enkephalin--leucine-2-alanine and Heart-Diseases

The article discusses 434 one-stage concurrent and combined surgical interventions in the cavities. The type of anesthesia and the volume of infusion-transfusion therapy were determined for each type of combinations. A concurrent-combined method, i. e. combined endotracheal (NLA with Kalipsol) and epidural anaesthesia is advisable in supertraumatic interventions (evisceration of the organs of the true pelvis, hemicorporectomy). The method of dissociative total intravenous anesthesia must be used for patients with heart diseases, especially in patients with various disorders of the conduction system. The specific features of this method is exclusion of nitrous oxide and reduction of the doses of Phentanyl, (which produce a negative effect on the conduction system of the heart) and increase of the doses of Kalipsol and droperidol, which allows the operation to be conducted in full volume in these patients. Agents for NLA with Dalargin are preferable for general anesthesia in patients undergoing operations on the hepatopancreatoduodenal zone. In other concurrent and combined operations on patients without concomitant heart diseases, NLA and NLA in combination with Kalipsol may be used; the last-named is particularly valuable in massive blood loss, when the hemodynamics are insufficiently stable. Particular attention is given to extensive, traumatic interventions attended by massive blood loss. The performance of hypervolemic hemodilution to the main stage of the operation is suggested, which makes it possible to stabilize hemodynamics at the peak of the hemorrhage. With the chosen tactics of anesthesia and infusion-transfusion therapy the incidence of complications and the lethality rate in such extensive operations were significantly reduced.

Topics: Analgesics, Opioid; Anesthesia, Endotracheal; Anesthesia, Epidural; Anesthesia, Intravenous; Combined Modality Therapy; Droperidol; Enkephalin, Leucine-2-Alanine; Fentanyl; Heart Diseases; Hemodilution; Humans; Intestinal Diseases; Ketamine; Surgical Procedures, Operative; Sympatholytics

The authors studied the effect of dalargin, a Russian produced synthetic analogue of regulatory opioid peptides on the incidence, severity, and outcomes of infectious complications in cardiosurgical patients with congenital and acquired heart diseases. The use of dalargin in the complex of multicomponent anesthesiological protection--neuroleptanalgesia, facilitated relative limitation of the sequelae of stress-induced secondary immunodeficiency in the form of increased risk of the development of postoperative purulent and inflammatory diseases. This resulted both in reduction of lethality from infectious complications, anterior purulent mediastinitis among others, and in decrease of the absolute number and percentage of postoperative complications of infectious etiology. This points to the principal possibility of formation by means of dalargin of the corresponding level of adaptation to the damaging action of surgical stress, which is evidently mediated by optimization of neurovegetative protection in particular due to the antistress properties characteristic of the synthetic opioid hexapeptide.

Topics: Adjuvants, Immunologic; Drug Evaluation; Enkephalin, Leucine-2-Alanine; Gram-Negative Bacterial Infections; Gram-Positive Bacterial Infections; Heart Defects, Congenital; Heart Diseases; Humans; Neuroleptanalgesia; Surgical Wound Infection

Dalargin is a Soviet synthetic analog of leu-enkephalin. It was used in a complex of anesthesiological protection (in the form of permanent infusion at a rate of 40-55 micrograms/kg/h) in 331 patients who suffered different operations on the heart, lungs and abdominal cavity. Potential mechanisms of the protective action of the drug were studied in experimental surgical distress. It was found advisable that dalargin may be included into combined general anesthesia to maintain intraoperative organ protection, to stabilize vital functions of the patient at the most crucial and traumatic stages of intervention, and to decrease requirements of narcotic analgetics. It is assumed that dalargin may interact with peripheral opiate receptors. The interaction is likely to be viewed as the main mechanism by which the protective properties of the drug are realized.

Topics: Abdomen, Acute; Anesthesia, General; Animals; Disease Models, Animal; Enkephalin, Leucine-2-Alanine; Heart Diseases; Hemodynamics; Humans; Intraoperative Complications; Lung Diseases; Models, Biological; Rats; Stress, Physiological; Sympatholytics