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The article deals with the first comparative study of haemodynamics, gas exchange, and metabolic lung finction in patients with underlying respiratory and cardiovascular diseases. Different anaesthesia and ventilation (conventional AVL, OLV differentiated ALV) techniques were used. Respiratory support methodology with the use of HFV or CPAP during the main phase of thoracic surgery in patients with severe associated cardio-respiratory diseases was developed. Indications for differentiated AL V in thoracic surgery were developed.

Treatment results of 96 patients with ischemic heart disease, operated on with the use of artificial blood circulation and polycomponent anesthesia, were analyzed. The modified protocol of infusion therapy and functional tests (passive limb elevation and volume load test) were used to assess the dynamic vascular reaction among patients of the main group (n=54). Patients from the control group (n=42) received only standard infusion therapy. The use of functional test permits more individual calculation of the necessary volume to correct vascular reactions on the initial anesthesia. The simultaneous monitoring of tissue and brain oxygenation permits adequate assessment and correction of short vascular reactions during the cardiac surgery. During short vascular reactions the tissue perfusion in the absence of cardiac insufficiency changes in an inverse proportion to arterial blood pressure.

In this review TIVA and combined general anaesthesia are not opposed to each other, but considered as having common physiological, clinical, pharmacological, technological and methodological features. This approach will help to borrow useful qualities of each anaesthesia method.

The authors report their experience with the application of the local antiseptic preparation Ambipor for the treatment of operative wound infection in the patients presenting with malignant neoplasms. Ambipor was used in 23 patients receiving surgical treatment of locally advanced intranasal and paranasal tumours. It was shown that the application of ambipor allows decreasing the risk of development of wound infection in the postoperative period.

Cholinesterase blockers are widely used in various fields of clinical medicine. In anesthesiology they are used for the means of decurarisation, as well as for performance of central segmental blockades. In recent years, along with the most frequently used neostigmine again an opportunity arose to use the well-known galantamine. A brief overview of the pharmacological properties of galantamine is completed by the study of its efficacy and safety in 30 patients (first group) who underwent general anesthesia with total myoplegia at a range of abdominal surgeries. The comparison group (second group) included 30 patients who were applied neostigmine. The method of clinical functional evaluation, the accelerometry and frontal electromyography confirmed that galantamine although inferior to neostigmine in efficiency, has a higher safety threshold.

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.

An educational-and-methodological complex (EMC) in the specialty 'Anesthesiology and Reanimatology", which promotes manageability, flexibility, and dynamism of an educational process, is of great importance in solving the problem in the systematization of knowledge and its best learning by physicians at a stage of additional professional education (APE). EMC is a set of educational-and-methodological materials required to organize and hold an educational process for the advanced training of anesthesiologists and resuscitation specialists at the stage of APE. EMC includes a syllabus for training in the area "Anesthesiology and Reanimatology" by the appropriate training pattern (certification cycles, topical advanced training cycles); a work program for training in the specialty "Anesthesiology and Reanimatology"; a work curriculums for training in allied specialties (surgery, traumatology and orthopedics, obstetrics and gynecology, and pediatrics); work programs on basic disciplines (pharmacology, normal and pathological physiology, normal anatomy, chemistry and biology); working programs on the area "Public health care and health care service", guidelines for the teacher; educational-and-methodological materials for the student; and quiz programs. The main point of EMC in the specialty "Anesthesiology and Reanimatology" is a work program. Thus, educational-and-methodological and teaching materials included into the EMC in the specialty 'Anesthesiology and Reanimatology" should envisage the logically successive exposition of a teaching material, the use of currently available methods and educational facilities, which facilitates the optimization of training of anesthesiologists and resuscitation specialists at the stage of APE.

To implement the basic provisions of the Bologna Declaration for postgraduate professional education of anesthesiologists-resuscitators, to upgrade the quality of training specialists, it is important that, by preserving the existing forms of an educational process, to introduce into continuing professional development the following innovation educational technologies, by taking into account the existing forms and technologies of the Russian higher medical school: to realize the continuing professional development (CPD) concept; a credit accumulation system as a generalizing function during CPD; distance and multimedia learning; and a modular organization of a learning and educational process.

Sixty patients who had undergone cardiosurgical operations under extracorporeal circulation (EC) were enrolled in the study. All the patients were divided into 2 groups: (1) 40 patients were injected tranexamic acid (TA) (its loading dose was 15 mg/kg; maintenance infusion 1 mg/kg/h throughout the operation; 500 mg in the primary packing volume for an EC apparatus (EA); (2) 20 patients received epsilon-aminocapronic acid (ACA) (its loading dose was 5 g; 5 g in the primary packing volume for an EA and 10 g for infusion after EC). The effects of TA and ACA on the fibrinolytic system were evaluated from the time of XIIa-kallikrein-dependent fibrinolysis (sec) and the concentration of D-dimer (mg/ml). The hemocoagulation system (activated partial thromboplastin time, thrombin clotting time, prothrombin time with the determination of the international normalized ratio, fibrinogen) was studied. The thromboelastogram (the time R, K, and alpha-angle, MA) was analyzed. The indices were determined at the beginning and end of, and 12 hours after surgery. The analysis of the clinical efficacy and safety of the agents was based on the following perioperative data: the incidence of adverse reactions and complications associated with the administration of the agents, the frequency and amount of transfused donor blood components, the volume of blood loss, and the rate of resternotomies. The laboratory and clinical findings lead to the conclusion that TA (Tranexam, OOO "MIR-PHARM") has a 4-fold antifibrinolytic activity as compared with epsilon-ACA. The more pronounced TA-induced suppression of fibrinolysis affects the clinical course of a perioperative period in this group, which manifests itself as a reduced blood loss volume during and after surgery and a lower frequency of use of donor blood elements. By taking into account these data, TA may be recommended as one of the blood-preserving technology components during cardiosurgical operations under EC.

The purpose of the investigation was to study whether isoflurane and sevoflurane might be used for pharmacological myocardial preconditioning (PMP) in patients with coronary heart disease during myocardial revascularization on the working (Part I) and arrested (Part II) heart and to develop a possible procedure for PMP. Part I deals with the study of the effect of PMP with halogen-containing anesthetics during myocardial revascularization on the working heart. The study included 66 patients who were divided into 4 groups; 1) sevoflurane feeding was started just after anesthesia induction and it lasted until some coronary arteries were ligated; 2) sevoflurane was fed for 15 min; 3) isoflurane was used; 4) controls. The markers of myocardial lesion (troponin T, I) were measured and the incidence of perioperative myocardial ischemia and needs for inotropic support were also analyzed. Part II was dedicated to the study of the effect of PMP during myocardial revascularization under extracorporeal circulation (EC). The study covered 65 patients who were divided into 4 groups; 1) sevoflurane was administered throughout the anesthesia until the aorta was ligated; 2) it was used for 15 min before aortic ligation; 3) sevoflurane was employed only to induce anesthesia; 4) controls. The variables similar to those in Part I of the investigation were chosen to assess the results of this study. The use of sevoflurane and isoflurane reduces a risk for myocardial ischemic lesion during myocardial revascularization both under EC and on the working heart. Short-term (15-min) use of an agent before myocardial ischemia suffices for PMP to develop its effect. The effect of PMP has its duration that is 76 min, as shown by our findings.

The paper deals with the development of a procedure for using loading tests to predict the development of intraoperative heart failure in cardiosurgical patients. A volumetric loading test (limb elevation) was carried out to assess the mechanisms of responsible for the regulation of performance of the heart and the efficiency of its work. Cardiac output, end diastolic volume index, and ejection fraction were recorded and a hemodynamic response was assessed from their changes. Loading tests enabled the authors to identify 3 types of a hemodynamic response to a volumetric load. The incidence of postperfusion heart failure may be predicted depending on the identified type of a hemodynamic response to the volumetric load given at the very beginning of surgery.

Background: Implementation of an innovational educational space program by the I. M. Sechenov Moscow Medical Academy envisages for the specialty "Anesthesiology and Reanimatology "first of all the development of a new-generation state educational standard, that considers the underlying principles of the Bologna Declaration, its introduction into educational process practice, and the maintenance of the high competence of a physician throughout his/her professional activity. The subject of the study was a system for controlling the educational process of continuous postgraduate training of anesthetists-resuscitation experts, by developing a model of the state educational standard taking into account the European educational traditions that adequately unified in form and content and the specific features of the Russian national school of higher medical postgraduate education. The object of the study was to modernize approaches to transforming the continuous postgraduate educational system for physicians in the area of anesthesiology and reanimatology, which had been laid down and vested in the new-generation state educational standard taking into account the new forms and technologies of an educational process in accordance with the principles of the European educational system. The aim of the study was to provide conceptual and methodological rationales for the use of innovational and traditional educational technologies for the postgraduate training of physicians in the area of anesthesiology and reanimatology according to the measure schedule within the general plan "Development of draft new state standards projects, including the state certification in the specialties "Internal Medicine", "Pharmacy", "Nursing", "Medical and Preventive Science", "Dentistry", "Pedagogics", etc., to elaborate plans of training and subjects, a range of specialties, as well as qualification characteristics in a specialty, etc." within the innovational educational space program by the I. M. Sechenov Moscow Medical Academy. The tasks of the study: 1) to provide conceptual and methodological rationales for the incorporation of innovational educational technologies into the Russian national system for the postgraduate medical training in the area of anesthesiology and reanimatology; 2) to adapt the European educational traditions to the Russian national normative base of the postgraduate medical education in the specialty "Anesthesiology and Reanimatology"; 3) to develop ways of mating the methods for estimation of professional competence within the continuous professional improvement system for the specialty "Anesthesiology and Reanimatology", which are accepted in the countries of the European Union and which are customary for the Russian Federation., Methods: a conceptual and methodological analysis and adaptation of the European experience of postgraduate education of anesthetists and resuscitation experts to the Russian educational system, by working out a new-generation state educational standard that provides for the use of innovational educational technologies., Novelty: The authors first present the conceptual and methodological rationales for the use of innovational educational technologies to develop a new-generation state educational standard in the specialty "Anesthesiology and reanimatology", which is based on the incorporation of the European educational traditions and innovational educational technologies into the Russian postgraduate medical training system. They first propose the model for reforming the structure of postgraduate education of anesthetists and resuscitation experts, which has been adapted to the World Medical Education Federation requirements stated in the Bologna Declaration., Contents of the Study: The concept and methodology of development of the form- and contents-uniformed state educational standard of postgraduate training in specialty 14.00.37 "Anesthesiology-Reanimatology" for the postgraduate training of medical specialists in Russia in accordance with the principles of the Bologna declaration.

The uniquely shaped and contained structure of a modular approach to organizing an academic process, which comprises a conceptual rationale for the conversion of an educational process in accordance with a modular design, is detailed in the paper. All learning modules have the similar structure consisting of the following sections: background, general and specific objectives, contents, methods of teaching and assessment, the place and conditions of training. The authors provide evidence for the use of a module as a form of organization of individual educational programs, curricula, and academic plans of subject-matter during postgraduate training of physicians. Module education is shown to get over the fragmentariness of an academic process, by working out a comprehensive educational program and making a problem presentation of the contents in the module. The development of educational modules is to eliminate parallelism, temporary and logic gaps between various topics, to upgrade the quality of education, and to enhance the efficiency of a medical specialist's self-work. The authors analyze in detail the advantages of the module approach in improving an academic process during postgraduate training of physicians. They also present guidelines for the introduction of module technology in accordance with the principles of the European educational system.

The specific features of balanced anesthesia utilizing sevoflurane (versus isoflurane) during thoracic operations under artificial one-lung ventilation (AOL ) have been studied in patients at high operative and anesthetic risks. Unlike isoflurane, sevflurane fails to cause vasodilatation in both the greater and lesser circulation (including in the gas-exchange part ofpulmonary circulation). The difference of the anesthetics in their vasodilating capacity in the vessels of pulmonary and systemic circulation determines various mechanisms of pathophysiological and adaptive circulatory changes in pulmonary collapse and under AOL V Under sevoflurane anesthesia, compensatory blood flow limitation along the collaborated lung due to permanently vasohypertension in gas-exchange microcirculation is accompanied by a systemic circulatory response that is aimed at reducing right ventricular load. Termination of hypoxic pulmonary vasoconstriction in the collaborated lung occurs not early than 80-125 min of AOLV, fails to lead to recovery of impaired gas exchange due to vasohypertension and high shunt in the ventilated lung, and is attended by right ventricular overload. The latter differentiates sevoflurane anesthesia from isoflurane one wherein completion of pulmonary hypoxic vasoconstriction upon 80-125-min exposure to AOL V results in the recovery of gas exchange to the baseline levels. The pattern of reperfusion changes in ventilation emergence in the operated lung under anesthesia using both sevoflurane and isoflurane is of no significant pathological tinge and it is followed by no pulmonary and systemic metabolic disturbances. Isoflurane should be recognized to be preferable component at the stage of anesthesia maintenance in patients with cardiopulmonary diseases during thoracic operations under prolonged AOL V (more than 2 hours).

Russia 's joining the European higher educational space and an increase in the international competitive capacity of the European higher educational system envisage first of all that the European credit test system (ECTS) should be accepted and introduced into all national higher educational schools, which ensures both credit test and cumulative functions and guarantees the academic recognition of the education abroad. The issues of modernization of approaches to reforming the continuous postgraduate training of physicians, by using the credit test system, as well as new forms and technologies for an educational process in accordance with the European educational system principles are under discussion. The novelty of the proposed development is that the credit test system is first applied to the continuous postgraduate training of physicians within the framework of the Russian higher medical educational system. The Russian continuous postgraduate medical training pattern that is common in form and content is proposed in accordance with the Bologna declaration principles; approaches have been developed to incorporating the European educational traditions into the Russian national continuous postgraduate medical training system, by employing the credit test system; criteria have been elaborated for adapting the European credit test system at all stages of reformation of the Russian educational system; guidelines have been worked out for the conversion of academic load of various forms of the continuous postgraduate training of physicians to the credit test system; ways of introducing the new forms and technologies into an educational process have been proposed in accordance with the European education system principles, by taking into account the credit test system. The introduction of new technologies of an educational process, by using the credit test system will contribute to personality formation in a physician who has a high competence, a capacity for valuable independent work in health cared facilities and further postgraduate training during his/her professional activities, which is required to provide a high-skill aid to patients in compliance with his/ her work status and employment place.

Twenty-five patients with coronary heart disease were examined in the preperfusion stage of myocardial revascularing operations under extracorporeal circulation. All the patients received combined anesthesia with xenon (Xe) as minimum flow anesthesia with flow of gases: oxygen, 0.4 l/min; Xe, 0.9 to 0.4 l/min. Cerebral circulation was investigated by transcranial Doppler study. The following parameters of the circulation: maximum systolic and diastolic blood flow velocities and pulsatile index were bilaterally estimated, by insonating the middle cerebral artery (MCA). When the concentration of Xe was as high as 50-60%, systolic and diastolic blood flow velocities along the MCA increase and the pulsatile index decreased. Opposite results were obtained 8 minutes after Xe feed was stopped. The findings provide evidence that Xe increases cerebral circulation and has a significant hypnotic effect. The increased systolic and diastolic blood flow velocities with the decreased peripheral resistance index in the MCA suggest that Xe diminishes peripheral vascular resistance in the pial arteries of the brain.

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 paper deals with the effect of isoflurane (IF) as a component of combined anesthesia during thoracic interventions in the lateral position on the development of adaptation mechanisms to a change in artificial ventilation (AV) modes--from ventilation of both lungs to that of one lung (unilateral ventilation, ULV), long exposure to ULV and to a change from ULV to ventilation of both lungs. Eighteen patients at a high operation-anesthetic risk were examined. Measurements were made in 6 steps, including conditions in AV, exposure to ULV for 15-30, 55-60, and 80-120 minutes, AV after 20-min exposure to ULV, and at the end of surgery in the supine position. While analyzing the results, the authors made an important observation that IF has a property of preventing capillary formation in the ventilated portions, without impairing the mechanism of pulmonary hypoxic vasoconstriction in the area of atelectized alveoles. This contributed to the optimization of a ventilation-perfusion relationship and creates conditions for adequate oxygenation. The use of IF as a component of combined anesthesia during thoracic operations associated with a need for artificial unilateral ventilation in patients at a high operation-anesthetic risk created conditions for optimizing gas exchange and blood circulation at all stages of an operation and anesthesia.

A randomized comparative study of the effect of 20% Albumin (Plasbumin) solution and 4% succinylated gelatin (helofusin) solution on homeostasis was conducted in 36 cardiosurgical patients when the solutions were used as components to fill a pump oxygenator (PO). A comparative analysis has indicated that the use of albumin in the primary volume of PO at a concentration of 2-3% provides a higher level of total protein and better maintains colloid osmotic pressure during extracorporeal circulation than that of helofusin. At the end of an operation, the oxygen index was higher in the patients given albumin (Plasbumin). It has been also ascertained that plasbumin is well tolerated, causes no adverse reactions, and produces no dose-dependent effect.

The paper considers two thermal dilution methods for monitoring central and pulmonary hemodynamics, such as pulmonary thermal dilution (Swan-Ganz-REF) and transpulmonary thermal dilution (PICCO-Plus technology) in the context of their invasiveness, informative value, and the easiness-to-use in high-risk patients during thoracotomic interventions. They have been comparatively analyzed. The limitations of and contraindications to their use have been systematized. It has been found that these methods are not only interchangeable, but they also complement each other. Concurrent application of these methods may be recommended in high-risk patients during traumatic thoracotomic interventions.

The immune status was analyzed in 28 patients with cicatricial stenosis of the trachea for the purpose of determining the type and nature of affection as well as for the purpose of evaluating the clinical efficiency of galavit immunomodulator. Combined impairments were diagnosed in the patients. Moderately decreased CD4+, CD8+, CD16+, significantly decreased CD25+, HLA-DR, CD71+ and increased CD4+/CD8+ were detected at the cell level. An essentially lower CD20+, a higher content of IgG and a reduced FAN were observed in the humoral chain. Therefore, galavit, when used preoperative and immediately after surgery in patients with cicatricial stenosis of the trachea, had a positive effect on the immune status; it reliably increased the count of T-helpers (CD4+) and of natural killers (CD16+) and it induced the phagocyte activity of neutrophils.

A double blind study of the therapeutic effect of the opioid tramadol hydrochloride (Gruenenthal, Germany) in the treatment of postoperative trembling was undertaken in 2 groups of patients (50 patients in each) versus that of placebo. The results obtained denoted that tramadol at 1-2 mg/kg arrested completely the postoperative trembling or cut significantly its intensity in 49 (98%) patients. Such high efficiency of tramadol as compared to that of other opioids can be explained by its dual mechanism of action. The dependence of an effective tramadol dose on intensity of shivering and on degree of impaired temperature hemostasis was demonstrated. A comparison of hemodynamic parameters observed before and after the administration of tramadol did not reveal any valuable changes in arterial pressure or cardiac beat rate. Mildly intensified sedation was registered in 17 patients, which is typical of all opioids.

Described in the paper are the results of a multicenter study that was conducted at 11 health-care facilities of the Russian Federation and that was based on an analysis of 623 medical records of adult patients operated on with general anesthesia of different variations. There were 154 (24.7%) males and 469 (75.3%) females, aged 16 to 90. The study denoted the need in and possibility of preventing and arresting the PONV; it also outlined those forms of ondansetron (Zofran) that can be used for the purpose, they are: parenteral and lingual pills and rectal suppositories. An assumption was put forward on the significance of PONV conductive factors and on the most effective forms of ondansetron from among the mentioned above. An understanding, resulting from the study, on that PONV is of the multietiology nature and on that its probability increases in proportion to a compatibility of provoking factors, like sex, surgery technique as well as duration of anesthesia and its variation is of importance. The efficiency of medicamental prevention of PONV by a blocker of HT3-receptors, i.e. by ondansetron (Zofran), is to a great extent predetermined by that if the form and, probably, dose of the drug is in line with a combination of the above factors, which needs further research.

The experience of clinical use of the new Russian myorelaxant of the non-depolarizing action vero-pipecuronium (pipecuronium bromided) manufactured by "Veropharm" is described. Vero-pipecuronium was found to ensure splendid and good conditions for the intubation of the trachea and to maintain reliably myorelaxation. The recommended doses and availability of an antidote (prozerine) provide for a sufficiently controllable myorelaxation. Vero-pipecuronium does not virtually exert any effect on the parameters of hemodynamics and can be successfully used in patients with a high anesthetic risk including heart surgeries. Thus, Russian vero-pipecuronium has now an effective and safe myorelaxant manufactured inside the country, whose parameters are not inferior to those of pipecuronium bromide (arduan) manufactured by "Gedeon Richter", Hungary. Since the described drug is made in Russia, one can hope it will be highly effective both economically and pharmacologically.

The results of monitoring of immune parameters in different categories of surgical patients with postoperative purulent-inflammatory complications are described in the paper. The combined type of secondary immunodeficiency and degree second immunodeficiency according to A.M. Zemskov were detected in all patients. Immunocorrecting drugs, like polyoxidonium, imunofan and likopid, were added to the complex treatment of patients with the above complications. Their administration normalized the dynamic clinical course of the purulent-inflammatory processes and restored the immunological parameters.

Maintenance of effective gas exchange made with respect to surgical comfort and lower risk of intraoperative lung damage is the main problem in the anesthetic management of surgical reduction of pulmonary volume (SRPV). Described in the paper is the experience of anesthetic management made in 10 patients in SPRV. The method of differential ALV (DALV) with continuous positive pressure in airways (CPPA) made for the ventilation support of the independent lung was found to be the only effective technique ensuring an adequate gas exchange in surgery for SPRV in patients with diffusive pulmonary emphysema (DPE). It accounts for the pathophysiological specificity of diffusive pulmonary lesion. At the same time, it provides for an optimal surgical comfort and for the most cautious manipulations on the lung. Such a combination improves the overall surgical results. The high-frequency respiratory support to the operated lung is contraindicated in such patients because of hyperinflation of the affected lung.

The paper analyzes anesthesiological maintenance of infusion therapy, optimal criteria for effective brain protection, complications and mortality in 42 patients during operations on the ascending portion and arch of the aorta under deep hypothermic circulatory arrest. For this purpose, the patients were divided into 2 groups: Group 1 comprised 20 patients operated on before 1998; Group 2 included 22 patients operated on in 1998 to 2001. In both groups, circulatory arrest lasted 44 +/- 7 min. The patients were cooled to a temperature of 13.5 +/- 0.5 degrees C, to 15 +/- 0.6 degrees C in the nasopharynx. The duration of cooling was 58 +/- 5 and 73 +/- 6 min, respectively; that of warming-up was 70 +/- 8 and 83 +/- 6 min. Investigations have indicated that determination of the optimum brain cooling requires a complex assessment of central temperature values, electroencephalographic monitoring (visual estimation of a curve and quantitative characteristics), SjbO2 and cerebral metabolism. The investigations have shown that the procedure for anesthesiological maintenance and cerebral metabolism is safe and effective even in patients with arrested circulation lasting longer than 60 min. The operative mortality does not depend on the use of circulatory arrest under deep hypothermia and on its duration. Hemodynamic instability due to bleeding, as well as myocardial infarction, marked hemodilution during extracorporeal circulation are major factors that cause an increase in the rates of incidence of complications and mortality. The procedure used for anesthesiological maintenance and infusion therapy, decreased blood loss, and a reduction in the incidence of myocardial infarction could significantly reduce operative mortality. The fact that there were no neurological complications even during prolonged (80-min) circulatory arrest has shown that the brain-protective procedure including both general and regional cooling is reliable and to the extent of the indicated criteria. So is pharmacological protection.

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.

This paper discusses the results of examinations of 87 anesthesiologists and intensive care specialists, aimed at elucidation of the effects of stress factors on their work, analyzes various aspects of stress in these specialists. The resistance of a physician to psychological (information) stress is determined by biological, social, and psychological factors. The desirability of creating a universal system of psychological monitoring of anesthesiologists and intensive care specialists is validated.

A comprehensive study was undertaken to examine morbidity due nosocomial pneumonia. An epidemiological survey demonstrated a growth in morbidity and mortality from this disease among the adult population of the Republic of Tatarstan. Pharmacological and epidemiological survey indicated that antibacterial therapy was in conformity with the federal protocols in 43.9% of cases, revealed the optimization of the use of antibacterial agents after introduction of the federal standards. At the same time the low social status of patients dying from pneumonia was accompanied by their appeal for medical aid, which leads to late hospitalization and untimely intensive therapy.

A new anesthetic pofol is characterized by predominantly hypnotic effect; it is a pharmacological analog of a well-known drug diprivan (propofol). The drug was used in 60 anesthesias for bronchoscopic manipulations and cardiosurgical operations. Its effects on hemodynamics, gas exchange, and reactions during induction and after anesthesia were evaluated. The present findings and results of previous clinical trials of diprivan indicate identity of pofol and diprivan. Clinical course of induction and anesthesia and hemodynamic reactions and effects on the respiratory system of patients were virtually the same. Pofol is well tolerated by the patients, its allergenic activity is low, it is rapidly metabolized and causes virtually no side effects. Positive results of clinical trials of pofol recommend it for clinical use.

Hemodynamics, gas exchange, velocity of psychomotor recovery, pain intensity during and after laparoscopic cholecystectomy were studied in patients anesthetized (total intravenous anesthesia) by two methods: 1) remifentanyl and propofol, forced ventilation of the lungs, and myoplegia (n = 21, ASA I-III) and 2) fentanyl and propofol, forced ventilation of the lungs, and myoplegia (n = 18, ASA I-III). Total intravenous anesthesia based on remifentanyl was characterized by stability of hemodynamic and gas exchange parameters at all stages of the intervention. This method ensured a smooth and rapid course of resuscitation, characterized by absence of signs of central respiration depression, predictable normalization of psychomotor status, and low incidence of factors provoking postoperative nausea and vomiting, on condition of their prevention. Further studies of remifentanyl are needed in interventions of different degree of traumatism and within the framework of different protocols of postoperative analgesia.

57 ischemic heart disease (IHD) patients entered the study of right and left heart function at different stages of anesthesia and operation to reveal possible reasons of myocardial dysfunction and to propose effective prevention of this dysfunction. All the patients were operated on under multicomponent balanced anesthesia (relanium, fentanyl, arduan, nitric oxide with oxygen 1:1). Left ventricular function was assessed at Doppler echocardiography, right ventricular function--at catheterization of the lung artery with a Swan-Ganz catheter with low time constant. Hemodynamic monitoring was made with a domestic MX-04 monitor. It was found that in the preperfusion period diastolic function of the right and left ventricles is impaired much more than the systolic one. The conditions of anesthesia and operation affect right ventricular function more than the left one. Diastolic and systolic right ventricular dysfunctions were observed at all stages and three stages of the operation, respectively. Diastolic and systolic left ventricular dysfunction was observed at four and one stages, respectively. Basic causes of the above systolic and diastolic disorders in the preperfusion period may be tachycardia, arterial hypertension, reduction of the preloading and increased postloading (for the right ventricle) in artificial lung ventilation.

The authors analyze the role of "human factor" in anesthesiology as a combination of characteristics which can influence the efficiency of physician's work. Anesthesiologists should possess professional skills directly concerned with mental adaptation of personality responsible for decision making in stress or emergency. Examination of 37 anesthesiologists who had given their informed consent helped determine the psychodiagnostic criteria of professional skills and gave grounds for forming groups liable to maladaptation under high psychoemotional strain. Relationships between age, sex and professional activity were assessed. It is recommended to introduce a system of professional selection of candidates wishing to become an anesthesiologist, of individual approach to optimization of the work intensity for practicing anesthesiologists. Psychological relaxation for anesthesiologists is also essential.

Total intravenous propofol anesthesia with target control (TCI) infusion was used in 61 surgical patients (43 women, 18 men, ASAI-II). Propofol concentration in the central compartment at awakening was in high correlation with the effective concentration (Ce) at the moment of falling asleep (r = 0.64). A model investigation demonstrated the advantages of longer induction for minimization of the hemodynamic disorders. Propofol TCI in a dose of 2 micrograms/ml led to an increase in the EEG spectral potency in the 1-12 Hz range, appearance of biomodality, and a decrease in the right-side frequency. The studies helped determine the policy of intravenous propofol TCI anesthesia using the Ce values at the moment when the patient lost consciousness and the right-side frequency of EEG spectrum.

Clinical trials of a new anesthetic Recofol were carried out. This analog of well-known drug diprivan is characterized by a predominantly hypnotic effect. The effect of recofol on hemodynamics, gas exchange, and EEG was studied in 30 clinical trials during anesthesia for bronchoscopic manipulations and operations on the abdominal and thoracic organs, microsurgery, and during peripheral vessel repair. The results indicate that recofol is virtually identical to diprivan (propofol). Clinical course of induction and anesthesia, hemodynamic reactions and effect on the respiratory system of patients were virtually the same. Recofol was well tolerated, its allergenic activity was relatively low, it was rapidly metabolized, there were virtually no side effects. Positive results of recofol trials carried out by Leiras Oy firm recommend the drug for wide use in anesthesiology.

Anesthesia-respiratory equipment (ARE) mainly including assisted ventilation apparatuses, inhalation anesthesia apparatuses, as well as the monitors employed in the use of these apparatuses are and will be the lead on the market of medical equipment in Russia. Therefore it is important to consider the immediate prospects of ARE development. For each of the above three types of ARE, the paper briefly lists the current and promising applications, the sites of their use, procedures, principal quantitative requirement and design. It refers to the most specific Russian and foreign items. The authors outline their own views of the immediate tasks of ARE design in Russia.

The specific features of placing a laryngeal mask (LM) under total myoplegia were studied. The first attempt at placing LM was successful in 98.7% of cases. A pressor response to LM appeared as increases in heart rate by 5.6% with combined intravenous ketamine anesthesia used during laparoscopic cholecystectomies (Group 1), by 10.2% at saphenectomies (Group 2), and by 6.7% with barbiturates. When diprivan was used, changes were absent in Group 1, there were increases in mean blood pressure and heart rate by 10 and 6.6%, respectively, in Group 2. The response to tracheal intubation was significant under all types of anesthesia. Regurgitation and aspiration were absent in all groups. The use of total myoplegia to place LM allows different current anesthetics to be used in the optimal doses and the procedure for placing LM to be greatly simplified.

Thirty patients aged 23 to 65 years with ASA class III operated on the heart under total intravenous anesthesia were examined after the Good Clinical Practice protocol. Mivacurium in bolus dose of 0.2 mg/kg was injected for intubation of the trachea; neuromuscular blocking (NMB) was maintained by a repeated injection of the drug in a dose of 0.15 mg/kg, after which it was infused at a rate of 1 to 10 micrograms/kg/min. Accelerometric control of neuromuscular conduction was carried out by the Organon (Belgium) TOF-Guard device. Central and peripheral hemodynamics was monitored. Side effects of the drug were recorded. Bolus injection of mivacurium in a dose of 0.2 mg/kg caused T1 suppression (90%) after 2.6 +/- 0.7 min. Maximal (97.7 +/- 4.5%) suppression was observed after 4.17 +/- 2.5 min. The conditions of intubation of the trachea after 3.9 +/- 1.8 min in the presence of 78 to 100% T1 suppression (97.7 +/- 4.5%) were considered excellent or good in 96.6% of cases. Clinically and neurophysiologically sufficient muscle relaxation after the first injection of the drug persisted for 27.7 +/- 7.3 min. Minimal rate of infusion for maintaining the NMB at 95 +/- 4% level of T1 suppression was 6.3 +/- 1.7 micrograms/kg/min. Bolus injection of mivacurium in a dose of 0.2 mg/kg for 60 sec involved a 1-3-min drop of the mean arterial pressure by 10.5% and a 10.3% decrease of heart rate. Repeated bolus injection of the drug in a dose of 0.15 mg/kg and its infusion did not change the peripheral and central hemodynamics. The most typical side effect of the drug in a dose of 0.2 mg/kg is short-term reversible reddening of the skin of the face and neck, observed in 20% of patients. The results permit us to consider mivacurium as an effective, safe, and controllable agent, which can be used in cardiosurgical patients.

This study was aimed at assessing the airtightness of the airways during the use of a laryngeal mask (LM) under conditions of myoplegia and traditional forced ventilation of the lungs (FVL) with carboperitoneum (CP) during laparoscopic cholecystectomy (LCE). A total of 146 anesthesias for LCE were carried out using LM (n = 86) or endotracheal tube (ETT) (n = 60). The groups did not differ by the demographic characteristics or concomitant diseases. After premedication and induction of anesthesia it was maintained with N2O:O2--2/1 (Fi O2 = 0.3), fractionated administration of fentanyl (0.1-0.2 mg), and pipecuronium bromide (0.06 mg/kg). A gastric tube was inserted. Two variants of FVL were used: 1) permanent minute respiration volume (MRV) was maintained and 2) MRV was increased in order to maintain the Et CO2 at a constant level. The amount of gastric contents was measured and its pH assessed. Regurgitation and aspiration was assessed (in 33 patients) using methylene blue in gelatin capsules administered orally 10 min before anesthesia. Gas exchange was monitored by the Datex Capnomac-Ultima and by check-ups of acid base balance in the arterial capillary blood, hemodynamics was monitored by noninvasive Criticon Dynamap monitor. Manual FVL with inhalation P no more than 10 cm H2O completely prevented the entry of gas narcotic mixture into the stomach. Application of LM under conditions of total myoplegia and FVL with inhalation P of 23-25 cm H2O provided a satisfactory airtightness of the LM-airways contact without audible (appreciable) leaking of gas narcotic mixture. Leakage of gas narcotic mixture during LM application under total myoplegia and carboperitoneum (with CO2 pressure in the abdominal cavity 12 cm Hg) is no more than 6%, which indicates that LM is a reliable air guide providing good airtightness of the LM-airways contact even under conditions of increased abdominal pressure. No cases of regurgitation and aspiration were observed.

The efficacy of midazolam (0.071 +/- 0.006 microgram/kg) inactivation by flumazenil, a direct antagonist of benzodiazepines, was assessed in 20 patients during local and regional anesthesia. The hemodynamic values were assessed and a complex of psychological tests used. A single intravenous injection of flumazenil in a dose of 0.2 mg (2.8 +/- 0.41 micrograms/kg) resulted in a smooth an reliable arrest of benzodiazepine effect and effective repair of the main psychomotor reactions. Reversion of benzodiazepine effect is possible after an hour, which may require repeated injection of flumazenil.

The problem of using a laryngeal mask (LM) under total myorelaxation and artificial pulmonary ventilation (APV) is still topical and unsolved. A hundred and forty six anesthesias for laparoscopic cholecystectomy by employing LM in 86 patients or endotracheal tube (ETT) in 60 were comparatively evaluated. Anesthesia included premedication (diazepam, dimedrol, atropine, the H2-blocking agent ranitidine), induction (ketamine, barbiturates and propofol in combination with diazepam and fentanyl; the NMBs pipecuronium bromide and succinylcholine), maintenance (N20:O2 = 2:1. Fentanyl, pipecuronium bromide), monitoring (Capnomac-Ultima (Datex), Dinamap (Criticon) and acid base balance measurements. The quantity and pH of gastric contents were examined. Methylene blue in gelatin capsules was used as a regurgitation indicator. Unlike ETT, LM caused no reactions. The hemodynamic parameters at the traumatic stages of an operation were higher in the ETT group. Smaller amount of analgetics was used in the LM group. The use of manual APV at Pinsp of < 10 cm H2O fully prevented a gas mixture from entering the stomach. Pneumoperitoneum caused increases in Et CO2, pCO2, P inspiration and decreases in breathing volume and lung compliance. The hermetic sealing of joints was 95.6-98.5% in the LM group. Regurgitation was not found in 33 patients. LM NMB and APV may be successfully and safely used in clinical practice.

Creation of computer monitoring systems (CMS) for operating rooms is one of the most important spheres of personal computer employment in anesthesiology. The authors developed a PC RS/AT-based CMS and effectively used it for more than 2 years. This system permits comprehensive monitoring in cardiosurgical operations by real time processing the values of arterial and central venous pressure, pressure in the pulmonary artery, bioelectrical activity of the brain, and two temperature values. Use of this CMS helped appreciably improve patients' safety during surgery. The possibility to assess brain function by computer monitoring the EEF simultaneously with central hemodynamics and body temperature permit the anesthesiologist to objectively assess the depth of anesthesia and to diagnose cerebral hypoxia. Automated anesthesiological chart issued by the CMS after surgery reliably reflects the patient's status and the measures taken by the anesthesiologist.