[Features of general anesthesia and infusion-transfusion therapy in extensive surgery of the organs of the abdominal cavity].

The article discusses variants of infusion-transfusion therapy (ITT) in early stages of expanded operations on the abdominal organs attended by massive blood loss (2 to 4 BCV and more). Seventy-three patients were examined, they underwent resection of the liver (30), pancreatoduodenal resection (37), or removal of a retroperitoneal tumor (6 patients). On the basis of precise study of central and peripheral hemodynamics, acid-base equilibrium, and blood oxygen transport function the authors find it necessary to increase the volumes of ITT to 70-80% BCV in the first stage of the operation with a colloid/crystalloid ratio of 1:4. The described method makes it possible to avoid critical fluctuations of cardiac output and blood pressure in massive bleeding. At the same time, such hemodilution causes no considerable decrease in hemoglobin concentrations (which was 79.0% of the initial level at the beginning of the main stage) and specific oxygen transport (85.0%, respectively). In absolute expression the specific oxygen transport before the hemorrhage is 465 + 29 ml/min/m2, which significantly exceeds the critical value. The authors believe the ITT method to be indicated in inevitable blood loss and absence of serious cardiovascular diseases. From comparative analysis of the different variants of general anesthesia, the authors conclude that the following combination of agents is preferable for the discussed category of patients: phentanyl, droperidol, seduxen, kalipsol (ketamine), and dalargin. Their balanced use ensures stability of the main homeostasis indices in all stages of the intervention; the hepato- and pancreatoprotective properties of dalargin are also of importance.