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Comparative study of postoperative analgesia and sedation with trimeperidine and dexmedetomidine and their effects on haemodynamics and vegetative nervous system was performed. Assessment of analgesia and sedation during vagotonia (first part of the study) and hypokinetic type of haemodynamics (second part of the study) was carried out with visual analogue scale (VAS) and Richmond scale. Results of the study showed that dexmedetomidine is more effective and safer than trimeperidine for analgesia and sedation in patients with spontaneous breathing after abdominal surgery. Dexmedetomidine use allows keeping optimal type of haemodynamics and vegetative nervous system parameters on first day of postoperative period.

A differentiated administration of calcium antagonists in preoperative preparation of pregnant patients with hypertension enabled the conversion of circulatory system state to "normal pregnancy range": a conversion of hypokinetic (including the HES solution infusion) and hyperkinetic types of haemodynamics to eukinetic one, with the decrease of total peripheral resistance and myocardium need for oxygen, autonomous nervous system state to physiological sympathicotonia. Evidence shows that continued intra-operative treatment including tranexamic acid enables to maintain those results during the surgery. In postoperational period, the clinical manifestations of SIRS in patients who has received the mentioned therapy were marked less then in control group, and the newborns have a higher Apgar score.

Pregnancy is considered in the spotlight of creation of general adaptation syndrome. It was revealed that 85% and 58% of healthy non-pregnant women had an inadequate autonomous nervous system (ANS) and circulatory system response respectively. This favoured the labour activity malfunction in 20% of women in childbirth when an abdominal delivery was needed. A traditional subarachnoid anesthesia (SA) in control group was accompanied by decrease of blood pressure (BP) to the numbers requiring a medicamentous correction (as by literature data). However, the central haemodynamics measures has shown a normal blood flow and the blood pressure correction was not performed. During surgery and in early post-operative period in all women in this group a parasympathetic tone has prevailed over, and the cardiac output was at the lower limit of the hypokinetic type of haemodynamics, which was accompanied with nausea and vomiting in 30% of women. Including the atropine administration into the traditional protocol of SA in cesarean section in pregnant patients with eu- and parasympathotonia (research group) has favoured the optimization of the neurovegetative inhibition of reflexes and stabilization of haemodynamics within the physiological ranges. Vagosympathetic block has been accompanied by sympathotonia with a lesser BP decrease compared to control group, absence of bradycardia, nausea and vomiting. Thus the BP can not serve as a criterion of the perfusion of essential organs, including uteroplacental haemodynamics, especially non-invasibe BP. Including the control of ANS tone dynamics, central haemodynamics and oxygen transport into monitoring guidelines in neuroaxial anaesthesia in abdominal delivery is necessary.

Pregnancy in patients with hypertension is considered in the spotlight of creation of general adaptation syndrome. According to evidence, when a stable hypertension in pregnant patients with hyper- and eukinetic types of haemodynamics is observed, the response of circulatory system and body fluid compartments has a moderate difference with normal. In pregnant patients with hypertension and a hypokinetic type of haemodynamics and pregnant patients with gestosis developed against the background of eukinetic type of hypertension, a physiological decrease of total peripheral resistance (TPR) is absent, which contributes into interstitial hyperhydration. In pregnant patients with gestosis developed against the background of hypokinetic type of haemodynamics, a pathological rise of TPR occurs, which is followed with a more significant interstitial hyperhydration. A differentiated preoperative preparation of pregnant with hypertension with the calcium antagonists and hydroxyethyl starch solution (130/0,4) favours the conversion of hyper- and hypokinetic types of haemodynamics to eukinetic, forms a physiological type of sympathicotonia and improves the water-salt metabolism.

High-frequency oscillations in a pulse wave signal in the range of 1-50 Hz and their relation to heart rhythms have been investigated. Informative parameters to estimate the adaptation reactions have been determined using the Kohonen maps, the results of simulating the pulse wave signal (single rheocycles), and the experimental data. The coefficient of harmonic variation was used as an informative parameter. It was shown that the space of signs in the frequency range of 1-12.5 Hz, formed on the basis of the coefficient of harmonic variation, possesses a significant degree of structuring relative to the distribution of data for different types of adaptation reactions.

By taking into account the fact that the autonomic nervous and cardiovascular systems (ANS and CVS) are the major links of development of the general adaptation syndrome in pregnancy, which are affected by all the processes involved in the development of the syndrome, the author analyzed the state of these systems in healthy non-pregnant and pregnant women (HNPW and HPW) and in pregnant women with gestosis. HNPW were found to have already a prerequisite for impairing pregnancy adaptive processes as ANS and CVS dysfunction. In HPW, these impairments were more pronounced. In the pregnant women, impaired adaptive processes manifested themselves as excess sympathicotonia in 72% and parasympathicotonia in 23% of cases despite the treatment performed, which was accompanied by hypokinetic hemodynamics in 53 and 50%, respectively. In hyper- and eukinetic hemodynamics, there were no physiologically required decreases in total peripheral vascular resistance while in hypokinetic hemodynamics, there was its pathological increase. Such disorders enhance the significance of abdominal compartment syndrome, aortocaval compression, ischemia-reperfusion, hydrodynamic and membranogenic (capillary leakage) factors of impaired water metabolism, which contributes to adaptation derangement. Based on the findings, the authors have created a developmental modulation algorithm for the general adaptation syndrome by completed pregnancy and surgical delivery.

Based on their own findings and the data available in the literature on pregnancy including that complicated by gestosis, the authors consider these conditions in the context of Selye's general adaptation syndrome. They identify its basic links (the autonomic nervous and cardiovascular systems) the function of which is affected by all the physiological and pathophysiological processes involved in its development. There is a high likelihood of baseline impaired adaption processes in these links, which may lead to an inability to accommodate (dysadaptation) by the moment of delivery. The paper gives the current interpretation of functional disorders, called Zangemeister'a triad in 1913, from the present-day points of view of the evaluation of pregnancy as the systemic inflammatory response syndrome and, probably, adaptation disease. Based on the results of analyzing the data available in the literature, the authors indicate physiologically the basic trends in the modulation of impaired development processes of the general adaptation syndrome towards the completion of pregnancy and surgical delivery.

The paper analyzes the results of using in the anesthetic maintenance of pregnant females with gestosis the algorithm of preventing possible impairments in the development of the general adaptation syndrome in response to pregnancy and surgical labor. Calcium antagonists (eliminating dysfunction of secondary calcium messenger), ketonal, and tranexamic acid (which inhibiting a number of pain and inflammation mediators), and hydroxyethyl starch-130/04 solution (regenerating the endothelium) were administered to prevent the clinical manifestations of the intraabdominal compartment syndrome, ischemia-pefusion, and the second wave of the systemic inflammatory response syndrome in response to surgery. The differential use of the above agents at all stages of anesthetic maintenance in pregnant women with gestosis promoted the postoperative preservation of the most efficient eukinetic hemodynamics and physiological sympathicotonia and the elimination of water metabolic disturbances more early than in the control puerperas. A more physiological postoperative course in the study group puerperas called for much less pharmacotherapy, which created more favorable conditions for postoperative maternal-neonatal contact (feeding, etc.).

Differential preoperative preparation of pregnant women with gestosis, which is aimed at eliminating dysfunction of the universal secondary calcium messenger and preventing further disorders caused by calcium antagonists, is accompanied by positive changes in the basic links of development of the general adaptation syndrome--the autonomic nervous and cardiovascular systems. A physiologically required reduction in total peripheral vascular resistance (TPVE) is achieved in pregnant women with hyper- and eukinetic hemodynamics. In pregnant women with hypokinetic type, who receive hydroxyethyl starch-130/04 solution in the infusion therapy protocol, there is elimination of its pathological increase and there is a tendency for its physiological reduction. Obviating the discrepancy between cardiac index and TPVE causes a change of the hyper- and hypokinetic hemodynamic types to the eukinetic one, which is attended by development of physiological sympathicotonia and by almost complete normalization of water metabolic parameters in pregnant women with gestosis.

It was established that non-operated patients with duodenal ulcer and patients after organ-saving operations associated with vagotomy show an essential increase of insulin and cortisol secretion and reveal a strict dependence of hormonal secretion on the severity of the pathological process and time after operation. The increased cortisol/insulin ratio correlated with a reduction of the body mass of patients.

Examinations of different patients with duodenal ulcer performed during one year revealed seasonal changes in the function of the regulatory systems. Secretion of histamine, serotonin, insulin, and hydrocortisone was increased in spring and reduced in autumn. Secretion of adrenalin, noradrenalin and acetylcholinesterase activity were high in summer and low in autumn. The acid-producing function of the stomach did not depend on the season. It is suggested that deviations in the activity of the regulatory systems in spring and autumn may cause seasonal exacerbations of duodenal ulcer.