Biomedical subjects
Publications and source records attributed to V I Smirnova.
The first successful hemicorporectomy performed in this country is described. Clinical data are presented and specific features of anesthesia, infusion-transfusion therapy and management of the postoperative period are reviewed in detail.
300 single-step, combined and complex operations have been performed to patients aged 16 to 82 years in the Institute of Proctology, USSR Ministry of Public Health, over the last 10-year period. Surgery was performed under various types of endotracheal combined analgesia: NLA, NLA in combination with halothane or calypsol. Arterial hypotension (short-term BP decrease by more than 40% baseline) was found in 29 patients (9.6%), no intraoperative lethal outcomes have been observed. The volume of the infusion-transfusion therapy depended on intraoperative blood loss, duration of surgery and the extension of surgical interventions (8.4-12.4 ml/kg.h). An overall mortality rate was 3.6%, which does not exceed the mortality rate observed during conventional operations on the colon.
The entrapping of a plague capsular antigen into the liposomes, prepared by the "reverse phase" evaporating method, was investigated. Both the native antigen and the antigen modified by palmitoylchloride were used. The entrapping of the modified antigen into the liposomes was greater than that of the native one: 46.1 +/- 5.4% and 3.7 +/- 2.7%, respectively. The highest content of the antigen on the membrane surface was observed when using palmitoylized protein and liposomes with egg lecithin, cholesterol and dicethylphosphate in the molar ratio 7:2:1.
Indirect calorimetry was used to study the basal metabolism and energy expenditure at rest in 31 patients aged 20-80 years, on day 2 after surgery on the large intestine. It was found that the basal metabolism was increased by 13% in 64.5% of the patients (group 1) and decreased by the same value in the rest patients (group 2). The fluctuation range of energy expenditure in some patients of group 1 was from 1000 to 3400 kcal, in those of group 2, from 500 to 2000 kcal. The respiratory guotient in both groups was about 0.7. The direct measurement of energy expenditure at the early postoperational period would aid in proper rationing energy components in the total volume of the parenteral nutrition of operated on patients.
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Efficacies of several relatively new methods of anesthesia are compared. The data of electroencephalographic monitoring, early components of somatosensory evoked potentials, parameters of the central and peripheral hemodynamics (pulsometry supplemented with estimation of photoplethysmography coefficient, among other things), acid-base balance, were used as criteria of the adequacy of analgesia. A total of 369 anesthesiologic modalities are analyzed, which were compared with traditional and modified neuroleptanalgesia (NLA) with inhalation of fluothane vapors. A high efficacy of NLA carried out in parallel with inhalation of gaseous anesthetics (fluothane) was confirmed. If traditional NLA is used in long traumatic operations, fentanyl in dose at least 10 mcg/(kg.h) should be infused during the main stage of the intervention to provide effective anesthesia; during cardiopulmonary bypass surgery fentanyl dose should be at least 15 mcg/(kg.h). Use of moradol as the principal analgesic in surgery on the open heart and aorta and in long traumatic interventions on the thoracic and abdominal organs was found unjustified. Combined total anesthesia with fentanyl, droperidol, seduxen, dalargin, and clofelin may be effectively used for intraoperative protection in interventions of any kind. Clinical significance of the phenomena detected is discussed.
The use of graded infusion of dalargin (a home-made synthetic analogue of leu-enkephalin) in a complex of anesthesiological protection has been analysed in patients with radical correction of tetralogy of Fallot and atrial septal defect. It has been shown that delargin has a pulmonoprotective effect, moreover, it is supposed to possess a certain analgetic activity. Dalargin reduces total pulmonary resistance, the normalizing effect of the drug on the vascular tone and the degree of pulmonoprotecive action being higher in cases when the preceding pathological shifts were more pronounced. The author believes it is indicated to apply the drug in a complex of anesthesiological protection during radical correction of tetralogy of Fallot and atrial septal defect primarily to ensure intraoperative pulmonoprotection and optimization of the vascular tone in the pulmonary artery.
The situation of aggression is accompanied by metabolic alterations with an important neuro-endocrinal context. Extracorporeal surgery is an especially aggressive situation which involves both surgery and the added metabolic state of hypothermia. In 48 patients subjected to extracorporeal circulation with hypothermia, the metabolic parameters of Oxygen Consumption (VO2), Production of carbon dioxide (VCO2), Respiratory Quotient (RQ) and Energy Expenditure (GE) were studied. It was observed that the patients could be divided into two subgroups, depending on their metabolic response. Studying the RQ parameter, it was seen that this divided patients into two subgroups depending on their posterior evolution. Patients in whom RQ did not exceed 0.8 showed more favourable evolution than those in whom RQ was higher than 0.8. The correct metabolic response was regarded as a parameter indicative of the evolution, directly correlated to the hemodynamic parameters studied. In one patient, creatine phosphate was infused at a dosage of 30 mg/kg for 60 min, and an improvement was noted in GE and Cardiac Index. It was concluded that the intravenous intake of creatine phosphate in patients undergoing extracorporeal surgery improved both metabolic parameters and the myocardiac function.
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