The profound deepening of medicamentous sleep down to the burst-suppression electroencephalography pattern is used to provide medication-based protection of brain during preventive temporary clipping of the major arteries when performing surgery due to cerebral aneurysms. There is no consensus about the effect of profound suppression of electrobiological activity on the development of post-operative cognitive dysfunction. The goal: to evaluate the impact of anesthesia with the burst-suppression electroencephalography pattern on the post-operative cognitive status of the patients with no cerebral disorders. Subjects and methods. 30 patients were enrolled into the prospective randomized study, they all had surgeries due to degenerative spinal diseases. All patients were divided into two groups. Anesthesia in the main group (Group 1) differed from the one in the control group (Group 2); it included administration of propofol till achieving suppression of the electrobiological activity of burst-suppression electroencephalography pattern during 15 minutes. Prior to the surgery and in 4 days after it, all patients had neuro-psychological tests using Montreal Cognitive Assessment (MoCA), Frontal Assessment Battery (FAB) and numbers memorization techniques (NMT). Results. When testing in 4 days after surgery, results in the patients from Group 1 did not differ from pre-operative results of MoCA (Me_before = 28, Me_after= 28, Z = 0.714, p = 0.476), FAB (Me_before = 18, Me_after = 18, Z = 0.592, p = 0.554), memorization of numbers in the direct order (Me_before = 18, Me_after = 18, Z = 0.178, p = 0.859) and in the reverse order (Me_before = 18, Me_after = 18, Z = 0.548, p = 0.583). The results of the post-operative testing in Group 2 were compatible with pre-operative results of (Me_before = 18, Me_after = 18, Z = 0.459, p = 0.646), FAB (Me_before = 18, Me_after = 18, Z = 1.348, p = 0.178), memorization of numbers in the direct order (Me_before = 18, Me_after = 18, Z = 0.21, p = 0.843) and in the reverse order (Me_before = 18, Me_after = 18, Z = 0.809, p = 0.418). None of the tests detected significant differences between the Groups (U = 88, p = 0.319, Z = 0.995 for MoCA; U = 102.5, p = 0.644, Z = 0.394 for FAB; U = 92.0, p = 0.407, Z = -0.829 for memorization of numbers in the direct order, and U = 33.5, p = 0.62, Z = 0.572 for memorization of numbers in the reverse order). Conclusion. Anesthesia with burst-suppression electroencephalography pattern as a model of medication-based cerebral protection during temporary clipping of the major arteries does not cause the deterioration of cognitive status in the patients who had no cerebral pathology initially.

The post-operative cognitive dysfunction is an adverse disorder of higher functions of the nervous system, which develops in the post-operative period and it is associated with surgery and anesthesia. The goal: to investigate the impact of sedation through spinal anesthesia on the frequency of the post-operative cognitive dysfunction after uterus amputation. Subjects and methods. 65 middle age women were examined, they all had the uterus amputated with spinal anesthesia with 15-20 mg of 0.5% hyperbaric solution of bupivicaine. Dexmedetomidine (0.5-1.2 mcg/kg per 1 hour) was used in the patients from Group 1 (28 women), and propofol (2-10 mg/kg per 1 hour) was used in Group 2 (37 women). Mini Mental State Examination (MMSE) and Montreal Cognitive Assessment (MoCA) were used for assessment of cognitive functions before and after the surgery. Results. The statistically significant difference in the level of cognitive functions was observed between the Groups on the 1st and 5th day after the surgery. The level of cognitive functions was statistically significantly higher in the group where dexmedetomidine was used versus the group where propofol was used, which provided the evidence of the minimum negative effect of spinal anesthesia with dexmedetomidine on the cognitive potential in the patients undergoing gynecological surgery. Conclusion: Spinal anesthesia with dexmedetomidine during uterus amputation reduces the risk of the post-operative cognitive dysfunction.

The goal: to study the actual situation related to the intensive care tactics when treating children with severe burns during the first 24 hours after the injury. Subjects and methods. The study was designed based on an anonymous survey among anesthesiologists and emergency physicians, providing care to children with thermal injuries. The interactive questionnaire was developed using the free platform of Google Forms and distributed through medical social media and communities. Respondents were supposed to answer 26 questions on the actual issues of intensive care of burns. The participation in the survey was free and voluntary, no remuneration was paid for it. The survey was performed from August 28 to October 21, 2017. The results were presented in the format of actual numbers and/or percent out of a number of respondents. Pearson's chi-squared test (χ²) was used for defining statistically significant differences, the comparison included departments providing care both to children and adults and children only. The level of statistical significance was ascertained at the probability of error of 0.05. The applied software of Statistica 10 и SAS JMP 11 was used for statistic processing of data. Results. The replies were received from 56 departments, providing care to children with burns. 8 questionnaires were incomplete, the remaining 48 questionnaires were analyzed. The survey demonstrated the lack of the unified approach to the intensive care of children with severe burns. Conclusion. It is necessary to review organizational and methodical approaches in the routing of patients in large children burn centers where many children are concentrated, and it is necessary to continue clinical trials and to develop federal clinical recommendations with consequent development of hospital protocols based on the above.

The current development of oncological surgery requires maximum possible radical interventions both for the patients with concurrent conditions and those with large tumors. In thoracic surgery, provision of the adequate surgical access by the anesthesiologist is crucial, and first of all, it requires the full collapse of the operated lung for the whole time of surgery. A chest tumor often results in the changes of the trachea and main bronchi anatomy, compression of their lumen, which can make lung separation difficult. Introduction of double lumen tube with an integrated video camera into clinical practice is aimed to provide easy and reliable separation and isolation of the lungs in case of pathological changes in the trachea and main bronchi without control bronchoscopy. The article analyses 17 cases when double lumen tubes with video monitoring were used for oncological thoracic surgeries, assesses the results and opportunities for their use in the patients with the changed anatomy of the tracheobronchial tree. Video monitoring provides safe and fast intubation of the left main bronchus reaching the required depth, reduces the time of preparation for surgery and its duration providing good working conditions for surgeons.

In order to improve outcomes of surgical treatment of thoracic diseases, the peri-operative protection is to be constantly enhanced. Goal: to assess the effect of combined anesthesia with thoracic epidural analgesia in the peri-operative period on hemodynamics and respiratory exchange during radical pulmonary surgery. Subjects and methods. The prospective randomized study was performed aiming to assess the effect of various options of anesthesia in 46 patients who had planned radical pulmonary surgery. The patients were randomly divided into two groups. Group 1 (n = 23) had combined anesthesia. Analgesia was provided through segmental epidural block on the level of Th₄ ‒Th₅ by intermittent bolus dosing of 0.75% solution of ropivacaine (0.7-0.8 mg/kg) and fentanyl (1.3-1.5 mcg/kg), and during the surgery, the mixture of 0.02% solution of ropivacaine and fentanyl (4 mcg/kg) was continuously infused at the rate of 4-6 ml/h. In Group 2 (n = 23), analgesia was provided by infusions of fentanyl, epidural analgesia was used in the post-operative period as a component of multi-modal post-operative pain relief. In both groups, the cortical component was provided by the low-flow inhalation of sevoflurane under BIS monitoring. Pipecuronium bromide solution was intermittently administered in order to provide muscle relaxation. Conclusion. The positive impact on hemodynamics and respiratory exchange was observed when using combined anesthesia based on thoracic epidural analgesia and inhalation anesthesia with sevoflurane.

Goal: to investigate the impact of extracorporeal haemocorrection on free-radical oxidation and antioxidant defense in those with abdominal sepsis. Subjects and methods. 46 patients were examined. All patients were divided into two groups. Patients from the main group (n = 23) had metabolic support with succinate-containing antioxidants additionally to the standard intensive care and active detoxication (continuous venovenous hemofiltration). Patients from the control group (n = 23) received standard intensive care and active detoxication. The study included five stages: before hemofiltration and in 1 day, 3, 5, and 7 days after its start. Results. It was found out that the investigated rates in the main group differed from the ones in the control group at the last stage of the study, achieving normal values. The significant improvement of the above rates was observed in the control group only at the 5th stage. Conclusion. The combined use of traditional treatment of sepsis, active detoxication and metabolic support with succinate-containing antioxidants results in the faster elimination of oxidative stress, earlier restoration of activity of anti-oxidant protection system and respiratory exchange recovery.

Acute renal injury is a relatively new notion (introduced into the practice since 2012), which is currently understood as a fast failure of renal functions (within 48 hours) with increasing absolute rates of serum creatinine up to 26.5 mcmol/l and more, with the relative increase of the creatinine concentration up to 50% and more (i.e. by 1.5 times) versus the initial level or as a documented oliguria with diuresis less than 0.5 ml per kg of the body weight during 6 hours. The frequency of acute renal injury increases every year especially in the patients undergoing massive surgical interventions. The effect of acute renal injury is often underestimated in the routine practice which can cause the increase in the mortality rate. There is no generally accepted procedure for prevention and management of acute renal injury. The review describes the aspects of diagnostics of acute renal injury and principles of peri-operative management.

Neurogenic pulmonary edema is one of the complications of acute cerebral diseases and traumas and it is accompanied by severe respiratory failure. It is associated with a high mortality level. There are several theories about neurogenic pulmonary edema development. The theory of the double hit is the most recent causing significant discussion. The theory is based on the pulmonary injury due to systemic inflammatory response when the glial tissue of the injured brain becomes the source of inflammatory mediators. A similar pathogenesis allows considering neurogenic pulmonary edema to be one of the forms of acute respiratory distress syndrome. It has diagnostic criteria common with acute respiratory distress syndrome, which are identified during acute cerebral injury and not associated with the other etiological factors. Currently, there are no effective prevention and treatment of neurogenic pulmonary edema. Support of respiratory exchange through artificial pulmonary ventilation is a major tool used for its management, which is recommended to be performed in compliance with protective ventilation principles. And some particular approaches of the preventive ventilation can be applied only with neuromonitoring.

Currently, the issue of organ protection is being actively studied. According to results of a big number of studies conducted all over the world, dexmedetomidine, the agonist of α2-adrenoreceptors, possesses certain protective properties. Further multi-center randomized studies are needed in order to prove that this drug can be used to reduce the number of peri-operative complications and the risk of organ dysfunction, and to improve outcomes of surgical treatment in patients with cardiac and non-cardiac operations.

The article describes the clinical case when malignant hyperthermia was diagnosed in the patients during the cardiac surgery. The patient had anesthesia with desflurane. The state of the patient was stabilized due to timely diagnostics and aggressive therapy with non-specific agents and cardiopulmonary bypass. The article presents different variants of clinical manifestations of this complication, ways of diagnostics and specific therapy.

The mortality rate reaches 50% in the patients with a terminal cardiac failure within one year after it is diagnosed. Orthotopic cardiac transplantation is a radical method to solve this problem and enhance life quality of such patients. Even 10 years ago this surgery and the most important post-transplantation management could be performed only by leading research centers. Currently, given the improvement and accessibility of cardiac surgery, anesthesiology, intensive care, cardiology, and immunology, this type of surgery and post-transplantation management have been mastered by multi-specialty regional centers. The latter improves the accessibility of high tech care for people residing in the periphery.