Clinical experience in use of Buvanestin and other local anesthetics (Marcaine,Naropin) in traumatology and orthopaedics is presented. Careful evaluation of the effect of various drugs (Refortan, Ringer’s solution, Mafusol) preinfusion upon the status of hemodynamics in elderly and senile patients at operations for femoral fractures has been performed. It has been shown that by the anesthetic properties Buvanestin practically does not differ from Marcaine. Preinfusion of Mafusol has shown the advantages over the Ringer’s solution and Refortan in ensuring more stable hemodynamics during operation and in the early (within 20-30 min) postoperative period.

The problem of the safety of elderly patients at surgical intervention for femur fracture is broached. Different types of anesthesia (regional and general) exert both direct and indirect influence on hemodynamics parameters. Ninety patients (mean age 68±4.2 years) were divided into 2 groups depending on the type of anesthesia: epidural and general anesthesia based on proforol and sevoflurane with caudal block. In every group different infusion solutions (Ringer’s solution, 10% Refortan, Mafusol, Cardioxipin) were used prior to anesthesia. The following parameters of central hemodynamics were studied: mean arterial pressure, heart rate, cardiac output and cardiac index, stroke volume index, total vascular resistance. The least changes in hemodynamics were observed when general anesthesia based on proforol and sevoflurane in combination with ropovicain caudal block and cardioxipin preinfusion were used.

Fifty-one patients with diffuse peritonitis were treated. 40 of these presented with the toxic stage and 11 had terminal stage with lethal outcomes. Studies of the antioxidant status showed an important role of lipid peroxidation metabolites in the formation of endogenous intoxication during the early postoperative period, manifesting, among other things, by decreased albumin transporting function. Analysis of correlations showed some relationships in the studied parameters which can be used in complex with other values in clinical laboratory diagnosis of endotoxicosis severity in peritonitis and in evaluation of the time course of this condition during intensive care. It can serve as a prognostic criterion of peritonitis development and outcome.

Local hepatic bloodflow (LHB) and metabolic processes were examined in patients with abdominal diseases during intensive transfusion and infusion therapy attended by incomplete parenteral feeding. A reduction of LHB and disorders of lipid metabolism were observed before surgery. After surgery LHB was still reduced on days 1-3. Cholestatic and cytolytic syndromes developed after the intervention, and a reduction of the protein-synthesizing function of hepatocytes and disorders of the lipid status were observed. By days 7-10 the protein-synthesizing function recovered, as did the enzymatic activity, but no complete recovery of LHB and lipid spectrum were observed.

The course of diffuse peritonitis has been followed up in 219 patients, 20 of these with the reactive, 165 with toxic, and 34 with the terminal stages of the condition. Multiple-modality intensive care included, besides routine therapy, local abdominal hypothermia, UV irradiation of autoblood (UVIAB), and, if indicated, hyperbaric oxygenation (HBO) and hemoperfusion. In addition to clinical tests, immunobiochemical monitoring of medium-molecular peptide fractions MM1 and MM2 and index of their distribution, as well as of circulating immune complexes CIC1 and CIC2 and the levels of immunoglobulins IgA, IgM, and IgG were the criteria for assessing the severity of intoxication and efficacy of intensive care and for predicting the course and outcome of the disease. The results indicate that HBO in combination with hemoperfusion, local abdominal hypothermia, and UVIAB have a positive impact on the clinical picture of the disease and on the time course of markers of endogenous intoxication and humoral immunity in patients with the terminal and toxic phases of diffuse peritonitis.

Retrospective analysis of 9262 formalized case histories has been made to compile a protocol of anesthesia. Each blank contains 223 items describing the patient and is intended for retrospective computer analysis of the information. Phases of the complications onset have been established and a working classification of complications has been suggested. Organization measures, which reduced the frequency of complications by 2.4% have been elaborated. The factors that increase the frequency of anesthesia-induced complications are reviewed.

Cerebral blood flow (CBF) and central hemodynamics (CH) have been studied during anesthesia and after surgery in patients with tumours located in brain hemispheres. CBF and CH were determined by radiography. GOBA, diazepam and sodium thiopental were used for anesthesia. It has been shown that GOBA fails to normalize CBF both during and after surgery, diazepam normalizes blood flow in both brain hemispheres. Sodium thiopental leads to further CBF depression up to critical level in the affected hemisphere with parallel blood flow ingress in the intact brain hemisphere. It is concluded that the use of diazepam is advisable for anesthesia during surgery for tumours located in brain hemispheres.

Local abdominal hypothermia in intensive therapy of peritonitis in children checked abdominal inflammation, prevented the onset of hyperthermic reactions, promoted early stabilization of central hemodynamic parameters and early normalization of humoral immunity and led to certain clinical improvement. Taking into consideration the above data as well as possible indications and contraindications one can recommend local abdominal hypothermia for intensive therapy of generalized suppurative peritonitis in children.