Lyashok A. Choosing anesthetic providing in patients with coronary heart disease during abdominal surgery

Тheoretically justified and proposed a new way of solving of important scientific and practical problem - to reduce the risk of cardiac events in patients with coronary heart disease during abdominal surgery by optimizing anesthetic management. A comprehensive diagnostic algorithm verification of ischemic myocardial injury in the perioperative period, including minimal myocardial damage based on the study of central hemodynamics, level of cardiac troponin I, the MB fraction of creatine kinase, N- terminal fragment of prohormone brain natriuretic peptide. It is proved that the best cardiac safety profile option has a total intravenous anesthesia and main anesthetic propofol and ketamine in comparisation with variants of anesthesia on the basis of sodium thiopental and a continuous infusion of ketamine. It is found that the use of anesthesia with propofol and microdose ketamine provides optimal hemodynamic profile of anesthesia and is not accompanien by ischemic myocardial injury. Implementation of the proposed algorithm diagnosis of ischemic myocardial injury and cardioprotective option anesthesia allows to reduce the incidence of perioperative myocardial ischemia and reduce the number of cardiac events in patients with coronary heart disease during abdominal surgery.