[Pharmacological prophylaxis of reperfusion syndrome in patients with severe polytrauma accompanied by shock].

A comparative assessment of buffer activity of reamberin and polyoxyfumaren was made. Their influence on systemic consumption of oxygen, content of lactate in blood, parameters of central hemodynamics were followed. The research includes 44 victims (aged 25-70 years) with severe shockogenic injuries. Reamberin was included in composition of fluid therapy of I group (n=30)and polyoxyfumaren was used in 11 group (n=14). Parameters of acid-base balance of arterial blood, VO2, VCO,, contents of lactate in mixed venous blood, parameters of central hemodynamics were measured in monitor regimen before the infusion. It was proved, that the intravenous infusion of reamberin and polyoxyfumaren accompanied by reliable rise of minute consumption of oxygen (27 and 18% respectively). The drugs decrease the lactate level in blood, reliably increase buffer capacity of blood, correct the metabolic acidosis. Both antihy-poxanthines allow the increase of minute volume of circulation: reamberin on 15%, polyoxyfumaren on 34,9%. The volemic effect of polyoxyfumaren resulted in the increase of circular plasma volume after finishing the infusion on 49,5%, in the case of reamberin - on 16%.

[Patient-controlled postoperative analgesia in obstetrics and gynaecology].

A prospective study researches features of patient-controlled epidural analgesia (PCEA) in 42 women after cesarean section, mid- and high-traumatic gynaecological surgery. It was found out that the quality of while using the PCEA is significantly better than while using a traditional parenteral infusion of analgesics. Use of PCEA favours the circulatory and breathing systems functioning. Compared to continuous epidural infusion of analgesics and anaesthetics, use of PCME returns the expenses better due to less consumption of the drugs up to 35% during the first 24 hours after the surgery. This method is suitable for continuous estimation of the pain therapy.

[Psycho-emotional changes in women during delivery under the influence of opioid analgesics].

A study of psycho-emotional condition was carried out in 408 women during opioid analgesia in different delivery stages with estimation of the changes in reactive and personal anxiety and rank pain index (RPI). The obtained data suppose that analgetic effect of opioids is carried out especially through the sensor component of RPI. On the other hand, the evaluated (targeted) and the effector components of psycho-emotional condition after administration of opioids have changed insignificantly and not evidently. The effect of medicamental analgetics on emotional component of pain perception in every stage of labour had it own features. This should be taken in account while practical work.

[Complications of endoscopic video-assisted surgical interventions in gynaecology].

An analysis of specific complications in gynaecological endovideosurgery has been conducted, such as occurrence of extra-abdominal gas after laparoscopic surgery or resorption of the irrigation solution in hysteroscopy. Possible mechanisms of subcutaneous emphysema, pneumothorax, mediastinal emphysema and hyperhydration development are presented along with discussion of diagnosing and treatment methods.

[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.

[Postoperative anesthetization by the method of transcutaneous electroneuroanalgesia].

The article is devoted to effectiveness of tanscutaneous electroneuroanalgesia using apparatus "Romitron 14T" for postoperative anesthetization in patients after not very traumatic operations. The efficiency of anesthetization was estimated by the visual-analogue scale, scale of sedation, changes in indices of hemodynamics, respiration and content of glucose in blood. It has been established that transcutaneous electroneuroanalgesia is an effective method for elimination of postoperative pain and can be used for complete substitution of medicinal kinds of postoperative anesthetization after not very traumatic operations.

[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.

[Use of noninvasive ventilation in patients at high postoperative risk for cardiopulmonary complications].

Sixty-two patients undergoing elective abdominal surgery with a high operative risk and anesthesia by the ASA scale (III/2-3), and with a high index of cardiopulmonary risk after S. Epstein were examined. The study group comprised 31 patients who had undergone noninvasive ventilation (NIV) in the early postoperative period for preventive purposes. In the control group (n = 30), moistened oxygen was insufflated after transition to spontaneous breathing. In patients with low functional reserves, the preventive use of NIV contributes to a rapider normalization of gas exchange, stabilization of hemodynamics, a reduction in the incidence of complications (from 66.6 to 25.6%) and in the length of stay in an intensive care unit.

[Role of transplantation coordination in the development of organ donorship].

The paper considers the interaction of resuscitative anesthetists and transplantologists in the development of donorship in Russia. It is established that despite the presence of a full-fledged legal base, the-state-of-the-art of organ (cadaveric or postmortem) donorship in the country cannot be recognized as satisfactory. For this way out, the authors propose to introduce the institute of transplantational coordinators and consider the lines of their activities in case of Saint Petersburg public health care.

[Artificial ventilation with pressure monitoring during lararoscopic operations].

The efficiency of artificial ventilation (AV) with volume and pressure monitoring was compared during laparoscopic interventions. Certain advantages of AV with pressure monitoring were established, which appeared as a lower negative effect on pulmonary gas exchange, better parameters in oxygenation and respiratory mechanics as compared with volumetric ventilation, including at the stage of carboxyperitoneum. There is evidence that with the use of this ventilation mode, the cardiac performance parameters, such as cardiac and stroke indices, decrease to a lesser extent. The authors show it possible to use ventilation with pressure monitoring in patients at high risk of cardiac ventilation. With the use of this mode, the trend in hemodynamic and respiratory changes is the same in such patients as in those without comorbidity and the risk of cardiac complications is not higher than when volumetric ventilation is made.

[Brain protection during ischemia: state-of-the-art].

The paper reviews the studies dealing with cerebral ischemia and neuroprotection. On this basis, the authors make conclusions on the perspectives of development of this direction and indicate the difficulties investigators and practitioners face in solving the problems in the protection of the brain from local and global ischemic lesion. Current views of the effectiveness of drugs and procedures used in daily practice and the authors' own experience in solving this topical anesthesiological and resuscitative problem are given.

[Noninvasive lung ventilation in intensive care].

This is a brief review of the literature on the use of noninvasive ventilation in intensive care units. The physiological bases of the use of noninvasive ventilation and some technical aspects are discussed. The data on the clinical effectiveness of this mode of ventilation are given. In addition, indications for and contraindications to the use of noninvasive ventilation and the specific features of its application in patients of different nosological entities are considered.

[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.

[Specifics of intensive therapy in abdominal gunshot wounds]. / Osobennosti intensivnoi terapii pri ognestrel'nykh raneniiakh zhivota.

Among the wounded admitted to the departments of anesthesiology, resuscitation and intensive therapy there were from 57.8 to 77.6% of gunshot injuries of the abdomen. Successful treatment of such patients is dependent not only on the timeliness and quality of surgical interventions but also on the correct choice of intensive therapy before and during operation and in the postoperative period. The temporizing strategy providing for expanding the list of the methods used as late as the symptoms of the unfavorable course of the postoperative period can not be considered sufficiently effective. Complex intensive therapy with a forestalling action on different links of the wound disease pathogenesis in most cases allows not only the elimination of organic and systemic impairments resulting from the wound but also is more effective for defensive compensatory mechanisms. Differentiation of the programs of treatment depending not only on the severity of the patient's state but also on the character of injuries of organs of the abdominal and retroperitoneal areas is of the leading significance.

[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.

[The Military-Medical Academy contribution to the establishment and development of anesthesiology and resuscitation in Russia (to 45th anniversary of the chair for anesthesiology and resuscitation of the Military-Medical Academy)]. / Vklad Voenno-Meditsinskoi Akademii v stanovlenie i razvitie anesteziologii i reanimatsii v Rossii (k 45-letiiu kafedry anesteziologii i reanimatologii Voenno-meditsinskoi akademii).

Contributions made by some researchers of the Military-Medical Academy (former Imperial Medical-Surgical Academy) made to establishing and promoting the home anesthesiology and intensive care are historically revised in the paper. In particular, the related activity of N.I. Pirogov, S.K. Klikovich, S.P. Kolomnin, S.N. Delitsin, P.A. Kupriyanov and of other widely-known public figures is shortly described.

[Assessment of the state of water sectors in neurosurgical profile patients in the pre-, intra- and postoperative periods]. / Otsenka sostoianiia vodnykh sektorov u bol'nykh neirokhirurgicheskogo profilia v do-, intra- i posleoperatsionnom periodakh.

The state of water sectors has been analyzed at the stages of preparation to and performing anesthesia as well as in the early postoperative period in neurosurgical patients in connection with planned surgical procedures (37 cases). The impedance method of control of the hydration degree before operation allowed to find out a risk group--hypohydrated patients. In most cases the detected disturbances of the water-electrolytic balance could not be diagnosed clinically. Despite a relative stability of traditionally analyzed indices of circulation during anesthesia, the reactions of central hemodynamics were more pronounced than could be considered undesirable. The analysis performed makes a foundation for optimization of infusion and cardiotropic therapy both during anesthesiological maintenance of neurosurgical procedures and at the postoperative period.