PubMed Health⌕ Search

Biomedical subjects

A A Eremenko

Publications and source records attributed to A A Eremenko.

At least 19 recordsLinked to original sources
PubMed2006

[Preventive intraaortic balloon counterpulsation during surgical myocardial revascularization].

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.

Arrhythmias, Cardiac↗
PubMed2006

[Surgical treatment of dilated cardiomyopathy].

The efficacy and safety of different variants of left ventricular geometrical reconstruction (LVGR) in patients with dilated cardiomyopathy (DKMP) were studied in 2-stage clinical trial during 4 years. Results of left ventricle plication, "Myosplint" surgery and implantation of extracardial net framework (ECNF) complemented with mitral insufficiency correction (in case of need) have been evaluated on the first stage of the study. Based on this study, the implantation of ECNF and correction of mitral insufficiency are recognized as the most effective and safe method of DKMP surgical treatment. Short- and long-term results of these surgical procedures have been studied on the second stage of the study. Overall 30 surgeries of LVGR have been performed (18 on stage 1 and 12 on stage 2 of the study). Hospital lethality on stage 1 was 27%, 4-year actuarial survival rate (taking into account hospital lethality)--54+/-12%. Original protocols of surgical, anesthetic and intensive care management led to decrease of hospital lethality to 8% and an increase of 2-year actuarial survival rate to 91.6+/-7.9% (that significantly higher than in the control group treated with therapeutic methods only).

Cardiac Surgical Procedures↗
PubMed1998

[Anatomic orthotopic heart transplantation: the surgical characteristics and the advantages of the method].

Standard technique of establishment of interatrial anastomoses allows to carry out orthotopic transplantation of the heart quickly and reliably. However the accumulation of collective experience evidences about a number of unavoidable shortcomings of such operation: rhythm disturbances, worsening of hemodynamics in discordant atrial contractions of recipient and donor, atrio-ventricular valve insufficiency, thromboembolism, coronary fistulas. Since 1990 in RRCS 25 operations were carried out with the use of standard technique and we also met with the risk of developing the above complications. In experiment on 30 mongrel dogs the technique of anatomical, truly orthotopic transplantation of the heart with six anastomoses was developed: left pulmonary veins with a common cuff, separate anastomoses of the superior and inferior caval veins, anastomoses of aorta and pulmonary artery. Particular attention was paid to developing of original surgical modes for prophylaxis of stenoses in the area of anastomoses of pulmonary and caval veins. In 1997 the anatomical technique of heart transplantation was successfully introduced by us into clinical practice. Clinical electrophysiological, echocardiographic and functional examinations have confirmed the results of the experiments and have evidenced for substantial advantages of the anatomical technique of orthotopic transplantation of the heart. By reliability the new operation is not inferior to standard method of N. Shumway.

Anastomosis, Surgical↗
PubMed1998

[Orthotopic liver transplantation].

Orthotopic liver transplantation is the only method of choice for many severe liver diseases with poor prognosis. The development of liver transplantation programmes is based on medical science achievements and high technology in surgery, anesthesiology and perfusiology. The experience of the Surgery Research Center, Russian Academy of Medical Sciences, made it possible to obtain positive results of liver transplantation and posttransplantation management. This in turn provided longer survival for 80% of recipients. At the same time the mortality of potential recipients was 60.4%, which is due to the greater shortage of donor organs and which is the main problem in the development of organ grafting in Russia. The fact that there is a high proportion of children who are recipients for the donor's liver requires that liver transplantation from living related donors should be developed.

Adolescent↗
PubMed1997

Simultaneous separate assessment of the cardiac and LVAD output.

The electroimpedance indicators' dilution (EIID) technique was used to study the possibility of a simultaneous separate assessment of the biological heart and LVAD performance in the position of LVB. The experimental part of the research was performed on 5 dogs; an artificial ventricle of the pulsing type (USA) with cusps was used as a pump. The clinical part of the work was conducted on 5 patients after open-heart surgery who had the clinical picture of postcardiotomy cardiogenic shock; a centrifugal pump "Biopump" (Medtronic, USA) was used. The authors have shown a principally important possibility of applying the EIID, technique for studying the performance curves which are the integral derivatives of the work of a specific hybrid system--"the biological heart-assist device". From the practical viewpoint the EIID technique permits in the read time mode to control continuously the part of the pumping function which is assumed by the patient's own heart. This information can serve as the basis for making the prognosis and determining the further tactics of treatment; the restoration of the heart performance or its replacement by transplantation.

Animals↗
PubMed1997

[Orthotopic liver transplantation: surgery research center's experience].

From 1990 to 1996, 178 patients with severe diffuse and advanced focal liver diseases with grave prognosis were observed for indications to orthotopic liver transplantation (OLT). According to the revealed indications and contraindications, 95 patients were enrolled for the procedure. Eighteen patients underwent 19 OLTs, including 1 urgent retransplantation and 3 living related graftings. Surgical techniques were conventional; with these, intraoperative mortality and biliary complications could be avoided. Long-term survival (6 to 68 months) was achieved in 8 recipients, including in those after liver retransplantation. Double or triple suppressive regimens were used. These included corticosteroids, cyclosporin A, azathioprine, antithymocytic globulin. The life quality of recipients promoted restoration of their working capacities. Two recipients gave birth to healthy babies.

Adolescent↗
PubMed1997

[Use of software "Aggregate state of the blood" in staged diagnosis and correction of disorders of blood coagulation and rheology].

The "Aggregate State of the Blood" software was created at the National Research Center of Surgery in 1994. The software is intended for comprehensive assessment of the blood fluidity under different conditions of clotting, rheology, and acid-base balance and shows deviations of the detected values from the norm, predicting the risk of thrombotic and/or hemorrhagic complications. From 1994 to 1996, the program was used in more than 1000 patients subjected to cardiopulmonary bypass surgery with complicated and uneventful peri- and postoperative period. The operations were as follows: heart and liver transplantations (19 and 7 cases), intraaortic balloon counterpulsation (16), extracorporeal detoxication (10), acute myocardial infarction (9), etc. The results were compared with the data recorded in case histories of 255 patients who underwent similar operations in 1991-1994. The results of diagnosis and prediction were commented in the protocol for each case. The conclusions were used for therapy or prevention. The incidence of thrombotic and hemorrhagic complications and the DIC syndrome in 1995-1996, when the new software started to be used, was significantly lower than before. The best clinical results were attained in the patients examined before surgery (n = 92). In this group application of the program (and subsequent preventive treatment) helped improve the adaptive potential of the physiological systems maintaining the blood fluidity. This resulted in a lower postoperative blood loss and a lesser incidence of thrombotic and hemorrhagic complications and the DIC syndrome as against the reference group.

Blood Coagulation↗
PubMed1991

[Computerized monitoring of patients in the intensive care and resuscitation unit].

Monitoring-computed systems were used during the therapeutic-diagnostic process at the resuscitation department of the All-Union Surgery Research Center in more than 1,000 patients who underwent operations on the heart, coronary arteries, bronchi, trachea, and esophagus. The main importance is attached to examination of the cardiorespiratory system. More than 90 derived parameters characterizing intracardiac hemodynamics, ventricular contractility, and oxygen transport are calculated according to special programs. For evaluation of the function of the lungs in an automated regimen, 32 parameters characterizing lung ventilation, gas exchange in the lungs, mechanism of respiration, and metabolism are calculated. Monitoring-computed care makes it possible to appraise the patient's condition in a given situation, the transient nature of changes in the physiological systems of the organism under the effect of therapy, and helps in choice of the optimal regimens of artificial lung ventilation and the methods of treatment. Computed appraisal of hemodynamics by means of the algorithm of the nearest point was found to be correct in 93% of cases. Storage of the results in the computer memory ensures an operative approach to information on any of the patients.

Diagnosis, Computer-Assisted↗
PubMed1986

[Use of sympathomimetic agents in the treatment of acute circulatory insufficiency in the immediate postoperative period of heart surgery patients].

Sympathomimetic agents: isoproterenol (novodrin), dopamine, noradrenalin, adrenalin were used in 137 patients with acute circulatory insufficiency. Their hemodynamic effects were assessed, using catheterization of heart chambers and radiocardiography, and studies of circulating blood oxygen transport, acid-base state and metabolic product levels. A differential approach to sympathomimetic treatment has been developed. Isoproterenol is primarily indicated in those cases where myocardial failure is combined with decreased heart rate, conductivity disorders and markedly increased total peripheral resistance. Dopamine is more justified in cases where increasing the heart rate is more desirable, and there are signs of renal failure and heart rhythm disorders. The possibility of dopamine-induced pulmonary hypertension and pO2 fall should not be dismissed. Correct choice of an agent or a combination of agents makes it possible to control the patient's condition through action on various hemodynamic mechanisms that determine the magnitude of cardiac output.

Acute Disease↗
PubMedDate not supplied

[The hemodynamic effects of lomir and adalat in patients with postoperative arterial hypertension].

Comparison of the hypotensive effects of lomir (isradipine) and adalat (nifedipine) in 36 patients showed lomir to be more effective after aortocoronary bypass surgery. Normalization of arterial pressure started 5-10 min after lomir infusion, followed by a 24.5% increase in cardiac output and decrease in peripheral vascular resistance by 43.8%. Arterial pressure did not rise after lomir infusion was discontinued. With adalat, arterial pressure normalized 30 min later, and the therapeutic effect was achieved with a very high dose (5-7 times higher than recommended). Cardiac output did not change, and cardiac arrhythmias were observed in 11.7% patients. Therefore, lomir is a preferable Ca channel blocker for treating postoperative arterial hypertension after aortocoronary bypass surgery.

Adult↗
PubMedDate not supplied

[Current disinfecting and antiseptic agents in anesthesiology and resuscitation].

Prevention of nosocomial infection includes, along with other factors, measures aimed at maintenance of aseptic and antiseptic conditions by means of modern effective antiseptics and disinfectants. Efficacy of skin antiseptics (plivasept tincture, plivasept blue, plivasept foamy), disinfectants for instruments, surfaces, equipment (plivasept with and without PAV, aldesol, isosan G) manufactured by Pliva (Croatia) is assessed at Surgical Center. All these agents are recommended for improving the epidemiological situation in intensive care departments.

Anesthesiology↗
PubMedDate not supplied

[Results of the treatment of cardiac surgery patients with postoperative acute respiratory distress syndrome by prone-position pulmonary ventilation].

Prone position ventilation (PPV) became an effective method of management of ARDS since 1974. Its positive effects on arterial oxygenation have been amply described, but its impact on the results of treatment and hospital mortality remains a disputable point. We observed 2 groups of patients, 36 pts. each, with ARDS after cardiovascular surgery. The main causes of ARDS were shock syndrome, massive blood loss and transfusion, previous COPD, and postcardiopulmonary bypass ALI. Because of impaired lung function (PaO2/FiO2 < 200), all patients were supported by special methods of ventilation including PEEP, high FiO2, and PCV with inverse I:E ratio. In the main group, PPV was started on days 3.6 +/- 1.2 postoperation. Daily duration of PPV was 4-12 h, after which the patients were turned into a supine position. Controls were treated in a supine position. The groups were identical by age, sex, types of surgery, severity of ARF, and manifestations of MOSF. PPV improved lung function and arterial oxygenation. Clinical outcomes were better in the PPV group than in the controls: a lower frequency of threatening arrhythmia, better results of MOSF treatment, and lower mortality (69 and 33.4%, respectively). Prone position is an effective measure improving arterial oxygenation in patients with ARDS after cardiovascular surgery. The main results of PPV are decrease in complications induced by hypoxia and higher survival rate.

Acute Disease↗
PubMedDate not supplied

[Principles of prevention of pneumonia associated with the use of artificial ventilation of the lungs in resuscitation and intensive care units].

Pneumonia ranks among the most incident complications associated with forced ventilation of the lungs (FVL). Its incidence depends on FVL duration and according to published reports varies from 9 to 70%. Pneumonia deteriorates the prognosis and essentially increases the mortality in intensive care wards. Based on published reports and their own experience, the authors formulate the fundamentals of prevention of pneumonia in patients on FVL: use of intubation tubes with low-pressure cuffs; minimum duration or no procedures involving the intubation tube cuff blowing off; regular sanitization of the tracheobronchial tree and oropharynx; use of devices for removal of tracheobronchial secretion in the closed contour and of disposable catheters; inhalation of bronchomucolytics and antibiotics through a nebulizer; patient's position in bed with elevated head part; rigid approach to prescription of antacide drugs and H2-receptor blockers; decontamination and regulation of intestinal function; antibiotic therapy with consideration for the results of bacteriological studies; no or minimum exposure to procedures involving the respiratory contour seal opening; use of sterile gloves; use of disposable respiratory contours and hydrophobic bacterial filters instead of humidifiers.

Age Factors↗
PubMedDate not supplied

[Clinical experience with the use of gelofusin (gelatin) in anesthesiology, resuscitation and intensive care].

Published reports on the use of colloid plasma substitute gelofusin, widely used in practical anesthesiology, intensive care, and resuscitation, are analyzed. The drug is characterized by positive effects on the hemodynamic status and oxygen-transporting function of circulation, with the minimum side effects. It can be used for blood loss compensation, planned normovolemic hemodilution, afferent procedures, and filling the artificial circulation device. Gelofusin is preferable for use in patients with cardiac failure and marked dehydration. No negative effect on renal function and blood clotting system, even in infusions in high volume, are its positive qualities.

Anesthesia↗
PubMedDate not supplied

[Postoperative period in early activated patients after myocardial revascularization].

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, p < 0.05). 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%, p < 0.05). Chills occurred in 6, 4, and 15% of cases in Groups 1, 2, and 3, respectively (p < 0.05). 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.

Aged↗
PubMedDate not supplied

[Continuous epidural infusion of ropivacaine hydrochloride (naropin) during postoperative analgesia in cardiosurgical patients].

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), (p < 0.05) 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).

Amides↗