[Professional selection and successful residency training in anesthesiology-resuscitation].

The professional carrier of 356 residents, the 1960-2007 graduates of the Saint Petersburg Medical Academy of Postgraduate Education, was studied to specify approaches to professional selection of anesthesiologists. Thirty (8.4%) graduates did not work as anesthesiologists at all. It should be noted that most (n = 24) of the 30 graduates had successfully completed the residency. The anesthetic activities were generally altered under the influence of factors that are not related to successful education, namely financial, social, familial, etc. In this connection, long-term forecasting underlying professional selection appears to be of doubtful feasibility. The selection made within the first year of training (a follow-up by teachers) is valid. However, it is impossible to consider each residency graduate to be a well-trained anesthesiologist. An intermediate decision to solve this problem is to establish the new nationally accepted order: a graduate may start his/her professional career only at a university clinic or other large hospital especially licensed for this purpose, by being supervised by senior colleagues. Permission for fully independent practice should be given not earlier than after 2-3-year work at the above mentioned clinics.

[Clofelin in the anesthesiological support system for surgical operations]. / Klofelin v sisteme anesteziologicheskogo obespecheniia khirurgicheskikh operatsii.

The article presents clinical experience of using Clofelin in 251 patients as a part of general anaesthesia, in postoperative period and in patients with peripheral vascular disease. The experiments on 14 rabbits chinchilla have been done prior to peridural use of Clofelin. The control for adequate use included estimation of hemodynamics parameters, cortizol, vasopressin and B-endorphin levels in plasma on different anaesthesia. The analgetic activity of Clofelin in postoperative period in patients with peripheral vascular disease was estimated by subjective tests using 5 steps of pain estimation scale. The clinical trial demonstrated the efficacy of intravenous and peridural use of Clofelin during surgery and in postoperative period.

[Erythrocyte membrane permeability and the sorption capacity of erythrocytes--optimal criteria of the severity of endogenous intoxication]. / Pronitsaemost éritrotsitarnykh membran i sorbtsionnaia sposobnost éritrotsitov--optimalnye kriterii tiazhesti éndogennoi intoksikatsii.

Sorption capacity of erythrocytes (SCE) and erythrocyte membrane permeability (EMP) have been determined along with a number of other biochemical parameters to assess the degree of intoxication in 265 critically ill patients. EMP was determined by a modified technique of V. N. Kolmakov. A high correlation between EMP, SCE and the level of biologically active substances has been established. Therefore, EMP and SCE are regarded as basic criteria reflecting the severity of endogenous intoxication and changes in these values form the basis for intoxication classification.

[Epidural analgesia with clofelin as a component of general anesthesia]. / Epidural'naia analgeziia klofelinom kak komponent obshchei anestezii.

A clinical experience with using peridural analgesia with Clophelin in the composition of general anesthesia in 35 patients operated upon because of surgical, gynecological and urological diseases is presented. Clinical application of Clophelin in anesthesiological maintenance was preceded by an experimental study in rabbits. Control of adequacy of the anesthesia was performed by parameters of central hemodynamics and the level of vasopressin in blood plasma at stages of the research. The adequate level of defense of the patient from the operative stress was determined for using this combined method of general anesthesia.

[Central hemodynamics and hormonal homeostasis during surgical stress in young patients with different levels of physical preparation]. / Tsentral'naia gemodinamika i gormonal'nyi gomeostaz pri operatsionnom stresse u lits molodogo vozrasta s razlichnym urovnem fizicheskoi podgotovlennosti.

Twenty-two patients, aged 16 to 35 years who were to be operated on for varicocele have been examined. It has been established that the degree of shifts in hormonal homeostasis and central hemodynamics depends on the baseline level of physical training. Analysis of central hemodynamic response to operation stress has shown that the prognosis of favourable operation stress tolerance was observed in well trained patients or in those poorly trained without hyperkinetic hemodynamic reaction 1 day before surgery. The above data make it possible to predict the nature of reactions in response to the operation stress by the level of circulation function activation 1 day before surgery.

[Epidural analgesia with clofelin in treating a pain syndrome]. / Epidural'naia analgeziia klofelinom v lechenii bolevogo sindroma.

The article presents a clinical experience with using epidural analgesia with Clofelin in 20 patients to arrest the pain syndrome developed at the postoperative period and resulting from atherosclerotic lesions of the lower extremity vessels. Control of the adequacy of anesthesia was made by registration of the H-reflex value. The investigations have shown that epidural analgesia with Clofelin is an effective measure to arrest the pain syndrome.

[Benzofurocaine analgesia in acute myocardial infarct]. / Analgeziia benzofurokainom pri ostrom infarkte miokarda.

A native non-narcotic analgetic agent benzofurcaine was used in 51 patients. It was shown that the analgetic activity of benzofurocaine had a dose-dependent character. Most effective was its use in doses of 2.1-2.7 mg/kg of body weight. It was established that the character of hemodynamic reactions due to benzofurocaine depended on the initial state of circulation. Benzofurocaine did not depress breathing. It is concluded that benzofuricaine is an effective means in moderate pain syndrome due to residual pain as well as in pain of pericardial genesis.

[Detoxification in the combined intensive therapy of patients with multiple organ failure]. / Detoksikatsiia v kompleksnoi intensivnoi terapii bol'nykh s poliorgannoi nedostatochnost'iu.

Studies of the influence of the UV irradiation of autologous blood (UVIAB) and hemosorption (HS) upon changes of indices of endogenous intoxication in patients with the syndrome of polyorganic insufficiency (SPOI) have shown that the isolated (without HS) UVIAB reduces toxemia and prevents the development of SPOI in patients without pronounced alterations of microcirculation. Using the UV irradiation of autoblood in patients with clinically marked alterations of the peripheral blood circulation increases toxemia at the expense of release of toxic products from the "disclosed" system of microcirculation. HS with the simultaneous taking the blood from the subclavian vein and abdominal aorta with using "Actilen" and return of the mixed blood into the peripheral artery interrupts and relieves the course of SPOI.

[Effect of ketamine anesthesia on patients with severe trauma at the pre-hospital stage on the course and outcome of shock]. / Vliianie anestezii ketaminom, provodimoi u postradavshikh s tiazheloi travmoi na dogospital'nom étape, na techenie i iskhod shoka.

Under study were remote results of treatment of patients with critical traumas followed by shock who were given prehospital Ketamine anesthesia. The data obtained were compared with remote results of treatment of patients who did not receive anesthesia at the prehospital stage or who were given narcotic analgetic drugs for anesthesia. Reliable data were obtained showing the course of trauma disease to be more favourable in a group of patients who were given Ketamine anesthesia at the prehospital stage.

[The use of clofelin in the acute period of myocardial infarct]. / O primenenii klofelina v ostrom periode infarkta miokarda.

Data are reported on the action of intravenous clophelin in 30 patients administered within the first 24 hours of myocardial infarction. The agent exhibited a significant analgetic effect, sedative action and normalized the main hemodynamic values. The effect of clophelin on the hemodynamics depended on its initial state. The possibility is shown to predict the pain-killing and hemodynamic effects of the drug by the initial response.

[Evaluation of the analgesic action of clofelin in cardiogenic pain (clinico-experimental research)]. / Otsenka boleutoliaiushchego deistviia klofelina pri kardiogennoi boli (kliniko-éksperimental'noe issledovanie).

In chronic experiments on conscious rats analgesic and autonomic-corrective effects of clopheline in cardiogenic pain were demonstrated. The drug was also shown to decrease emotional and motor manifestations and to stabilize central hemodynamics in patients with acute myocardial infarction.

[Long-term regional anesthesia in closed chest injuries complicated by rib fracture]. / Dlitel'naia regionarnaia anesteziia pri zakrytoi travme grudi, oslozhnennoi perelomami reber.

Prolonged regional anesthesia used for relieving pain was given to 65 patients with closed traumas of the chest complicated by fractures of the ribs. The method was shown to be effective, simple and safe. It may be used both at the hospital and at prehospital stage. The prolonged regional anesthesia allowed reducing the amount of pulmonary complications from 4.5% to 1.7%.