Basing on the existing data about the positive impact of inhalation induction and anesthetic support (IIAS) and levosimendan it is planned to study and compare within framework of the coming study the impact of IIAS and pre-operative preparation through administration of levosimendan on the rates of myocardial contractility during intra and early post-operative periods, the need in inotropic agents, and 30-day and 1 year mortality of the patients with lower ejection fraction of left ventricular during surgery on infrarenal part of aorta.

This paper is the second part of an overview dealing with experimental and clinical studies in ischemic and pharmacological preconditioning. It considers the possibilities of practically using the available knowledge on the mechanisms of preconditioning, the interaction of agents from different groups in exhibiting the protective effects of inhaled anesthetics in anesthesiology and resuscitation. Data are given on the efficacy of the discussed processes in different organs and tissues. The possibility of using opioids and other biologically active substances that are likely to have a protective effect against hypoxia is discussed separately. The problems of remote preconditioning and post-conditioning are touched upon. The available data on the impact of choosing an anesthetic mode on the course of immediate and long-term postoperative periods and mortality rates are analyzed; the problem of the old heart is discussed. It is concluded that studies dealing with the problems of pre- and postconditioning are urgent and of great scientific and practical value. Key words: ischemic preconditioning, pharmacological preconditioning, anesthetic preconditioning, postconditioning.

Objective: to optimize anesthetic tactics for perioperative management in elderly patients during lower abdominal surgery under mixed anesthesia with preserved spontaneous breathing without myoplegia. Subjects and methods. Examinations were made in 142 patients aged over 65 years. The patients were divided into 2 groups: 1) inhalation anesthesia under total myoplegia and controlled mechanical ventilation (MV); 2) inhalation anesthesia without myoplegia with preserved spontaneous breathing or assisted mechanical ventilation (AMV) in the pressure-support (PS) mode. Results and discussion. The AMV procedure allows mixed anesthesia with preserved spontaneous breathing in elderly patients during operations on the lower abdomen and great vessels in 89% of the patients without a risk for inadequate transport of oxygen under its relative uptake. MV used to maintain external respiratory function under mixed anesthesia and total myoplegia causes a decrease in cardiac index (CI) by 58.8% (p<0.05) and increases in total peripheral resistance (TPR) by 50% or more (p<0.05), and intrapulmonary shunt threefold (p<0.05). Mixed anesthesia without myoplegia and MV prevents induced changes in CI, TPR, and Qs/Qt. The differences were significant throughout the follow-up (an intraoperative stage and 9 postoperative hours). The older age group patients are more susceptible to the damaging action of MV; they were also found to have a more pronounced preventive effect of modified anesthesia. Conclusion. To rule out myoplegia and MV during mixed anesthesia prevents MV-induced changes in CI, TPR, and Qs/Qt. Key words: mixed anesthesia in elderly patients, spontaneous breathing, hemodynamics, blood oxygen transporting function.