[Malignant hyperthermia--complication of general anesthesia in the clinic of maxillofacial surgery].

Malignant hyperthermia (MH) is a rare genetic disease that manifests itself more frequently in the use of general anesthetics that are triggers of MH and results in death when specific treatment is not performed. The authors have observed a case of MH during anesthesia at maxillofacial surgery. The patient could not be saved irrespective of the attempts being made.

[Criminal clozapine intoxications].

The paper deals with the topical problem--study criminal clozapine intoxications that have recently ranked first in the total structure of criminal intoxications, by ousting poisoning by clofelin. Thus, in 2004 to 2006, the number of victims taken to the Prof. A. A. Ostroumov Moscow City Hospital No. 33 increased by 1.9 times, by amounting to 1120 cases in 2006. At the same time, its correct prehospital diagnosis was made only in 1.76% of the victims. Abundant clinical material (2720 cases) has been analyzed, by using the currently performed studies. The specific features of the development and clinical manifestations of these intoxications, including those concurrent with alcoholic intoxication, are described in detail. The characteristic manifestations of impaired consciousness, hypersalivation, and myosis in the absence of generally, respiratory failure and hemodynamic disorders, as well as altered clinical and biochemical blood parameters are shown. At the same time there were elevated ammonia levels within the first hours after intoxication, which, in the authors' opinion, may suggest the development of hepatic dysfunction. Emphasis is laid on the fact that the leading component in the complex of medical measures is the administration of central anticholinesterase agents (aminostigmine and galantamine hydrobromide) that may be used as an antidote and for the differential diagnosis of these intoxications.

[New actual options in anesthesiological monitoring].

New aspects of rational monitoring in contemporary anesthesiology are discussed. Not only conventional pulsoximetric parameters of circulation and respiration disorders but also new noninvasive methods are suggested to determine blood losses (degree of its compensation), certain parameters of external respiration, gas exchange, and cardiac stroke volume (Fick's principle). Cardiac stroke volume is a cardinal parameter of oxygen transport and consumption. The level of monitoring implemented in the suggested system provides maximum patient safety during surgery. It also provides anesthesiologist with information about mechanisms of circulation and respiration dysfunction.

[Correction of arterial hypoxemia during early postoperative period]. / Metody korrektsii arterial'noi gipoksemii v rannem posleoperatsionnom periode.

The article is dedicated to investigating the reasons of development of hypoxemia during the early postoperative period when the patient is switched to an unassisted air breathing. It was established that hypoxemia develops, after abdominal operations with a multi-component total anesthesia, in 68% of patients, although there is a recovery of adequate ventilation of the lungs, and it is related with an insufficient anesthesia, which results in an increased volume of expiratory closure. Epidural anesthesia prevents an increase in the closure volume and development of hypoxemia.

[The prognosis and correction of circulation disorders following laparoscopic operations]. / Narusheniia krovoobrashcheniia pri laparoskopicheskikh vmeshatel'stvakh, ikh prognozirovanie i korrektsiia.

50 patients, suffering from accompanying cardio-vascular disorders (ischemic heart disease, arterial hypertension) were investigated in pre- and intraoperative period to carry out the analysis of influence of intraabdominal pressure on their hemodynamics. During preoperative period external abdominal cuff was used to imitate pressure elevation during operation. The data obtained showed the development of hypodynamic circulation disorders under abdominal hypertension. It permitted to use the technique of creating the external abdominal compression for prognosis of circulatory alterations during laparoscopic operative interventions. The method of pneumomassage of low extremities was suggested as a corrective therapy of circulatory disorders.

[Effect of hyperventilation on the cerebral blood flow and metabolism in patients with craniocerebral trauma]. / Tserebral'nyi krovotok i metabolizm vo vremia giperventiliatsii u bol'nykh s izolirovannoi cherepno-mozgovoi travmoi.

Cerebral blood flow and metabolism were studied in 44 patients with acute severe craniocerebral injuries (contusions of the brain and removal of intracranial hematomas) with consciousness depression (moderate coma), hospitalized in intensive neurological care wards. Oxygen supply to the brain was repeatedly evaluated (acid-base status of the jugular vein blood, oxygen arterio-venous difference, oxygen extraction coefficient), oxymetry of the brain was repeatedly carried out, and vital functions were monitored over the entire period of disease. Cerebral blood flow was monitored by rheoencephalography, which helped timely detect the changes in cerebral blood flow in patients with craniocerebral injuries during different ventilation protocols used in intensive care. All studies were carried out during three stages: 1) initial stage, when the patients were brought to intensive neurological care wards after surgical intervention, and during normoventilation (paCO2 36-40 mm Hg; 2) moderate hyperventilation (paCO2 35-26 mm Hg); and 3) pronounced hyperventilation (paCO2 25-20 mm Hg). Specific changes in the cerebral blood flow during the acute period of craniocerebral injury were detected during different ventilation regimens in 2 groups of patients: group 1 with lethal outcomes and group 2 with positive changes.

[Extracorporeal detoxication in combined therapy of pancreonecrosis]. / Ekstrakorporal'naia detoksikatsiia v kompleksnom lechenii pankreonekrozov.

Extracorporeal detoxication methods (hemofiltration, discrete exchange and filtration plasmapheresis) were added to intensive care complexes for 53 patients with pancreonecrosis. Peritonitis with multiple organ dysfunction was diagnosed in all patients. The severity of intoxication, central hemodynamic parameters, blood gaseous composition were evaluated in the monitoring regimen. Oxygen transport and consumption were estimated. Pancreonecrosis was paralleled by severe endogenous intoxication. Hemofiltration led to a stable decrease in the level of pancreatogenic toxicosis in the majority of patients. Combination of hemofiltration and plasmapheresis led to a more rapid and effective elimination of creatinine, bilirubin, and amylase without essential changes in the electrolyte composition. Clinical symptoms of acute respiratory and cardiac insufficiency decreased, central hemodynamics and oxygen transporting function of the blood improved. Combination of hemofiltration and plasmapheresis mutually potentiated the positive effects of both methods and extended the potentialities of filtration methods in replacement of organ dysfunctions in multiple organ dysfunction.

[Use of perfluothane as a component of neurorehabilitation therapy in the acute period in patients with craniocerebral injuries]. / Primenenie perftorana v sostave neiroreabilitatsionnoi terapii ostrogo perioda u bol'nykh s cherepno-mozgovoi travmoi.

The effects of perfluothane on the course of posttraumatic period are evaluated in patients with craniocerebral injuries. Forty patients were divided into 2 groups treated and not with perfluothane. Hemodynamics, hemostasis, gaseous exchange and lung ventilation functions, and neurological status were evaluated over the course of treatment. The data evidence a favorable effect of perfluothane on the course of the posttraumatic period in patients with craniocerebral injuries.

[Hemodynamics and oxygen transport in patients with surgical sepsis during hemofiltration]. / Gemodinamika i transport kisloroda u bol'nykh s khirurgicheskim sepsisom pri provedenii gemofil'tratsii.

Effects of hemofiltration (HF) on central hemodynamics and oxygen transport are studied in 35 patients with surgical sepsis and multiple organ failure. HF is paralleled by development of hypovolemia and decrease of myocardial contractility, determining a decrease in cardiac output and oxygen transport. As a result, oxygen utilization by tissues decreases and hypoxia progresses. The only compensatory mechanism of oxygen supply in such patients is maintenance of cardiac output, which should be borne in mind when carrying out HF.

[The arteriovenous difference in osmotic and hemostatic indices as a criterion for the early diagnosis of pulmonary complications in severe combined trauma]. / Arteriovenoznaia raznost' osmoticheskikh i gemostaticheskikh pokazatelei kak kriterii rannei diagnostiki legochnykh oslozhnenii pri tiazheloi sochetannoi travme.

The arteriovenous difference in the values of plasma and its main ingredients' osmolality and hemostasis were examined in patients with grave combined injuries complicated with the adult respiratory distress syndrome (RDS) in the posttraumatic period. The findings showed a changed trend of arteriovenous difference in the osmotic homeostasis parameters in comparison with those during on uneventful course of combined injury: a-v Dosm. in stage IV RDS is (-)22.9 +/- 13.5 mosm/kg H2O versus 3.36 +/- 3.51 mosm/kg H2O in an uncomplicated course (p < 0.001). The arteriovenous difference for plasma COD was 8.1 +/- 3.0 mm Hg and (-)0.5 +/- 0.7 mm Hg in an uncomplicated course (p < 0.001). These changes permit a conclusion about the impaired osmolality regulating function of the lungs in RDS. Analysis of the arteriovenous difference of hemostasis once again confirms the presence of disorders in the hemostasis regulating function of the lungs: the arteriovenous difference of the structural and chronometric values of thromboelastogram is inverted, which indicates an increase of the coagulation potential of arterial blood: the a-v is equal to difference of blood clotting time 48 h after the injury and is (-)0.1 +/- 0.04 min, in contrast to the uneventful course: 2.5 +/- 0.27 min (p < 0.01): the a-v equal to the coagulation index difference was 2.26 +/- 0.49 arb. U, in contrast to (-)2.0 +/- 0.13 arb. U in an uncomplicated course of heating. Disorders in the other than respiratory functions of the lungs develop 11 h earlier than clear-cut x-ray signs of RDS appear, which gives us grounds to consider these changes as the earliest diagnostic criterion of RDS.

[Mechanisms of acute respiratory insufficiency in patients with hyperglycemic coma]. / O mekhanizmakh ostroi dykhatel'noi nedostatochnosti u bol'nykh s giperglikemicheskimimi komami.

Basic parameters of pulmonary gas exchange, central and pulmonary hemodynamics, and colloid osmotic pressure were investigated in 31 patients in diabetic hyperglycemic coma over the course of intensive care. Pulmonary gas exchange disorders were observed in all patients in the presence of increased shunting of the blood in the lungs and disorders of transcapillary liquid exchange. On the other hand, we failed to obtain data indicative of an increase in the volume of extravascular water in the lungs. However, it does not rule out the possibility of iatrogenic disorders of gas exchange during noncontrolled rehydration.

[The characteristics of myocarditis in diphtheria in adults based on data from the 1993-1994 epidemic]. / Osobennosti miokarditov pri difterii u vzroslykh po dannym épidemii 1993--1994 gg.

In 45% of 212 cases of diphtheria toxica in adults heart complications were observed. The earliest ECG signs are sinus bradycardia, AV dissociation, AV escape rhythms, prolongation of QT interval, high U wave (U > T, T + U wave). In the cases where differential diagnosis of myocarditis and other heart diseases in adults is difficult, the attention must be focused on the sickle-like depression ("sagging") of ST-interval that is a typical sign in diphtheric myocarditis. The most severe forms of diphtheric myocarditis are complicated by AV and intraventricular conduction disturbances and malignant ventricular arrhythmias.