[MODERN VIEWS ON THE PHARMACOGENETICS OF PAIN.]

Quality anesthesia during surgery and in the postoperative period remains a topical problem of modern anesthesiology. The study of genetic characteristics of a patient is a goal that may be allow us to develop a personalized approach to solve this problem. The purpose of the review is a synthesis of literature data about the influence of genetic factors on pain perception and its treatment. The review included information obtained from SCOPUS, MedLine, EMBASE. The search keywords were: pain, pharmacogenetics, polymorphism, analgesics.Describe the effect ofgene polymorphisms of OPRM, 5HTRIA, 5HTR2A, COMT GCHI, SCN9A, KCNSI, CACNA2D3, CACNG2, PTGSI, PTGS2, MDRJ/ABCB] on the perception of pain, and CYP2D6, CYP2C9, CYP3A4 on the pharmacokinetics and pharmacodynamics of medi- cations used in the treatment of pain.

[IMPROVING THE EFFICACY OF THERAPY FOR PATIENTS WITH MYOCARDIAL INFARCTION COMPLICATED BY CIRCULATORY FAILURE].

The effectiveness of drug remaxol inclusion in the scheme of treatment of patients with myocardial infarction on the background of degree III - III acute cardiac insufficiency was evaluated by the analysis of clinical and laboratory data of 126 patients with newly diagnosed acute myocardial infarction including ST-segment elevation on the background of acute cardiac insufficiency. Depending on the regimen, patients were divided into two groups. The first (control) group included 60 patients who received conventional thrombolytic therapy; the second (main) group included 66 patients which, after thrombolytic therapy, received remaxol (single daily intravenous administration, 400 mL at 3 - 4 mL/min rate) with controlled central venous pressure, arterial pressure, and diuresis. The course lasted for 3 - 5 days, depending on the severity of condition. A high efficiency of the treatment regimen including remaxol was established as characterized by more rapid (in comparison to conventional therapy) stabilization of disturbed systemic hemodynamics and recovery of weakened myocardial contractility, decreased risk of cardiac arrhythmias, and relieved hyperhomocysteinemia that, in turn, reduced the risk of complications such as thrombosis and thromboembolism.

[Monitoring of analgesia and amnesia during the general anesthesia in surgeries made on the lungs]. / Monitoring urovnia anal'gezii i amnezii pri anestezioligicheskom obespechenii operatsii na legkikh.

Somatosensorially evoked and auditorially evoked potentials (SSEP and AEP) were evaluated in 75 patients in different stages of general anesthesia during surgical procedures made on the lungs. N19-P23 latent increases of SSEP denoted an adequate level of analgesia. The AEP evaluation is recommended for monitoring the amnesia status during general anesthesia. N1 depression, long-latent N2 and P300 as well as disappearance of AEP and intracerebral asymmetry inversion with predominance of the bioelectric activity in the right cerebral hemisphere are regarded as objective signs of amnesia induction.

[Neuromediatorial mechanisms of analgesia during general anesthesia]. / Neiromediatornye mekhanizmy razvitiia anal'gezii pri obshchei anestezii.

Neuromediatorial analysis with an evaluation of the EEG total bioelectric activity of the cortical and subcortical brain structures was performed in rabbits at general anesthesia variants. Naloxone, mu-opioid antagonist, johimbine, alpha2-adrenoceptor antagonist, metisergide, serotoninergic blocker were made use of. The leading role of adrenergic, a less important one of serotoninergic and a minimal one of opioid mechanisms are under discussion within the analgesia status during somatosensory nociception. The adrenergic mechanism is considered to be more important in the development of analgetic effects during visceral nociception versus the opioid or serotoninergic ones.

[Computer analysis of components of general anesthesia]. / Komp'iuternyi analiz nekotorykh komponentov obshchei anaestezii.

Monitoring of cerebral evoked potentials during total anesthesia provides objective data on the depth of anesthesia. Somatosensory and auditory evoked potentials (SSEP and AEP, respectively) were recorded in 48 patients (ASA physical status 1-2) before and during surgery. AEPs were assessed using a two-stimulus oddball paradigm under passive ignore conditions. Decreased amplitudes and increased latencies of mid-latency SSEP were regarded as decreased conduction of pain pulse via specific and nonspecific pathways. The amplitude of late-latency AEP indicated the level of consciousness during total anesthesia. The removal of evoked potentials was followed by development of painful reaction. Registration of cerebral evoked potentials helps evaluate the depth of anesthesia and intraoperative memory in patients subjected to total anesthesia.

[The current objective criteria for the adequacy of general anesthesia in children]. / Sovremennye ob''ektivnye kriterii adekvatnosti obshchei anestezii u detei.

Auditory evoked potentials (AEP) were recorded and analyzed in 12 children during general halothane and ketamine anesthesia. Ketamine suppressed the amplitude of primary negative component and eliminated secondary AEP components with latencies more than 60 ms, including N-200 and P-300 waves. By contrast, halothane did not affect primary components with less than 95 ms latencies and suppressed the latest components. Hence, ketamine suppresses the nonspecific afferent pathways and the brain structures responsible for memory and emotional functions, while halothane does not affect the afferent pulsation and partially suppresses emotional and mnemonic functions.

[Systemic hemodynamics, oxygenating lung function and oxygen transport in patients with acute intestinal obstruction and an endotoxicosis syndrome]. / Sistemnaia gemodinamika, oksigeniruiushchaia funktsiia legkikh i transport kisloroda u bol'nykh s ostroi neprokhodimost'iu kishechnika i sindromom éndotoksikoza.

Systemic hemodynamics, oxygenating function of the lungs, and oxygen budgeting were studied in 32 patients with acute bowel obstruction (ABO) with severe endotoxicosis. Profound disturbances of systemic hemodynamics and blood oxygenation in the lungs underlie the hemostasis changes in this category of patients before and early after operation. These hemostasis changes lead to inadequate oxygen delivery and metabolic requirement of oxygen and are associated with development of oxygen deficiency in tissues. As a rule, patients with ABO with severe endotoxicosis develop acute respiratory failure presenting as adult respiratory distress syndrome on days 2-3 postoperation. Significant differences in the pattern of hemostasis changes and compensatory shifts in survivors and patients dying after ABO are detected at this period, which determine the prognosis and outcome of disease.