[Early cessation of artificial ventilation of the lungs (extubation of the trachea in the operating room) in patients undergoing surgery with artificial circulation]. / Rannee prekrashchenie IVL (ékstubatsiia trakhei v operatsionnoi) u bol'nykh operirovannykh s isskustvennym krovoobrashcheniem.

Forty-nine patients operated on the open heart under combined total anesthesia with nitrogen oxide, enflurane or isoflurane and propofol (group 1) and 22 ones anesthesized with high fentanyl doses (group 2) were examined. To group 1 patients fentanyl and pancuronium bromide were injected only in the preperfusion period of the operation. Early extubation was carried out in 44 (90%) group 1 patients. The duration of postoperative artificial ventilation of the lungs was 102 +/- 15 min in group 1 and 16 +/- 1 h in group 2. No grave postoperative complications or early mortality were recorded. In the morning of the first postoperative 24 h 7% of group 1 patients and 41% of group 2 ones were administered inotropic therapy (p < 0.05). Duration of stay in resuscitation ward was 0.96 +/- 0.05 days in group 1 and 2.04 +/- 0.09 days in group 2 (p < 0.01). The authors come to a conclusion on the desirability of early extubation after open-heart surgery. Indications for and contraindications against early extubation are discussed.

[Anesthesiological management in transplantation of the heart after temporary mechanical substitution of its function]. / Anesteziologicheskoe obespechenie transplantatsii serdtsa posle vremennogo mekhanicheskogo zameshcheniia ego funktsii.

The first experience of anesthesiological management of three two-step orthotopic heart transplantations is reviewed. As the first step of surgical treatment one recipient was implanted an artificial heart "POISK-IOM" (Russia), in 2 other patients left ventricular bypass was achieved using a "Biopump" ("Biomedics", USA). Anesthesia techniques, methods of infusion-transfusion therapy, and other components of intraoperative management are described. Hemodynamics, donor heart function recovery, and other homeostasis parameters have been analysed. It has been noted that high doses of fentanyl in combination with ketamine and diazepam ensured satisfactory course of general anesthesia. There were no cases of intraoperative lethality. A more complex aspect of anesthesiological management was correction of various homeostasis disturbances which progressed during surgery in patients with left ventricular bypass. In two cases the intraoperative period was characterized by the onset of multiorgan failure (heart, respiratory, renal failure, metabolic disorders, coagulopathy), which played a negative part for the postoperative period of heart transplantations. It is concluded that prediction of possible complications during temporary mechanical replacement of the cardiac function and timely determination of contraindications for the second step of two-step heart transplantations are the most important trends of investigations for anesthesiologists, intensive care specialists, and transplantologists.

[The use of ultra-high doses of insulin for the treatment of severe heart failure during cardiosurgical interventions]. / Ispol'zovanie sverkhvysokikh doz insulina dlia lecheniia tiazheloi serdechnoi nedostatochnosti vo vremia kardiokhirurgicheskikh vmeshatel'stv.

The experience is reviewed on the use of superhigh insulin doses 1200 to 3800 U (31.4 +/- 5.3 U/kg) for the treatment of acute heart failure in 17 patients subjected to open heart surgery. Symptoms of heart failure refractory to catecholamines and vasodilators were accompanied by marked hyperglycemia (23.1 +/- 4.3 mmol/l). It was impossible to discontinue assisted circulation. In 82.3% of patients myocardial contractility upon insulin administration improved considerably, which led to discontinuation of assisted circulation with moderate inotropic support. Possible mechanisms ensuring the efficacy of massive insulin therapy in patients with acute heart failure are discussed.

[Lipid peroxidation in open-heart operations]. / Perekisnoe okislenie lipidov pri operatsiiakh na otkrytom serdtse.

The intensity of lipid peroxidation (LPO) and antioxidant system activity (ASA) have been studied using chemiluminescent technique in 15 patients with ischemic heart disease subjected to surgery under moderate hypothermia. Two types of responses to surgical intervention and cardiopulmonary bypass have been demonstrated depending on baseline LPO intensity. Low baseline intensity of free-radical reactions at the beginning of perfusion is first enhanced and then attenuated by the end of perfusion, which is accompanied by ASA activation. This indicates adequate protective and adaptation body reactions. The same group of patients was characterized by a significant correlation between the parameters studied in venous blood and blood outflowing from the myocardium prior to and following the aorta clamping. With high LPO intensity that remained unchanged in the course of the intervention no correlation between LPO and ASA parameters has been observed in venous and coronary sinus blood. These patients develop various cardiovascular complications in the postperfusion period. It has been concluded that high baseline LPO level is prognostically unfavourable, with no correlations between the parameters under study observed in venous blood and blood outflowing from the myocardium.