[Evaluation of muscle relaxant requirement for hospital anesthesia].

The rationale for cost-effectiveness of modern muscle relaxants (MR) administration in general anesthesia was evaluated. New MRs are more expensive than traditionally used pipecuronium and succinylcholine. However, the old MRs are often required as a block reversion with anticholinesterase medicines at the end of surgery, the longer artificial lung ventilation and observation in patients during recovery in intensive care unit. It was found that the district military hospital had done an annual average of about 900 general anesthesia assisted with artificial ventilation and muscle relaxation. About 2% of all anesthesias accrue to short-term anesthesia, the 27% to medium-term and 71% to long-term. 81% of the medium-term anesthesia accrue small hospitals. According to cost/effectiveness the most optimal muscle relaxants administration scheme for short-term (up to 30 min) anesthesia was mivacurium, for the operation of medium duration (30-120 min)--rocuronium, for long-term (120 min)--pipecuronium. An electronic form of annual report, which allows to obtain the necessary data for calculation of annual muscle relaxants demand and costs both in hospital and in the whole of the armed forces quickly, was developed.

[Effect of acute anemia on blood oxygen-transporting function during postsurgical period].

The retrospective study was undertaken to examine the impact of anemia developing during abdominal operations on oxygen transport and consumption. The concomitance of anemia and low reserves of the blood circulatory system was shown to be accompanied by obvious cardiovascular system tension. This appeared as the greater magnitude of tachycardia, metabolic disorders and is attended by high oxygen extraction. The paper shows it necessary to decide whether hemotransfusion should be made, by taking into account the compensatory capacities of the cardiovascular system, and not just hemoglobin levels.

[Effect of premedication on the formation of postoperative pain syndrome]. / Vliianie premedikatsii na formirovanie posleoperatsionnogo bolevogo sindroma.

The pronouncement degree and dynamics of pain syndrome were assessed after surgeries in the abdominal cavity organs with regard for a nature of the analgetic component of premedication and of the postoperative analgesic therapy (n = 155). The administration of analgesics before extra-traumatic surgeries was found to be compulsory in order to prevent the onset of a persistent postoperative pain syndrome. A combination of non-steroid anti-inflammatory drugs, i.e. ketonal, and of a high-efficiency agonist of opiate mu-receptors, i.e. bupranal, was acknowledged as most effective in coping with this task. It was demonstrated that the application of "the forestalling analgesia" by ketonal (100 mg in 30 min before the beginning of moderate- and mild-trauma surgical interventions and immediately after the finalization of such surgeries) contributed to an essentially lower pronouncement degree of the postoperative pain syndrome and made the administration of narcotic analgesics unnecessary. Finally, it is pointed out that promedol could not be regarded as a drug ensuring a safe prophylaxis of the central sensitization and hyperalgesia.

[Characteristics of hemodynamic reactions during various endoscopic surgeries for cholelithiasis in patients with concurrent cardiovascular pathologies]. / Osobennosti gemodinamicheskikh reaktsii pri razlichnykh variantakh éndovideokhirurgicheskogo lecheniia zhelchnokamennoi bolezni u patsientov s soputstvuiushchimi zabolevaniiami serdechno-sosudistoi sistemy.

A prospective study of 170 patients with concurrent cardiac pathology, who had underwent the laparoscopic cholecystectomy under the conditions of a tense carboxyperitomium, led to isolating two groups of patients with high-risk of intra- and postoperative unfavorable cardiac-vascular responses: an original high risk degree (III-IV classes according to ASA), a high value of cardiac risk indices according to Goldman (III-IV classes) and according to Detsky (II-III classes), a hypodynamic blood circulation regimen under rest conditions, and ejection fraction (according to echocardiography) amounting below 50%. Such patients are recommended to be operated on by laparolifting or by low-gas laparoscopy with a local lifting, i.e. by using the surgical techniques free of any negative effects produced on the carboxyperitomium hemodynamics, while all positive features of small-invasion surgery remain intact.