Anesteziologiia i reanimatologiia
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Anesteziol Reanimatol · Jul 2009
Clinical Trial[The oxidant-antioxidant system and cognitive functions in patients undergoing elective abdominal operations under various general anesthesia modes].
The impact of various general anesthesia modes on the oxidant-antioxidant system (OAS) and cognitive function in the perioperative period was studied in 88 patients (4 groups, each comprising 22 patients according to the mode of general anesthesia who had undergone elective surgery for chronic calculous cholecystitis (out of an exacerbation) and inguinal, umbilical, and postoperative hernias. Oxidative protein and lipid damages with the lower activity of antioxidant defense enzymes were found in the surgical patients exposed to various modes of general anesthesia. ⋯ Propofol-based balanced anesthesia has a minimal impact on OAS parameters as compared to neuroleptic analgesia, ataralgesia, and sevoflurane anesthesia. After elective abdominal surgery, decreased free radical oxidation under propofol-anesthesia is concurrent with lower postoperative cognitive dysfunction.
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The PHA-induced and serum levels of IFN-alpha and -gamma, TNF-alpha, IL-4, IL-6, IL-8, IL-RA, as well as CD3, CD4, CD8, CD20, CD56 lymphocytic subpopulations and serum IgG, IgM, and IgA were studied in 53 patients with multiple trauma to detect the most informative parameters of laboratory monitoring of the immunodeficiency developing during treatment. The stages of the study corresponded to the phases of development of an immune response: (1) an induction phase (days 1-4); (2) an immunoregulatory phase (days 5-10); (3) an effector phase (days 11-24). The findings suggest that at the early stage of the study, the drastic reduction was revealed in CD3, CD4 T-lymphocytic subpopulations, accompanied by inadequate humoral immunological parameters. ⋯ According to the findings, at Stage 1 of the study, the production of IFN-gamma in all patients was much increased, by significantly dropping by the end of treatment (by more than twice), without achieving, however, the normal levels, except the examinees with a fatal outcome, in whom the concentration of IFN-alpha increased or underwent no changes. A relationship was also found between the serum levels of IL-6 and IL-8 and the outcome of the disease: throughout the observation, their concentrations remained invariably high in patients with a fatal outcome whereas in those with a good outcome, there was a uniform decrease in the content of both cytokines by the end of the observation. Thus, the simultaneous increase in the levels of IFN-gamma, IL-6, IL-8, and TNF-alpha and accompanying reductions in CD3, CD4 and serum IgG, IgM are poor prognostic factors and may be used both as additional immunodiagnostic criteria and for immunotherapy monitoring in patients with polytrauma.
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Anesteziol Reanimatol · Jul 2009
[Choice of agents for early activation-oriented general anesthesia in patients operated on for ischemic heart disease].
The purpose of the study was to analyze the choice of agents for general anesthesia in the implementation of an early activation in patients operated on for coronary heart disease (CHD). Anesthetic maintenance protocols were analyzed in 1008 patients who were operated on under extracorporeal circulation (EC) in 1995, 1999, 2001, 2004, and 2006. After aortocoronary bypass grafting, the trachea was extubated in 45% of cases. 1999 was marked by a significant diference in the use of agents for general anesthesia in patients activated in the operating suite and in those who had prolonged artificial ventilation. ⋯ The authors paid particular attention to the pharmacodynamics of anesthetics used for the early activation of patients operated on under EC for CHD. It is concluded that early activation of patients operated on under EC for CHD is possible after general anesthesia based on diferent agents. Early activation substantially changes the concept of general anesthesia during myocardial revascularization operations.