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Intraoperative correction of preload in patients with acquired valvular disease (AVD) complicated by right-ventricular failure and severe pulmonary hypertension necessitates search for pathogenetically based algorithms of anesthesiological strategy. The objective of this study was to develop a strategy of assessing and treating the preload at the stage of induction anesthesia in patients with right-ventricular failure. During surgery central hemodynamic parameters and their response to a short head-down-tilt (15-20 degrees) were evaluated in patients (n = 42) with cardiac index (CI) less than 2 l/min/m2 after induction anesthesia. The patients were divided into 2 groups with different severity of preoperative status. Group 1 (main) included 24 patients with stages II-III cardiac failure (according to N. Strazhesko and B. Vasilenko) and group 2 (control) consisted of 18 patients with stage IIA cardiac failure. Progressing preoperative cardiac failure resulted in decrease of cardiac index and failure of compensatory hemodynamic mechanisms in AVD patients. The level of right-ventricular preload, pulmonary resistance, and stroke index were lower in group 1 than in the controls; however, 8% of group 1 patients responded positively to increased preload. In the control group 50% responded favorably to head-down-tilt. Hence, comprehensive assessment of cardiac index, central hemodynamic parameters and their response to head-down tilt help individually choose the anesthesiological strategy.

The antinociceptive properties of dalargin (D) under nembutal anesthesia and artificial ventilation were studied in hemodynamic response to mechanical algesic stimulation in rats. D was introduced i/v (20 micrograms/kg) against a background of myoplegia with Arduan (0.1 mg/kg) and without it. The naloxon (100 micrograms/kg) prevented the protective effects of D. It is considered that injection of D (20 micrograms/kg) on the background of total myoplegia and artificial ventilation prevented hemodynamic response on algesic stimulus. Subsequent dose increase of opium peptide up to 3500 micrograms/kg does not cause amplification of protective properties.

Effect of Dalargin (40 micrograms/kg) on xanthine-oxidase (X) activity in experimental Arduan-induced myoplegia (0.1 mg/kg) was studied in the brain tissue of 70 rats under inhalation anesthesia and artificial ventilation. Neither Dalargin nor Arduan was found separately to induce statistically significant changes in X activity. Dalargin injections in myoplegia caused significant (24.7%) reduction of the enzyme's activity.

The creatine kinase activity in the skeletal muscles and heart of rats is investigated under the effect of preparations of the depolarizing (myorelaxin) and nondepolarizing (tubocurarin, arduan) action. It is stated that arduan and tubocurarin inhibit the enzyme activity in the myocardium but not in skeletal muscles. The creatine kinase activity in the myocardium extract decreases twice under the tubocurarin effect and more than thrice under the arduan effect. Inhibition of the enzyme activity in the myocardium mitochondria under arduan effect is pronounced more greatly.