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Purpose of the study was to assess a predictive value of body mass index for perioperative hyperglycemia occurrence in cardio-surgical patients without a diabetes mellitus.Retrospective analysis of glycemic profile, frequency and level of perioperative hyperglycemia was performed 120 patients without a diabetes mellitus, undergoing elective cardiac surgeries with cardiopulmonary bypass were included in the study. All patients were divided into three groups. Group-1 included patients with normal body weight (body mass index (BMI)25), Group-2--patients with increased body weight (BMI 25-29.9), Group-3--patients with obesity (BMI30).Elective cardiac surgeries with artificial circulation accompanied with episodes of hyperglycemia. Hyperglycemia occurrence did not have relation with initial glycemic profile of the patients. Glycemia level increased during surgery and the highest levels of both glycemia increasing of hyperglycemia frequency were fixed during cardiopulmonary bypass and postperfusion period. Increased body weight and obesity are predisposing causes of perioperative hyperglycemia.

We estimated the optimal dosage of inhalation anesthetic sevoflurane, for the maximum cardioprotective effect with minimal angioparalytic action. 25 pigs were included in this study, they were divided into 5 groups, depending on the sevoflurane dosage used for pharmacological postconditioning (PPC): control group - PPC has't been conducted, a group of PPC 0.5 - sevoflurane PPC in a dose of 0.5 V%, a group of PPC 1.0 - sevoflurane PPC in a dose of 1.0 V%, a group of PPC 1.5 - sevoflurane PPC in a dose of 1.5 V%, a group of PPC 2.0 - sevoflurane PPC in a dose of 2.0 V%, a group of PPC 2.5 - sevoflurane PPC in a dose of 2.5 V%. Ischemia was simulated by left coronary artery crossclamping. Further PPC was held according to the following Protocol: 20 min before left coronary artery clamp off and first 20 min of reperfusion sevoflurane was given into CPB circuit. Myocardial ischemia period was 60 min in all groups. It was found and experimentally proved that the optimal sevoflurane dosage for PPC is 2 V%

The Mesenteric blood circulation during myocardium revasculization was investigated 40 patients were divided in 2 groups: 1st group - normothermia CPB, 2nd group hypothermia CPB. It was found that reduced mesenteric perfusion occurred in both groups, but it was more pronounced in hypothermia CPB group and was caused by a significant deterioration of the microcirculation.

Volemic disorders are widely encountered in anesthesiology and intensive therapy. Lower cardiac output caused by inadequate preload leads to tissue hypoperfusion, increased frequency of perioperative complications and higher death rates. The objective diagnosis of the volemic status remains a challenge since before as all the indices characterizing the preload, which are currently used in clinical practice, enable the true preload to be estimated only to a certain extent. The paper considers the currently available diagnostic studies for volemic disorders in cardiosurgical patients, their merits, demerits, and possible limitations of their use.

The paper analyzes the efficiency of the authors' procedure for anesthetic maintenance based on a combination of inhalational (sevoflurane) and intravenous (1% propofol) anesthesia on spontaneous breathing through a ProSeal laryngeal mask airway in the X-ray endovascular correction of congenital heart diseases in infants and young children. The study included 118 children aged 2 to 7 years with secondary atrial septal defect, who had undergone endovascular defect correction, by applying an Amplazer septal occluder. The key points of the anesthetic maintenance proposed by the authors are: (1) substitution of routine pharmacological premedication for psychological (the presence of parents); (2) inhalational (sevoflurane) anesthesia in the induction of anesthesia; (3) replacement of an endotracheal tube by a ProSeal laryngeal mask; (4) refusal of myorelaxants and respiratory support without artificial ventilation. The authors' anesthesia protocol during these operations provides a safe perioperative period.

The paper analyzes goal-oriented infusion therapy used during myocardial revascularization on the working heart. Forty-seven patients with coronary heart disease were examined. Group 1 (control) (n = 20) received standard infusion therapy (a combination of colloids and crystalloids (1:1) at a rate of 6-7 ml/kg/h, by being oriented to indices, such as heart rate, blood pressure, central venous pressure, and diuresis rate. In group 2, an anesthetist was oriented to central hemodynamic parameters during infusion therapy. In addition, the patients of this group underwent the 45 degrees passive leg raising test. In this group, a volume load was done at the beginning of an operation until the maximum possible SV resulted from increased preload (global end-diastolic volume index). The goal of infusion therapy throughout the operation was to maintain these values of the latter index. Goal-oriented infusion therapy, the purpose of which was to determine and maintain the individual optimal values of preload, was found to minimize hemodynamic disorders at surgery and to reduce the frequency of use of cardiotonic agents and the duration of artificial ventilation.

Twenty-six patients with coronary heart disease who had undergone aortocoronary bypass surgery were examined. In all the patients, central hemodynamic parameters were monitored by transpulmonary thermodilution. The patients were divided into 2 groups. In Group 1 (n = 14), routine initial anesthesia was made without a preliminary volumetric loading test. In Group 2 (n = 12), a controlled volumetric loading test was carried out before induction; a decision on whether it might be made was taken on the basis of the results of a loading test for passive leg raise. The patients from both groups were hypovolemic at baseline, as suggested by the low values of central venous pressure (CVP) and global end-diastolic volume index (GEDVI). By the initiation of initial anesthesia, in Group 2 the mean blood pressure (BPmean), CVP, stroke index (SI), and GEDVI were significantly higher and total peripheral vascular resistance index (TPVRS) was significantly lower than in Group I (p0.05), as achieved via preliminary loading tests. After the maximum hypnotic effect being achieved in Group 1, there were reductions in BPmean, SI, GEDVI, dPmax, and TPVRS (p0.05). In Group 1, 50% of the patients were observed to have hypotension episodes requiring the patient to be placed in Trendelenburg's position and to be given colloids as jets, and 3 patients received bolus vasopressors. After achieving the maximum hypnotic effect, BPmean, SI, GEDVI, and dPmax also decreased in Group 2 patients (p0.05). However, due to preliminary loading tests, these variables remained to be in the normal ranges and were significantly higher than in Group 1 (p0.05). IOPSS objectively reflects the preload status at all stages of initial anesthesia and the leg raising test enables prediction of a cardiovascular response to a volumetric load. When infusion therapy is performed, it is advisable to take into account a relationship between altered preload (GEDVI) and cardiac performance (SI). This volumetric loading testing tactics before induction promotes GEDVI to be maintained in the normal ranges throughout the initial anesthesia and minimizes hemodynamic disorders at this stage.

Fifty patients with low myocardial functional reserves (left ventricular ejection fraction less than 40%, disseminated cardiosclerosis, multiple affection of coronary arteries, NYHA class III-IV) after coronary artery bypass surgery (CABS) were examined. All the patients were divided into 2 groups. Preventive intraaortic balloon counterpulsation (IABC) was used in 24 patients (group 1). Group 2 consisted of 26 patients with similar physical state where IABC has not been used. It was revealed that preventive IABC leads to stabilization of the left ventricle function and cardiac output, a decrease in the doses and period of catecholamines administration. The rate of cardiac rhythm disorders in group 1 was 7 times, myocardial infarction -- 2.5 times, respiratory failure -- 5 times, stay at the intensive care unit -- 2 times less compared with those of group 2. Lethality was 12.5% in group 1 and 26.9% in group 2.

The paper represents data on the condition of the hemostasis of plasma and platelet chains as well as of the system of natural anticoagulants and fibrinolysis as observed in cardiosurgical patients after mini-invasion coronary artery bypass surgery. An intensified generation of platelets, postoperative hyperaggregation of platelets and a lower level of natural anticoagulants in blood were shown as to be compensated for by an activated system of fibrinolysis.

An efficiency and safety of continuous infusion of naropin in the epidural analgesia of 38 patients after coronary artery bypass grafting were demonstrated. A variation of combined anesthesia, which was elaborated at the Russian Research Center of Surgery of the Russian Academy of Medical Sciences and which comprises (as a basic component of anesthetic management) a high thoracal epidural block (T2-T4) by continuous infusion of a 2% solution of naropin at a velocity of 5 +/- 2 ml/h. Anesthesia was supported by isoflurane (0.5 +/- 0.9%). The patients were extubated in the operated theater and taken to the resuscitation unit with continuous infusion of 0.2% naropin solution. All studied parameters were registered after discharge from the operating theater and 1, 3, 6, and 16-18 hours after surgery. The pain-syndrome intensity was measured at the verbal scale with 0 to 3 points. The mean duration of continuous naropin infusion was 16.7 +/- 0.5 h, mean dose--2.2 +/- 0.2 ml/h. Naropin was administered at a dose of 1-3 ml/h in 89.7% of cases and at a dose of 6 ml/h only in 2.9% of cases. The drug, when used in small doses, ensured a high anesthetic efficiency. A total lack of pain or a mild pain of 0.1 points was observed in 86.5% of patients at stage 5 of examinations and in 100% of patients at stage 3. Naropin infusion did not entail any impairment in ventilation or gaseous metabolism. A reliable decrease of arterial pressure (AP) and of central venous pressure (CVP), (p0.05) were registered beginning from stage 2. CVP decrease versus stage 1 was ensured in 38.% of patients by stage 4 and the number of patients with a decreased CVP (less than 60 mm H) went up, versus stage 1, by 3 times. APsyst of less than 90-80 mm Hg was registered in 15 (39.8%) of patients at different examination stages, which necessitated the use of noradrenalin at mean dose of 174 +/- 21 ng/kg.min. The infusion of naropin at dose of 1-6 ml/h did not entail any impairment in the central nervous system (hallucinations, convulsions, and headache).

The specific features of the course of anesthesia and the time of extubation were studied in 142 patients suffering from coronary heart disease who had undergone myocardial revascularization. All the patients were divided into 3 groups in accordance with the type of anesthesia. Group 1 patients (n = 48) received routine anesthesia with ketamine, benzodiazepines, and large-dose fentanyl. Group 2 (n = 45) had combined anesthesia with inhalational and intravenous anesthetics having their better pharmacodynamics (such as isoflurane, diprivan, tracrium). In Group 3 (n = 49), the authors employed another developed modality of anesthesia using high thoracic (TII-TIV) epidural anesthesia as a basic component of anesthesiological maintenance. The two developed modalities of anesthesia almost halved the use of total dose opioids, which promoted patients' early postoperative recovery of consciousness and respiration. The time before extubation was 9.9 +/- 2.1, 4.5 +/- 1.1, and 1.5 +/- 1.2 hours in Groups 1, 2, and 3, respectively (p0.05). The developed anesthesia procedure using isoflurane, midazolam, propofol, and small-dose fentanyl ensures safe and early (up to 6-hour) extubation in 73% of the patients undergone aortocoronary bypass surgery. The developed anesthesiological protocol based on thoracic epidural anesthesia enables extubation to be carried out on the operating table within an hour in 75% of patients after aortocoronary bypass surgery. A comparative intraoperative analysis of hemodynamics, the incidence of myocardial ischemia, arrhythmias, glucose levels has indicated that the anesthesia techniques aimed at a patient's early activation are not inferior in the degree of protection to routine anesthesia using large doses of opioids, ketamine, and diazepam. When used in combination with thoracic epidural block, the methods are superior to the latter.

The introduction of principles of bloodless surgery into different areas of practical medicine is favoured by not only risks from donor blood transfusion, but also by the results of the researches dealing with the body's adaptation to acute anemia, with the determination of its allowable limits, and with much experience with bloodless operations used in Jehovah's Witnesses. The present study was undertaken to make a scientific-and-practical assessment of actual own blood funds and their introduction in order to decrease or refuse to use donor blood at cardiac surgery under extracorporeal circulation (EC). A retrospective analysis of hemotransfusion policy in 1993-2001 was conducted in over 2000 patients operated on under EC for coronary heart disease, acquired and congenital cardiac diseases at the Open Cardiac Surgery Department, Russian Surgery Research Center, Russian Academy of Medical Sciences. Own blood saving methods, such as intraoperative autohemotransfusion as two modalities, washed autoerythrocytic reinfusion, autoplasma reinfusion, as well as the use of different pharmaceuticals effective in reducing hemorrhage after EC were evaluated. The introduction of the above own blood saving methods may decrease the use of donor erythrocytes and freshly frozen plasma by 2.6 and 1.8 times, respectively, may completely refuse transfusing thromboplasma, assure adequate hemostasis, reduce the incidence of adverse reactions associated with donor blood transfusion in cardiac surgical patients. A complex use of the developed saving donor blood methods and pharmaceuticals aimed at improving hemostasis allowed donor blood transfusion to be completely refused in more than 70% of patients at aortocoronary bypass surgery under EC.

The specific features of an early postoperative period were studied in 115 patients undergone myocardial revascularization who were divided into 3 groups according to the time of postoperative activation. Group 1 comprised 35 patients in whom tracheal extubation was made in the operating room 30-60 min after the end of the operation. Group 2 included 32 patients extubated 2-8 hours after admission to the resuscitation and intensive care unit (RICU); Group 3 consisted of 48 patients undergone tracheal intubation for more than 8 hours. The patients of this group received traditional anesthesia using ketamine, benzodiazepines, and large-dose fentanyl. The developed combined anesthesia with inhalational and intravenous anesthetics having their better pharmacodynamics, such as isoflurane, diprivan, tracrium, was used in 60.3% of the patients in Groups 1 and 2. The developed type of anesthesia using a high thoracic (T2-T4) epidural blockade as a basic component of anesthesiological maintenance was studied. In Group 2, the preextubation time was twice less than that in a control group (5.2 +/- 0.3 and 10.8 +/- 0.4 hours, respectively, p0.05). In groups with early extubation, the incidence of clinically significant cardiovascular disorders was less than that in the controls, which is indicative of better performance of the cardiovascular system. In Group 1, the frequency of reintubations for arterial hypoxemias was 2.8% and that of pneumonias and pulmonary microatelectasis was 2.5 times less as that in Group 3 (9%, p0.05). Chills occurred in 6, 4, and 15% of cases in Groups 1, 2, and 3, respectively (p0.05). A programme on early activation after aortocoronary bypass surgery could reduce the patients' stay at the RICU on an average by 24 hours without increasing the risk for postoperative complications.

Different blood saving methods are analyzed in 2000 cardiac surgical patients undergoing coronary and vascular bypass surgery in 1993 to 2000. The basic blood saving methods are as follows: intraoperative autoreinfusion (normovolemic thermodilution), reinfusion of the patient's blood, preoperative autologous plasma donation in combination with aprotinine, aminocapronic acid, etc. An analysis revealed a decrease in homologous blood components intraoperatively. Red blood cell transfusion decreased from 100% in 1993 to 44% in 2000, fresh frozen plasma and platelet transfusions did from 98 to 39% and from 96 to 1%, respectively. Intraoperative homologous blood transfusion could be avoided in 70% of those undergone coronary bypass surgery.

The efficiency of perioperative therapy with quamatel (histamine H2-receptor blocker) for preventing gastrointestinal complications in cardiosurgical patients was evaluated. Quamatel was used in 68 cardiosurgical patients subjected to aortocoronary bypass surgery for coronary disease. Perioperative pH profile of the gastric contents was evaluated by a Gastroscan-5 acidogastrometer (Russia). The volume of gastric juice secretion was evaluated after induction anaesthesia, at the end of operation, and 6-8 h after the intervention. Quamatel was highly effective and well tolerated by cardiosurgical patients with concomitant gastrointestinal diseases during preparation to surgery. Use of quamatel for premedication, particularly in patients with gastrointestinal diseases, stabilized pH and decreased the gastric juice hypersecretion during the entire intraoperative and early postoperative period, thus preventing gastrointestinal complications. High therapeutic efficiency of quamatel and its good tolerance recommend it for cardiosurgical patients and to surgical patients of other profiles for prevention of gastrointestinal complications.

The purpose of this study was to evaluate the possibility of using clofeline in anesthesiological protocol for myocardial revascularization as a drug preventing hemodynamic disorders and perioperative myocardial dysfunction. In group 1 (27 pts.) clofelin was used in premedication (150 micrograms at night on the eve of surgery and before the operation), group 2 (29 pts.) was control. Clofelin improved the stability of the cardiovascular system, decreased the incidence of hyperdynamic reactions, episodes of myocardial ischemia, and cardiac arrhythmia during surgery. Use of clofelin for premedication decreased the need in inotropic support during the postperfusion period from 49 to 37% and ensured a higher cardiac production during transfer from artificial to spontaneous circulation.

Two groups of coronary patients subjected to revascularization of the myocardium were examined in order to detect the negative hemodynamic effects of protamine sulfate (PS) and the possibility of their correction by simultaneous infusion of adrenaline microdoses. In group 1 (27 pts.) heparin was neutralized by infusion of PS alone (6 mg/kg) and in group 2 (27 pts.) by simultaneous infusion of PS and adrenaline (15 ng/kg/min). The functions of the right and left ventricles were evaluated by catheterization of the pulmonary artery by a Swan-Ganz catheter and transesophageal Doppler echocardiography. These methods provided volume and velocity characteristics of the right and left compartments of the heart. PS deteriorated the systolic function of the right ventricle, particularly in patients with initial dysfunction of the right heart. Infusion of adrenaline simultaneously with PS leveled its negative effects, thus preventing myocardial dysfunction.

As patients with ischemic heart disease (IHD) may develop intraoperative hypertensive and hyperdynamic reactions provoking myocardial ischemia, the authors estimated reactivity of the autonomic nervous system before giving anesthesia. This was made for prediction of intraoperative hypertensive reactions and choice of an optimal anesthesia variant. Combination of spectral analysis of variability of the heart rhythm and active orthostatic test was employed for this purpose in 50 IHD patients undergoing myocardial revascularization.

Methods of myocardial protection from ischemic and reperfusion injuries in various operations on the open heart were compared. The study demonstrated the advantages of combined antegrade-retrograde delivery of cardioplegic solution during ischemia in aortocoronary shunting and correction of valvular defects. The method of myocardial protection from reperfusion injury by perfusing the heart with blood solution of a special composition before removing the clamp from the aorta (controlled reperfusion) proved to be effective, which was confirmed by clinical and biochemical data presented in this paper. Hence, our findings confirmed that the optimal protection of the myocardium can be attained by combined cold crystalloid cardioplegia together with controlled reperfusion of the myocardium.

A total of 100 patients subjected to multiple aortocoronary shunting under artificial circulation were examined. All of them were administered aprotinin or placebo in standard doses in a double blind test. The drug was infused over the entire course of the operation, total dose being 6 million KIU. The groups of patients did not differ by duration of artificial circulation and aorta clamping, or by the number of shunts used. The data permit a conclusion that prolonged intraoperative infusion of aprotinin in a dose of 6 million KIU resulted in a twofold reduction of the blood loss during and after the operation, thus permitting less frequent and lower in volume transfusions of donor blood during the operation and in the early postoperative period.

Normo-thermal artificial circulation (NAC) with constant thermal blood cardioplegia (CTBC) was carried out for the first time in Russia in 12 coronary patients subjected to surgical revascularization of the myocardium. Artificial circulation device with the vesical type oxygenator was used for NAC. For CTBC, systems for delivery of the cardioplegic solution and blood from the oxygenator in 1:4 ratio were used. Freme type cardioplegic solutions made by the authors were used. NAC duration was 53 to 139 min, the mean value being 103.4 min. The aorta was clamped for 38 to 96 min, the mean value 70.1 min. Asystole developed soon after CTBC began. After CTBC was discontinued, heart work recovered without cardiotonics.

The aim of this research was to evaluate the effect of high aprotinin doses on activated coagulation time (ACT) in patients with aortocoronary bypass. A total of 100 patients were examined. All of them were administered in a double blind test either aprotinin or placebo in standard doses. Our results permit a conclusion that adequate heparinization during aprotinin therapy can be achieved at ACT values more than 750 sec and protamine sulphate dose should be estimated from initially administered heparin dose. With ACT values exceeding twofold the usual ones there was no evidence of excessive heparinization leading to marked thrombocytopenia and bleeding.

Forty-three patients operated on under conditions of aortocoronary bypass were examined. In 29 of them continuous circulation of cold solution in pericardial cavity was combined with antegrade cardioplegia. In 14 routine technique of external myocardial cooling with snow and antegrade crystalloid cardioplegia was employed. Intensive external cooling of the heard helped not only maintain a lower myocardial temperature but permitted also a reduction of temperature gradients between various myocardial sites. This was conducive to a better preservation of energy reserve and contractility of the myocardium.

Changes in the blood content of trace elements (E)--copper, zinc and iron--have been studied in 10 patients with ischemic heart disease subjected to cardiopulmonary bypass surgery. It has been shown that blood TE concentrations decreased considerably during surgery. Variability in blood TE levels could be accounted for by hemodilution caused by the administration of colloids and crystalloids that contained no TE under study. These solutions were used initially for filling assisted circulation device. However, it is noteworthy that the degree of hemodilution was not the only reason for the changes in blood TE content, as despite hematocrit normalization it was only blood iron content that returned to preperfusion level. It has been demonstrated that copper and zinc blood concentrations were considerably lower in patients developing heart failure in the early postperfusion period than in those with an uncomplicated postoperative period. It has been shown that the nature and degree of changes in copper, zinc and iron levels in the coronary sinus blood during heart surgery can be assessed by changes in their arterial blood content.

The study was performed on 47 patients with ischemic heart disease subjected to aortocoronary bypass surgery. The study has revealed adaptation changes of free-radical blood properties that led to the damage of the myocardium by oxygen free radicals. Blood sampling from the coronary sinus is of greatest diagnostic value, enhancement of antiradical properties of this blood indicate damage of the myocardium. Detection of lactate in coronary blood may be an early sign of hypoxic myocardial damage caused among other reasons by activation of free-radical processes. Abrupt changes from hypoxic to hyperoxic oxygenation may complicate the recovery of cardiac function, while an even regimen of oxygen supply with a certain tendency of hyperoxia and adequate myocardial protection will not promote damage of the myocardium.

A universal system for the delivery of cardioplegia solutions has been described. The use of the system makes it possible to conduct all the kinds of cardioplegia, i. e. antegrade, retrograde, combined and shunt cardioplegia (the combination of the first and second types with the delivery of cardioplegia solutions via coronary anastomoses). The system is a distributor with six taps, each of them supplied by a cannula for the delivery of cardioplegia solution via autovenous shunts via the aortic root and coronary sinus. Besides, at the stage of lateral aorta clamping (during aortocoronary bypass surgery) the delivery of oxygenated blood from cardiopulmonary bypass apparatus to the respective myocardial segments via autovenous shunts is possible. The above system improves even distribution and cooling of various myocardial zones, especially in the area of affected coronary arteries and makes it possible to shorten the period of warm-induced ischemia of myocardial shunts.

The myocardial function and metabolism were assessed in 12 patients with coronary heart disease intraoperatively during aortocoronary bypass surgery. The antioxidative properties of the blood of the heart were found to become lower along with activated peroxidation after the major stage of an arrested heart operation, that correlated with depressed myocardial function.

A new method of cardiovascular investigation with a multifunctional catheter was used in 56 cardiac and pulmonary patients. The multifunctional catheter enabled simultaneous measurement of the intravascular pressure and liner flow rate in large vessels (both arteries and veins). Prospects are outlined for the multifunctional catheter to be used for continuous hemodynamic monitoring, and developing, on this basis, of a computer monitoring system to assess cardiac performance during surgery.

The authors studied the effect of isoket on the central hemodynamics and myocardial contractility as well as on the conditions of myocardial functioning in 38 patients aged 28-53 years and suffering from coronary heart disease. The infusion of 2 mg of isoket at a rate of 400 micrograms/min was followed by a decrease in the arterial pressure with the maximum drop seen on the seventh minute (by 26% from the baseline value), a reduction in the end-diastolic pressure by 50%, and a lengthening of the preejection period without any significant changes in either the cardiac output or the total peripheral resistance. Taken as a whole these changes justify the conclusion that the influence of dinitrate isosorbite (isoket) on the central hemodynamics is largely due to its venodilating action leading to a reduction of the pre-load which in turn improves myocardial functioning.

The paper deals with a role of spectral entropy-based neuromonitoring at cardiac surgery. Eighty cardiosurgical patients were examined. The depth of entropy-based anesthesia was monitored in all the patients. The patients enrolled into the study were divided into 2 groups. Anesthesia was carried out in the study group (n=40), by taking into account entropic parameters, and in the control group (n=40) on clinical grounds. Information on entropic parameters in this group was accessible only to an investigator and inaccessible to an anesthesiologist who had made anesthesia. The results of the study indicated that entropy-based neuromonitoring permits more controllable and predictable anesthesia to be achieved, makes an individual adjustment of the doses of sedatives easier for each patient, at the induction of anesthesia particularly, enables hypo- and hyperhypnotic episodes to be timely revealed, thus reducing the frequency of hypo- and hyperdynamic reactions by 2.4 times.

The paper deals with the development of a diagnostic and therapeutic algorithm of intraoperative heart failure during cardiosurgical operations on the basis of evaluation of systolic and diastolic functions of the left and right ventricles. The study included 101 patients with low cardiac output in the postperfusion period. All the patients suffered from coronary heart disease and they underwent myocardial revascularizing operations under extracorporeal circulation. In all the patients, in addition to traditional hemodynamic parameters (heart rate, blood pressure, central venous pressure), the functional status of the left and right ventricles was evaluated by transesophageal Doppler echocardiography (TED echoCG) and the thermodilution technique using a Swan-Ganz catheter having a prompt thermistor. Evaluating the diastolic and diastolic functions of the right and left ventricles makes it possible to identify 2 types of left and right ventricular failure: 1) that due to systolic dysfunction and 2) that due to concomitance of systolic and diastolic dysfunctions. Dobutrex (5-7.5 microg/kg/min) should be used in right ventricular systolic dysfunction. Amrinone (5-10 microg/kg/min) should be given to patients with concomitance of systolic and diastolic dysfunction; in this situation, a combination of dobutrex and nitroglycerin (100-150 ng/kg/min) may be used. The drugs of choice in impaired left ventricular systolic function are epinephrine (30-100 ng/kg/min), dopamine (5-10 microg/kg/min), or dobutrex (5-7.5 microg/kg/min). Their combination with sodium nitroprusside can enhance the efficiency of therapy. In patients with left ventricular failure caused by systolic and diastolic dysfunction, epinephrine, dopamine, or dobutrex may be combined with amrinone (5-10 microg/kg/min) or nitroglycerin (100-150 ng/kg/min).

The effects of glycerol trinitrate (GTN), sodium nitroprusside and isoket on central hemodynamics, myocardial contractility and myocardial function have been compared. 65 patients with ischemic heart disease have been examined. All the patients were divided into 3 groups depending on the drug studied. GTN was administered sublingually at a dose of 0.5 mg, while sodium nitroprusside and isoket were infused at doses of 1.5 micrograms (kg min) and 400 micrograms/min, respectively. It has been shown that GTN and isoket effects on central hemodynamics were mainly mediated by their venodilating action and preload reduction, thus promoting to the improvement of the myocardial function. Hemodynamic effects of sodium nitroprusside on the cardiovascular system are mediated by its dilating action on the arterial bed and afterload reduction.

The electromyographic and hemodynamic profile and side effects of the new nondepolarizing myorelaxants Mivacurium chloride (Mivacron), Cisathracurium besilate (Nimbex), Rocuronium bromide (Esmerone) were studied in 117 adult patients. All the test myorelaxants as bolus or infusion in a dose of 3.ED95 were found to be effective in creating adequate conditions for tracheal intubation and neuromuscular block (NMB) maintenance during operations on the coronary arteries and cardiac vales under extracorporeal circulation. In terms of the onset rate of NMB, Esmerone is the drug of choice for tracheal intubation. Esmerone and Nimbex in a dose of 3.ED95 did not produce a noticeable hemodynamic effect. The former was found to have a slight vagolytic effect. When rapidly injected as bolus, Mivacron caused a significant decrease in blood pressure and heart rate by 10-12%. Based on a comprehensive study, the authors have scientifically substantiated principles in the choice of nondepolarizing myorelaxants in cardiac surgical patients in relation to the baseline hemodynamic values, the stage of an operation, and the duration of artificial pulmonary ventilation.