[Inhalation anaesthesia and total intravenous anaesthesia for hepatic resections].

Recently number of surgeries in patients with pathology of the liver increases. Therefore optimal and safe anaesthetic management for these surgeries is very topical. The article deals with analysis of 51 anaesthesia cases: 26 cases (51%) of multimodal balanced anaesthesia with sevoflurane inhalation and 25 cases (49%) of multimodal balanced anaesthesia with continuous propofol infusion. Both techniques provide optimal anaesthetic protection, however sevoflurane use influences on the liver metabolism more significantly.

[Assessment of anaesthesia sufficiency and stress response during liver resections].

Recently number of patients undergoing a surgery for primary and secondary liver damages is increased. Thus an adequate and safe anaesthesiological care for the surgeries is a very actual problem. The article deals with a study of anaesthesiological care in 51 patients. 26 patients (51%) received multimodal balanced anaesthesia based on sevoflurane and 25 patients (49%) received multimodal balanced anaesthesia based on continuous propofol infusion. Monitoring of haemodynamics, acid-base balance, common liquid volume, intracellular and extracellular liquid, stress hormones (cortisol and prolactin) was carried out during the surgeries. Haemodynamics and infusion and transfusion therapy were adequate during both methods of anaesthesiological care for liver resections. Strongly marked tissue injury during surgery causes neuroendocrine stress. Cortisol activity during anaesthesia based on continuous propofol infusion was less than during anaesthesia based on sevoflurane. This fact shows that propofol provides stronger protection than sevoflurane. Adequate level of anaesthesia does not cause outoregulative mechanisms suppression which is important during strongly traumatic surgery. Anaesthesia based on sevoflurane both to anaesthesia based on continuous propofol infusion is a method of choice for liver resection.

[Anesthesia in obese patients]. / Osobennosti anesteziologicheskogo obespecheniia u bol'nykkh s izbytochnoi massoi tela.

Anesthesiological aids were analyzed in 70 obese patients undergone a total of 88 surgical interventions (in 1992 to 2002). This category of patients presented difficulties with tracheal intubation and gas exchange management at all stages of anesthesia and medication, which is associated with high chest rigidity, large distribution volume due to excess fatty tissue and serious comorbidity. The authors propose basic ways of solving the problems occurring with the use of fibrooptic equipment for tracheal intubation and suggest that short-acting agents with extraorgan elimination for induction and maintenance of anesthesia and special methods of artificial pulmonary ventilation (traditional volume-cyclic and jetwise high-frequency pulmonary ventilation) should be used to maintain effective gas exchange.

[Use of laryngeal mask in a female patient with expected difficult intubation, polyvalent allergy and high grade myopia]. / Ispol'zovanie laringeal'noi maski u bol'noi s ozhidaemoi trudnoi intubatsiei, polivalentnoi allergiei i vysokoi stepen'iu miopii.

Use of laryngeal mask in combination with gastric intubation permitted anesthesia for laparoscopic cholecystectomy in a female patient with disseminated osteochondrosis of the spine, expected difficult intubation, manifest polyvalent allergy, neurocirculatory dystonia of the hypertensive type, and high myopia. The risk of anesthesia was higher than surgical risk because of manifest concomitant diseases and aggravated anesthesiologic anamnesis. The operation was effective, anesthesia involved no complications, hemodynamics and gas exchange were stable, the patient awakened on the operation table and after recovery of adequate spontaneous respiration and muscular tone was transferred to resuscitation ward.