[Selection of inhalation anaesthetic when low-flow anaesthesia with automated control].

Selection of inhalation anaesthetic when low-flow anaesthesia with automated control. A comparative evaluation of low-flow (0,5 l/min) and inhalation anaesthesia with sevoflurane and desfluranom with automated control of the concentration of inhaled anaesthetic on the exhale (Et-control), with the use of advanced monitoring in 76 patients operated on for the pathology of the spine and spinal cord is given. It was found that when using continuous measuring the achievement of the target concentration of the anaesthetic sevoflurane is faster in the group. Total consumption of desflurane was two times higher. Hemodynamic, SPI index were stable at all stages of the operation in both groups.

[Mass-spectrometric control of compound A during minimal flow anesthesia and its influence on liver and kidneys functions].

The article contains results of mass-spectrometric control of sevoflurane and compound A concentrations during inhalation anesthesia with minimal flow (< or = 0.5 l/min) and its influence on liver and kidney function. 40 patients (ASA I-II) were included in the study. Transsphenoidal pituitary adenomectomy was performed in all cases. Patients didn't have any signs of liver or kidneys disfunctions preoperatively. We used quadrupole mass spectrometer "Prisma Plus" (Pfeiffer vacuum, Germany) to determine the real time concentration of sevoflurane and compound A. Intensity of m/z = 131 peak sevoflurane and m/z = 128 peak compound A were registered. Laboratory blood tests to assess liver and kidney function were carried out before anesthesia, after anesthesia, and on the 1st day after anesthesia. They included: AST, ALT, total bilirubin, total protein, urea, creatinine. Quantitative analysis of the compound A and blood test before and after anesthesia showed only a tendency to increase biochemical markers levels within normal range, except small, but significant, AST elevation and total protein reduction in postoperative period. We concluded that maximal registered level of compound A (275 ppm/h) during minimal flow anesthesia didn't associate with significant liver and kidneys injury in healthy patients.

[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.

[Mass-spectrometric investigation of degradation of the inhalation anesthetic sevoflurane in flow anesthesia].

The highest concentration of the Sevoflurane degradation product in the gas mixture was 65 ppm. Biochemical analysis did not reveal any nephro- and hepatotoxic effect.

[Analysis of sevoflurane stability during low flow anesthesia].

Using the mass spectrometric method we studied the interaction of volatile anesthetic sevoflurane with a CO2 absorber during low flow anesthesia (0.5 l/min fresh gas mixture). The results of measurements of sevoflurane and one of the most toxic breakdown products of sevoflurane CF = C(CF3)-O-CH2F (substance A) throughout the anesthesia in the mode of inhalation-exhalation. The highest recorded concentration of substance A was 65 ppm. Biochemical analysis of blood before and after anesthesia did not show connection with nephropathy and function of liver toxicity.

[Is it time to improve nursing training in anesthesiologic and resuscitative care?].

The paper presents the author's thoughts of the formation, development, and state-of-the-art of the problem in continuous postgraduate nursing training in the specialty of Anesthesiology and Reanimatology, as well as specific proposals of its improvement.

[Improvement of equipment for anesthesiological and resuscitation monitoring in military hospitals].

Contemporary state and trends in further improvement of equipment for anesthesiological and resuscitation monitoring are considered on the bases of multiyear experience in the use and upgrade of this equipment in military hospitals of the USSR and RF. The developed and implemented policy and concept of technological engineering support of military anesthesiology and resuscitation allowed the priority directions to be determined and a number of its mane applications to be realized in military hospitals. Analysis of technological engineering support of anesthesiology and resuscitation equipment carried out in 2002-2003 revealed a trend toward improvement in supply of equipment for inhalation narcosis, artificial lung ventilation, and control diagnostic devices. On the other hand, certain disadvantages were found and their causes were analyzed. The main directions in improvement of monitoring support of military medical organizations were determined taking into account modern requirements for anesthesiological and resuscitation service.

[Intracellular disorders in the dog myocardium in low cardiac output syndrome caused by massive hemorrhage, approaches to correction]. / Vnutrikletochnye narusheniia v miokarde u sobak pri sindrome malogo serdechnego vybrosa, vyzvannom massivnoi krovopoterei, puti korrektsii.

It was shown on dog experiments that disorders in the phosphorylation-proteolysis-calcium transport system in the sarcoplasmatic reticulum of pathologically changed myocardium are an important component of cardiac activity depression in massive blood loss. Low cardiac output can be corrected by ammonium molibdate, phosphoprotein phosphatase inhibitor, and contrycal, proteolysis inhibitor.

[Concept of specialized training of nurses in anesthesiology and intensive care]. / Kontseptsiia professional'nogo obrazovaniia meditsinskikh sester po anesteziologii i reanimatologii.

The need in improving the training of medical workers necessitated the development of the concept of vocational training of nurses in anesthesiology and intensive care. The key points of this concept were discussed and approved as the basis at the Seventh All-Russian Congress of Anesthesiologists and Intensive Care Specialists in September 2000 in St. Petersburg.

[Ways of improving postoperative analgesia]. / Puti optimizatsii posleoperatsionnogo medikamentoznogo obezbolivaniia.

Analysis of many-year experience gained in the use of a variety of methods and means for treating the painful syndrome in victims and patients after planned and urgent surgery allowed the authors to determine the optimal approaches to postoperative analgesia. Special attention is paid to introduction of new drugs and methods of analgesia with differentiated approach to prevention and treatment of the painful syndrome. A conclusion on the necessity of pathogenetically based and strictly individual postoperative analgesia is made; such analgesia is often to be multilevel and multicomponent, with consideration for the complex origin of painful reaction (including the components of the painful syndrome) and the armory of available means.

[Prospects of the use of caudal epidural anesthesia]. / Perspektivy primeneniia kaudal'noi épidural'noi anestezii.

Caudal epidural anesthesia for interventions on the lower limbs and pelvic organs was used in 525 patients. A specific feature of the method is use of hypoosmolic local anesthetic solution (osmolality 260 mosmol/kg) containing lidocaine, 0.9% sodium chloride, and distilled water. Pathologic studies showed that in adult patients, at least 40 ml anesthetic should be injected into the caudal canal for adequate blocking. During surgery, caudal epidural anesthesia reliably protected from surgical trauma without side effects for respiration and circulation. The duration of analgesic effect was 3 +/- 0.5 h and even longer, if local anesthesia was potentiated with sedative drugs. No complications were observed, failures occurred in 5.2% cases. The method is simple and reliable and is recommended for practice.

[Intravenous anesthesia in surgical interventions in ambulatory practice]. / Vnutrivennaia anesteziia pri khirurgicheskikh vmeshatel'stvakh v ambulatornoi praktike.

Intravenous anesthesia with calipsol and diprivan was used in 297 gynecological patients subjected to various short-term interventions. The course of anesthesia was monitored (arterial pressure, respiration rate, SaO2, Fet CO2) and time course of recovery of attention, thinking, and motor activity in the postoperative period after different types of anesthesia was assessed. Diprivan and fentanyl (0.7-0.8 microgram/kg) anesthesia is preferable for surgical interventions in an outpatient setting due to a smooth and uneventful course of the postoperative period and its slight effect on the cardiovascular system.

[The problems of ambulatory anesthesiology]. / Problemy ambulatornoi anesteziologii.

Prospects of the development of ambulatory anesthesiology are greatly dependent on understanding its problems caused by the specific character of work of the ambulatory polyclinical institutions. The most important of them is responsibility for safety of the patients during general anesthesia and after it as well as comfort feelings of the patients in the nearest postoperative period. The solution of these problems is related not only with qualification of anesthesiologists but also with the adequate, corresponding to the present-day level of the material technical supply of their work. Of special importance are the "postnarcosis" wards, ability of the personnel to evaluate the psychophysiological state of the patients and correspondence of their life conditions to the requirements of ambulatory anesthesiology.

[Experience in giving anesthesiological and resuscitation care to therapeutic patients in Afghanistan]. / Opyt okazaniia anesteziologo-reanimatologicheskoi pomoshchi bol'nymh terapevticheskogo profilia v Afganistane.

The article analyses the experience of reanimatological care to medical patients in Afghanistan. These patients comprised 3% of all the contingency from anaesthesia/reanimation/intensive care unit. The experience obtained in these researches made it possible to reevaluate some principles concerning the improvement of work in this unit, as far as professional qualities of its specialists, organic structure and material support are concerned.

[Optimization of external respiration in patients during surgery with different types of anesthesia using transcutaneous electric stimulation of the diaphragm]. / Optimizatsiia vneshnego dykhaniia u bolnykh vo vremia operatsii v usloviiakh razlichnykh vidov anestezii metodom chreskozhnoi élektricheskoi stimuliatsii diafragmy.

Inadequate function of respiratory muscles, of the diaphragm among other ones, is responsible, together with other causes, for acute respiratory insufficiency. Transcutaneous electric stimulation of the diaphragm by ESD-2P and ESD-2N-NC devices was used under conditions of intravenous, epidural lidocaine anesthesia, epidural lidocaine+phentanyl, and combined anesthesia in 82 patients during surgery and in 49 patients in the immediate postoperative period. Transcutaneous electric stimulation of the diaphragm essentially improved ventilation volume and regularity, as well as pulmonary gas exchange, particularly so in marked disorders occurring during surgery under intravenous anesthesia.