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Differential preoperative preparation of pregnant women with gestosis, by using calcium antagonists is an effective preventive measure against a circulatory hyperdynamic response to transportation to the operating suite. In pregnant women who had all hemodynamic types at baseline, the eukinetic type achieved during the preparation is retained. The patients with gestosis who did not receive calcium antagonists were found to have a circulatory hyperdynamic response with increased myocardial oxygen uptake (during surgery in particular). The use of calcium antagonists, ketonal, tranexamic acid, and hydroxyethyl starch-130/04 solution in the anesthetic appliance promoted the preservation of eukinetic hemodynamics in all those operated on, without increasing myocardial oxygen demands. The better reaction of the circulatory system and myocardial oxygen demands to surgical injury (the second mediatory wave of the systemic inflammatory response syndrome) correlated with higher neonatal Apgar scores in this category of puerperas with gestosis.

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Results of optimization of general anesthesia during abdominal surgeries in patients with abdominal sepsis are analyzed. Inhibitors of proteases (transamin and antagozan) were used as non-opiate component in transduction stage. Central hemodynamics, gaseous metabolism and heart rate were analyzed in two groups of patients: group 1 -- anesthesia was carried out with inhibitors of proteases (32 patients), group 2 -- without it (30 patients). High efficacy of the inhibitors was demonstrated. Inhibitors of proteases are indicated for anesthesia in patients with severe metabolic disorders associated with tissues hypoxia. Analgesic activity of transamin permits one to decrease doses of anesthetic medication with a cardiodepressive effect.

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Experimental and clinical trials have shown that anesthesia and intensive therapy of shock incorporating tranexamic acid enhance analgesia, hyporeflexia, thus ensuring stable, adequate anesthesia which is safe under reduced doses of standard anesthesiological modalities. Application of tranexamic acid provided more favourable course of postanesthesiological and postoperative periods, decreased the number of complications and lethal outcomes compared to standard anesthesia.

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Optimal methods of endotracheal anesthesia using non-opiate drugs of four classes (clofelin, transamine, contrykal, ketanes) have been fundamentally grounded developed and tried in extensive and traumatic operations for ENT malignant and vascular tumors as well as inflammation in patients of high anesthesiological operative risk. The drugs were used in 174 patients including 13 children. 87.9% of the patients had concomitant diseases: blood hypertension, coronary heart disease, chronic nonspecific pulmonary diseases, bronchial asthma, asthmatic bronchitis, diabetes mellitus, anemia. Adequate stable anesthesia was achieved in reduced dosage of conventional anesthesiological agents.

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Clonidine in a dose of 2.5 to 3 mg/kg was used as a component of anesthesia in 150 patients aged 60 to 85. Essential hypertension of the second-third stages was diagnosed in 57% patients (group 1), systolic sclerotic arterial hypertension (SSAH) in 43% (group 2). Anesthesia was characterized by stable hemodynamics; however, analysis within the groups showed an increase of systolic and diastolic arterial pressure in 40% patients in group 2. There were no clinical signs of inadequacy of anesthesia. Remembering about the reduction of the reserve potential of the cardiovascular system in this cohort of patients, neurovegetative inhibition was supplemented by peripheral a-adrenoblocker droperidol, starting from the test dose of 1.25 and increasing it to 5 mg over the course of anesthesia; this led to stabilization of the peripheral and improvement of the central hemodynamics. Differences in the changes of central hemodynamics may be explained by specific features of circulation in patients with essential hypertension and SSAH, as well as by a higher tone of the sympathetic component of the CNS in SSAH patients.

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The new aspects of the use of the central adrenopositive agent clopheline as a component of combined endotracheal anesthesia were studied. In distinction to the recommendation of some authors, clopheline was used in the preanesthesia period in an average dose of 2.5-3.0 mcg/kg (in debilitated patients in a dose of 1.8-2.2 mcg/kg). The authors examined 86 patients 60 to 85 years of age during planned and emergency operations on the biliary tract. All of them suffered from arterial hypertension: 70% had three and more concomitant diseases; 20% of patients were related to IB category of anesthesiological risk, 65% to IIB category, and 15% to IIIB category. The condition of peripheral and central hemodynamics, the stress index, and the excretion of the free forms of catecholamines (CA), their precursors, and metabolites were studied. During anesthesia with the use of clopheline by the suggested method, moderate activation of the sympathoadrenal system within the stress-norm occurs. During anesthesia as well as in the postanesthesia period the mechanisms of autoregulation, which contribute to rapid return of the activity of the sympathoadrenal system to the initial level and the control of the relationship of the synthesis and inactivation of CA, their precursors, and metabolites, are maintained. The method made it possible to reduce the doses of barbiturates to 2-3 mg/kg, and the doses of fentanyl by 3-4 times as compared with those in neuroleptanesthesia, which, in turn, facilitated rapid regaining of consciousness, adequate spontaneous breathing, a good cough reflex, and sufficient physical activity immediately after the operation. There were no complaints of pain hyperdynamic circulatory shift, trembling of muscles, suppressed respiration, and acrocyanosis.

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Clopheline (2-3 micrograms/kg; 2-2.2 micrograms/kg in weak patients) as a component of premedication, for the induction to anesthesia, and in combined endotracheal anesthesia as an analgesic and vegetostabilizing agent has been used in 150 patients, aged 60 to 85 years during planned and emergency surgery. Reduced doses of barbiturates (3 mg/kg) and fentanyl (1.5-2.1 micrograms/kg for the induction to anesthesia and 0.5-0.67 micrograms/kg for analgesia maintenance) were used. At certain stages use was made of droperidol, beginning with a test dose 1.25 mg and not exceeding 5 mg during surgery. The use of clopheline in this category of patients ensures neurovegetative inhibition adequate to the operation stress. In 80% of patients favourable hemodynamic changes have been observed. 20% of patients require droperidol administration at a dose 1.25-5 mg during surgery. Due to low doses, the risk of complication associated with the use of narcotic analgesics in elderly and old patients is reduced considerably.

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Fetal gas exchange and a neonate's status were found to be closely related to the capacity of controlled maternal pulmonary ventilation during abdominal delivery. To calculate the minute volume of ventilation, correction factors were proposed. The optimization of gas exchange during an operation was provided by sombrevin. The proposed procedure decreased the incidence of fetal hypoxia and neonatal asphyxia.

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