[Comparision of stress response severity during intravenous, inhalation and combined anesthesia (inhalation plus local) for pituitary transsphenoidal adenomectomy].

Transsphenoidal pituitary surgery is usually accompanied by severe hemodynamic stress response which is hardly treated with fentanyl. The main goal of the study is to compare anesthetic methods for endonasal endoscopic transsphenoidal pituitary adenomectomy and single out the most effective way of reducing or preventing the stress reaction. 65 patients underwent endonasal endoscopic transsphenoidal pituitary adenomectomy. In all the patients general an- esthesia was induced with propofol. Analgesia was provided by phetanyl boluses. The patients were divided into three groups. In the first group of patients TIVA with propofol-TCI was used. In the second group of patients anesthesia was maintained by N20 plus sevoflurane. The third group of patients received an additional bilateral endoscopic mucosal 2% lidocain 5 ml infiltration of the pterygopalatine nerve branches zone. Pipecuronium was used for neuromuscular blockade. The simultaneous HR, ABP and metabolism increase were qualified as stress response. In the first and second groups of patients the maximum stress response was recorded on the stage of mucosal coagulation and on the opening of the blades of bivalve nasal speculum. No major difference in stress response severity was noted in these groups. In the third group stress response was significantly lower. According of the results of the study bilateral endoscopic mucosal lidocaine infiltration of the pterygopalatine nerve branches zone for anesthetic management of endonasal endoscopic transsphenoidal pituitary adenomectomy can be recommended.

[Correction of intracranial hypertension syndrome using hyperosmolar solutions in patients with severe brain damage (multicenter randomized clinical study)].

The paper presents the results of a muticenter study of the effect of 3 hyperosmolar solutions (15% mannitol solution, 10% sodium chloride solution, and the combined solution HyperHAES containing 7.2% sodium chloride and hydroxyethyl starch 200/0.5) on the value of intracranial pressure (ICP) (invasive ICP monitoring) and systemic hemodynamic parameters (PiCCOplus) in 94 clinical cases of intracranial hypertension (ICP more than 20 mm Hg) in 25 patients with acute cerebral pathology (severe brain injury, aneurysmatic subarachnoid hemorrhage). Intravenous infusion of the solutions was found to induce a reduction in ICP; however, this was most pronounced (by 30-40%) and longer (up to 4 hours) when HyperHAES solution was used. This solution produced not only an osmotic, but also hemodynamic effect.

[Effect of infusion therapy on central hemodynamics and the outcome of treatment in patients with subarachnoidal hemorrhages].

The study included 31 patients with constrictive and stenotic angiopathy (CSAP) that had developed due subarachnoidal hemorrhage. All the patients were operated on within the first 4 days after the moment of blood bleeding. Since the onset of CSAP, Groups 1 (n = 14) 2 (n = 17) received normovolemic and hypervolemic infusion therapy, respectively. In both groups, cerebral circulatory changes were found to depend primarily on cardiac productive parameters. The nature of infusion therapy had no impact on the results of treatment (according to the Glasgow scale). Hypervolemia used in such patients has no advantages over normovolemic water load when hyperdynamic circulation is created when inotropic agents are used.

[Use of computers for improving the activities of health facilities at industrial plants]. / Ispol'zovanie EVM po sovershenstvovaniiu raboty lechebnykh uchrezhdenii na promyshlennykh predpriiatiiakh.

The organizational and methodological aspects of computer application at treatment facilities serving the industrial enterprises are described. Some conceptions of operating the automated centre of mass medical examinations at Novomoskovsk tube plant are outlined. A methodological approach is suggested: the use of computer systems according to the number of industrial workers. Considerable reserves of improving the performance of treatment facilities serving the workers and employees of industrial enterprises are pointed out.