[Anesthesiological provision of surgical correction of dilated cardiomyopathy in patients with chronic heart failure].
When dilated cardiomyopathy (DCM) is surgically corrected, intraoperative intracardiac hemodynamic changes and additional ischemia of the disabling myocardium make special demands for anesthesia, prevention of cardiovascular insufficiency, and maintenance of circulatory oxygen-transporting function (COTF). For the development and evaluation of an anesthetic support protocol for patients with DCM, clinical parameters, hemodynamics and oxygen transport was comprehensively analyzed in 50 DCM patients aged 16-68 years in the intraoperative period of surgical correction of myocardial pathology. All the patients underwent implantation of an extracardiac mesh framework in combination, if required, with correction of mitral insufficiency under extracorporeal circulation (EC), drug-induced cold cardioplegia. Analysis of comprehensive clinical studies made it possible to provide scientific evidence and to successfully use the anesthetic support protocol for correcting operations of chronic heart failure in patients with DCM, the basic principles of the support being an effective preoperative preparation of a patient to attenuate the signs of congestive heart failure; preventive intraaortic balloon contrapulsation before surgery; overall monitoring of hemodynamics and oxygen transport; balanced use of anesthetic agents in the doses that exert no cardiosuppressive effect; preload optimization and postload reduction; the minimum use of catecholamines; prevention of arrhythmias; and a reduction in the duration of myocardial ischemia.
Trekova
N A
NA
Mukhametzianova
A R
AR
Iavorovskiĭ
A G
AG
Babalian
G V
GV
Zaĭtseva
S V
SV
Revunenkov
G V
GV
Koroteev
A V
AV
D000293:Adolescent; D000328:Adult; D000368:Aged; D000758:Anesthesia / Q000379:methods*; D002303:Cardiac Output, Low / Q000209:etiology / Q000601:surgery*; D002311:Cardiomyopathy, Dilated / Q000150:complications / Q000601:surgery*; D002319:Cardiovascular System / Q000503:physiopathology; D002908:Chronic Disease; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010100:Oxygen / Q000097:blood
D010100:Oxygen