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Prevention of cardiovascular complications, which often result in fatal events in the peri-operative period, is one of the most crucial issues of modern anesthesiology.The objective: to investigate the changes in arrhythmic activity and conduction disorders during anesthesia and in the peri-operative period in the patients undergoing open cholecystectomy under general anesthesia.Subjects and methods. 57 patients of 60.1 ± 3.8 years old were enrolled in the study; they all underwent planned open cholecystectomy under combined anesthesia with tracheal intubation and artificial pulmonary ventilation. Group 1 consisted of 28 patients suffering from coronary heart disease (CHD) in the form of exertional angina of functional classes of I and II; and Group 2 included 29 patients without CHD. The frequency of episodes of group and polymorphic premature ventricular contractions, supraventricular tachycardia and atrioventricular block of degree II, was analyzed by daily Holter ECG monitoring for certain time periods during anesthesia and the peri-operative period. Stages of the study: I – on the eve of the surgery (18 h); II – within 6 hours before the surgery; III – immediate preparation and induction of anesthesia (62.0 ± 6.7 min); IV – maintenance of anesthesia (57 ± 14 min); V – recovery from anesthesia (48 ± 11 min); VI – the 2nd day after surgery (18 h).Results. A significant increase in the frequency of episodes of group and polymorphic premature ventricular contractions, supraventricular tachycardia and atrioventricular block of degree II, was found out at the stages of induction, maintenance and recovery from anesthesia in patients with CHD and in patients without concurrent cardiovascular disorders. Increased frequency of episodes of group and polymorphic premature ventricular contractions was observed in patients with CHD at the stages of induction and recovery from anesthesia (by 242 and 225%). The highest increase in the frequency of polymorphic premature ventricular contractions was observed in patients with CHD during recovery from anesthesia (by 284%) and in those without cardiovascular pathology at the induction stage (by 461%); the increase in episodes of supraventricular tachycardia was maximum at the induction stage in the patients without cardiovascular pathology (by 291%).Conclusion: Open cholecystectomy in general anesthesia is associated with increased arrhythmic activity and higher conduction disturbances incidence at all stages of anesthesia in patients with coronary heart disease and those without concurrent cardiovascular disorders.

Anti-ischemic effects of high-dose cardiac cytoprotector Mexicor (0,014 g/kg/d, 0,019 g/kg/d) were examined in rabbits with experimental myocardial infarction. In addition, anti-ischemic activity of Mexicor (0,4 g/d) was assessed in patients with acute coronary syndrome (ACS). It has been demonstrated that Mexicor reduced the size of infarction area and decreased the ratio “necrosis area / ischemia area”, compared to the control animals. In ACS patients, Mexicor facilitated faster recovery of left ventricular diastolic function, and also decreased blood levels of NT-proBNP.

Aim. To study efficacy of cytoprotector mexicor in patients with unstable angina (UA), acute myocardial infarction (MI), hypertensive crises (HC) in combined therapy with conventional drugs. Material and methods. An open randomized study included 338 patients with acute forms of ischemic heart disease (IHD) and arterial hypertension running with crises. Combined therapy of 20 patients with UA, 90 patients with MI and 43 patients with HC (study groups) was supplemented with mexicor in a dose 6-9 mg/kg/day. The control matched patients (20, 86 and 79 patients, respectively) received conventional treatment alone. The effects of the treatments were assessed by ultrasound investigation of the heart in M-, B- and Doppler modes, by ECG and arterial pressure 24-h monitoring, by activity of lipid peroxidation (LPO). Results. Adjuvant therapy of urgent cardiological conditions with mexicor diminished oxidant stress, left ventricular dysfunction. In MI patients mexicor promoted reduction of the akinesia zones, recovery of disturbed segmentary contractility. In UA patients mexicor contributed to more pronounced decrease in the frequency, duration and severity of myocardial ischemia, enhanced stabilization of angina. In HC patients mexicor promoted earlier normalization of a 24-h AP profile and variability of cardiac rhythm, recurrence rate of HC decreased 2-fold. Conclusion. The addition of mexicor to conventional therapy of UA, MI, HC improves clinical course of these diseases, reduces oxidant stress, accelerates recovery of cardiac contractility and left ventricular diastolic function, normalization of central hemodynamics.