketamine and propofol, may be used for medical sedation. Prerequisites for designing this mixture are identified. The foreign experience with ketofol is analyzed. The authors' study evaluating the clinical efficiency of a ketofol-based sedation procedure during endoscopic interventions into the digestive tract (n=152; 94 males and 58 females) is described. Ketofol was found to reduce the use of drugs and a need for additional analgesia, by exerting a minimum depriming effect on respiration and blood pressure. A ketamine/propofol ratio of 1:4 is optimal for drug sedation at digestive tract endoscopy; with this ratio, ketofol has sufficient analgesic properties and a stabilizing hemodynamic effect. With the higher mass fraction of ketamine in the mixture, its controllability reduces. Overall, the mixture of ketamine and propofol has proved to be a safe and effective sedative; its use provides not only a good position comfort, possible avoidance of opioids, and no effect of ketamine on psychomotor recovery, but also a more controlled sedation than when these agents are used in the same doses alone.

[Efficacy and safety of sevoflurane in various anesthesia modes (according to the results of a multicenter study)].

The paper presents the results of the limited multicenter sevoflurane study initiated by Abbott Lab, which was conducted in 2006. The study was undertaken to examine the efficacy and safety of sevoflurane in various anesthesia modes in patients (ASA I-III) with surgical diseases during surgical interventions into abdominal and thoracic organs and lower extremities. The study covered 96 patients. The analysis indicates that the use of sevoflurane for mask induction and anesthetic maintenance is possible and safe for patients with ASA I-III.

[Use of the epiglottic airway I-gel during anesthetic maintenance: first clinical impressions].

The paper gives a concise account of the evolution of epiglottic airways and the emergence of the new product of this class--I-gel (Intersurgical, United Kingdom). It outlines the structural features of I-gel and the authors' experience in using the latter to maintain airway patency during anesthetic maintenance in 34 patients. Based on a review of the scanty data available in the literature on this airway and their clinical experience, the authors come to the conclusion that there is a great variety of I-gel inherent positive characteristics that make this airway highly promising for the needs of current anesthetic maintenance and, possibly, resuscitative care. The authors consider it expedient to expand the use of I-gel to specify the evaluation of its efficiency and competitive capacity of the epiglottic airways that have already well shown themselves.

[Use of different types of target propofol concentration-control infusion: theoretical and practical aspects].

Examinations were made in 105 patients who had undergone total intravenous anesthesia on the basis of the immune circulating components (ICC) of propofol by different pharmacokinetic models--Marsh and Schnider, by aiming at plasma or an effector zone. Along with good controllability of ICC-anesthesia, with theoretical and practical differences of the employed models are shown. The capacities of an up-to-date universal perfusor are demonstrated, by using Asena PK as an example. Practical recommendations on its application are given. The prospects of anesthesia automation are briefly discussed.

[Use of average-acting nondepolarizing myorelaxants in abdominal surgery].

The efficiency and safety of use of average-acting nondepolarizing myorelaxants, such as atracurium, vecuronuim, rocuronium, and cisatracurum, during abdominal surgical interventions under general anesthesia (combined or total intravenous anesthesia) were investigated in 162 patients. There is evidence that the use of the above agents ensures a qualitative myorelaxation during different types of operations (laparoscopic and laparotomic) and no impact on hemodynamics (according to the data of continuous non-invasive monitoring) allows these myorelaxants to be used in patients with concomitant cardiovascular diseases. Rocuronium is the myorelaxant of choice for rapid tracheal intubation. The high degree of predictability of the duration of an effect produced by atracurium and cisatracurium enables these myorelaxants to be used without monitoring neuromuscular conduction. With the equally good quality of myoplegia and with virtually comparable consumed diseases, the infusion procedure of relaxation maintenance is preferable for early activation of patients. Insignificant effects on histamine release make it possible to use vecuronium, rocuronium, and cisatracurium in patients with the compromised immune system.

[Analysis of complications and the problem of airtightness of the respiratory contour during the use of laryngeal masks in children]. / Analiz oslozhnenii i problema germetichnosti dykhatel'nogo kontura pri ispol'zovanii laringeal'noi maski u detei.

Feasibility of adequate gas exchange in artificial lung ventilation (ALV) through laryngeal mask (LM) is investigated in view of high occurrence of leakage of the respiratory contour. Adequate anesthesiological techniques of LM usage are proposed. It is shown that airtightness at the site of LM cuff contact with the upper larynx is not complete. The magnitude of respiratory mixture loss in audible leakage permissible for adequate ventilation and gas exchange is estimated.

[Prevention and treatment of postoperative nausea and vomiting (results of a multicenter study)]. / Profilaktika i lechenie posleoperatsionnoi toshnoty i rvoty (analiz rezul'tatov mul'titsentrovogo issledovaniia).

Described in the paper are the results of a multicenter study that was conducted at 11 health-care facilities of the Russian Federation and that was based on an analysis of 623 medical records of adult patients operated on with general anesthesia of different variations. There were 154 (24.7%) males and 469 (75.3%) females, aged 16 to 90. The study denoted the need in and possibility of preventing and arresting the PONV; it also outlined those forms of ondansetron (Zofran) that can be used for the purpose, they are: parenteral and lingual pills and rectal suppositories. An assumption was put forward on the significance of PONV conductive factors and on the most effective forms of ondansetron from among the mentioned above. An understanding, resulting from the study, on that PONV is of the multietiology nature and on that its probability increases in proportion to a compatibility of provoking factors, like sex, surgery technique as well as duration of anesthesia and its variation is of importance. The efficiency of medicamental prevention of PONV by a blocker of HT3-receptors, i.e. by ondansetron (Zofran), is to a great extent predetermined by that if the form and, probably, dose of the drug is in line with a combination of the above factors, which needs further research.

[Optimization of anesthesiological maintenance of x-ray surgical interventions in children]. / Optimizatsiia anesteziologicheskogo obespecheniia rentgenokhirurgicheskikh vmeshatel'stv u detei.

Two procedures for intravenous anesthesia during X-ray surgical interventions were evaluated in 38 children aged 3 to 13 years. Initial anesthesia (with intramuscular midazole and ketamine), followed by the fractional use of the latter agents in Group 1 and propofol in Group 2, in order to maintain anesthesia. Blood pressure (BP) (noninvasively), heart rate (HR), SpO2, and respiratory rate (RR) were monitored. After the initial anesthesia, mean BP (BPmean) increased by 40 and 24% in Groups 1 and 2, respectively. So did HR by 23 and 31%, respectively. In Group these changes retained throughout the basic stage of intervention. In Group 2 on propofol infusion, BPmean and HR returned to normal values and remained at this level till the end of the intervention, SpO2 and RR did not differ from the baseline values in both groups. Thus, a combination of intravenous ketamine and intramuscular propofol provides steady-state values of BP and HR at the basic state of X-ray surgical intervention in children, which increases the reliability of studies and surgical safety in patients.