[Successful implementation of shortened postoperative period program after ten hours of general anaesthesia in patient with morbid obesity].

Early patient's activation is the best method of prophylaxis of many complications of the postoperative period. Patients with obesity are at high risk of developing complications in respiratory system. The following clinical report is about the successful implementation of the shortened postoperative period program in patient with morbid obesity after general desflurane maintained anesthesia and, at the same time, epidural ropivacaine-based anesthesia. Anesthesia lasted for 10 hours. The intraoperative period was well controlled and characterized with stable hemodynamic indexes. On the fourth minute after desflurane intake was terminated and recovery of consciousness and spontaneous breathing of the patient were registered, patient was extubated. This clinical experience and also an information than can be found in the earlier publications allow us to consider a desflurane maintained anesthesia as one of the safest and comfortable methods of anesthesia for patients with a morbid obesity.

[Correction of disorders of tissue perfusion in surgical patients in critical conditions and their evaluation by changes in the indices of the acid-soluble fractions of blood plasma]. / Korrektsiia narushenii tkanevoi perfuzii u khirurgicheskikh bol'nykh v kritisheskikh sostoianiiakh i ikh otsenka po dinamike pokazatelei kislotorastvorimykh fraktsii plazmy krovi.

Rheopolyglucin infusion and vasodilation therapy with droperidol have been performed in 16 critically ill surgical patients with low O2 tissue utilization with the aim in view to assess tissue perfusion disturbances and normalize peripheral blood flow. Basic central hemodynamic parameters and oxygen transport system parameters have been determined. Using gel filtration, acid-soluble blood plasma fractions have been studied spectrophotometrically. Despite the fact that rheopolyglucin infusion caused an increase in oxygen flow index (OFI) at the expense of cardiac index (CI) growth, O2 extraction remained practically unchanged. Vasodilation therapy, with slight changes of CI and OFI, caused an increase in O2 consumption and arterio venous difference, as well as a reduction of mixed venous blood pO2, this accompanied by an increase in acid-soluble blood plasma fractions, especially second fraction at 255 nm. A direct correlation has been established between basic oxygen transport system parameters, characterizing O2 tissue utilization and changes of acid-soluble blood plasma fractions parameters. The changes in acid-soluble blood plasma fractions parameters may serve one of the criteria characterizing the efficacy of procedures aimed at the improvement of tissue perfusion.