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.

Objective: to improve the results of surgical treatment, by ruling out the negative effects of mechanical ventilation (MV) via combined anesthesia without myoplegia during operations on the lower abdomen. Subjects and methods. One hundred and twenty-one patients aged 20 to 64 years were examined. The patients were divided into 2 groups: 1) inhalation anesthesia under total myoplegia and continuous MV; 2) inhalation anesthesia without myoplegia and with preserved spontaneous respiration or pressure-support MV (PSMV). Results. The procedure of the latter allows combined anesthesia with preserved spontaneous respiration during operations on the lower abdomen and great vessels to have inadequate transport of oxygen under its relatively increased uptake in 98% of patients without any risk. MV made to prosthelytize external respiration function under combined anesthesia and total myoplegia causes a decrease in cardiac index (CI) by 40% or more (p<0.05) and increases in total peripheral vascular resistance (TPVR) by 50% or more (p<0.05) and intrapulmonary shunt by 3 times (p<0.05). Combined anesthesia without myoplegia and MV prevent induced changes in CI, TPVR, and Qs/Qt. The differences are significant throughout the follow-up (an intraoperative step and 9 postoperative hours). Conclusion. To rule out myoplegia and MV during combined anesthesia prevents MV-induced changes in CI, TPVR, and Qs/Qt. Key words: combined anesthesia, spontaneous respiration, hemodynamics, blood oxygen-transport function.

Objective: to study the hemodynamic effects of sevoflurane during the induction of anesthesia in elderly patients at high risk for cardiac events. Subjects and methods. This study enrolled 32 patients who had a left ventricular ejection fraction of <30% during preoperative examination. According to the presumptive type of anesthesia, the patients were randomized to one of the study groups: In the sevoflurane group receiving infusion of fentanyl (1 ig^kg”‘^hr”‘), anesthesia was induced by sevoflurane at the maximum concentration of 8 vol% at first inspiration, without the respiratory circuit being prefilled. After loss of consciousness, further saturation was carried out using Fianesth, 5 vol%. Combination anesthesia (CA) was that which was induced by successive administration of dormicum, ketamine, propo-fol, and fentanyl. The trachea was intubated during total myoplegia under the control of TOF (TOF-Watch, Organon, the Netherlands). Results. In all the patients under CA, its induction was made during infusion of dopamine (5 lg^kg”‘^min”‘), the dose of which had to be increased up to 10 ig • kg-1 • min-1 in 6 (75%) patients. Nevertheless, there were decreases in mean blood pressure (BPmean) to 46±6 mm Hg and in cardiac index (CI) to 1.5±0.3 fig • kg-1 • min-1 (by 32% of the outcome value). In the sevoflurane inhalation induction group, only 3 (12.5%) patients needed dopamine. Its dose producing a cardiotonic effect was near-minimal; its average maintenance infusion rate was 5.3±0.3 ig^kg”‘^min”‘. The reduction in CI was statistically insignificant; despite a 9% decrease in BPmean, this indicator in the sevoflurane group remained within acceptable ranges. Conclusion. The use of a sevoflurane-based inhalation induction technique permits higher hemodynamic stability in patients at high risk for cardiac events. Key words: inhalation induction, sevoflurane, ketamine, elderly patients.