The objective of the study: to find early hemodynamic predictors of a lethal outcome of abdominal sepsis.

Methods. 44 patients with abdominal sepsis with no signs of septic shock were enrolled into a retrospective study. The age of patients made 48.7 Ѓ} 2.26 years old; the severity of state according to APACHE II was 12.50 Ѓ} 0.55 scores, and as per SOFA ‒ 8 [6; 10]) scores. Hemodynamics was assessed through transpulmonary thermodilution.

Results. During the first 24 hours, the following rates were the most sensitive and specific in respect of a lethal outcome: cardiac function index (odds ratio – 0.582; 95%CI 0.388-0.872; p = 0.008), and cardiac power index (odds ratio – 0.027; 95%CI 0.001-0.6; p = 0.022). The same results were observed in 4-5 days of treatment. At different stages of the study, the following rates demonstrated stable predictive significance: cardiac index (CI), systolic output index, global ejection fraction; and the area under ROC-curves (AUROC) for these rates was compatible with AUROC as per SOFA.

Conclusion: The investigation of the after-load dependent relative cardiac efficiency proved that the normal values of CI could be predictive of an unfavorable sepsis outcome if after-load dependent relative cardiac efficiency was < 80%. It is sensible to define individual target values of cardiac hemodynamics, which significance is clinically proved in case of sepsis.

Critical states developed during infectious diseases are amongst main causes of lethal outcomes in children.

The objective of the study: to find major signs of iatrogenic risk of critical states during infectious diseases in children.

Subjects and methods. The examination protocols of 1 237 children in the age from 3 months to 15 years old were studied, all children had sepsis and were staying in central district hospitals and managed by doctors from emergency wards and planned care units from 2007 to 2011.

Results of the study. The retrospective analysis proved the significance of the delayed start of intensive care for the risk of unfavorable outcome of gastrointestinal infections in children. The maximum permissible time of 45 minutes before the start of intensive care was substantiated. The risk factors of unfavorable outcome of gastrointestinal infections were defined for the period of treatment before the transfer to anesthesiology and intensive care wards: early prescription of intestinal antiseptics during in-take of antidiarrheal drugs (OR=4.0) and use of paracetamol and ibuprofen (OR=3.2).

Conclusion: intensive care started as early as possible in children with infectious diseases and initiated within 15 minutes after the admission to intensive care ward is associated with the reduced risk of a lethal outcome.

The objective: to assess the efficiency of spinal analgesia as a part of anaesthesiologic support in laparoscopic colon surgeries within fast track programs.

Subjects and methods: 60 patients who had laparoscopic colon surgeries within fast track programs were divided into 2 groups. In Group 1 (n = 30), peri-operative analgesia was provided through intrathecal administration of 10.0–12.5 mg of bupivacaine and 200 mcg of morphine. In Group 2 (n = 30), the systemic multi-modal analgesia was provided (nonsteroidal anti-inflammatory drugs, opioids).

Results. The maximum intensity of pain at rest within 24 hours after surgery was assessed as 2 (2−3) scores as per the digital rating scale in Group 1 and 5 (4−6) scores in Group 2 (p < 0.0001). The intensity of pain by the first verticalisation made 3 (2−5) scores in Group 1 and 6 (6−7) scores in Group 2 (p < 0.0001). Intra-operative consumption of phentanyl, frequency of post-operative nausea, vomit and need for extra pain relief were much lower in Group 1.

Conclusion. Intrathecal administration of 10.0−12.5 mg of bupivacaine and 200 mcg of morphine as a part of anaesthesiologic support in laparoscopic colon surgeries provides effective peri-operative analgesia and promotes the implementation of fast track programs in this type of interventions.

Prevention and treatment of multi-organ failure after complicated surgeries on heart and major vessels remain to be crucial.

The objective: to evaluate the potential use and efficiency of high-volume plasmapheresis for prevention and early therapy of multiple organ failure syndrome.

Methods: high-volume plasmapheresis was used in 246 patients with the most disseminated complications of the peri-operative period. Plasmapheresis was done during the first 4–6 hours after surgery (157 patients) and in 6–12 hours after surgery (41 patients) and later than 12 hours (48 patients).

Results. After complicated surgeries with in vitro hemoperfusion, the activation of system inflammatory response and endotoxicosis was more intensive versus patients with no complications. Plasmapheresis in 4–6 hours after surgery promoted metabolic normalization and in the majority of cases prevented of multiple organ failure (if at least 50% of circulating plasma was removed). After early plasmapheresis, the level of markers of system inflammatory response and endotoxicosis reduced by 28–30%, which allowed preventing serious renal disorders and cytolysis manifestations.

Conclusion: Post-operative high-volume plasmapheresis performed in 4–6 hours after complicated cardiac surgeries is effective for prevention of multiple organ failure syndrome in 64% of cases.

The objective of the study: to find peri-operative risk factors of myocardial infarction during the intra-operative period in the patients undergoing non-cardiac surgery.

Subjects and methods. 85 case histories of patients were analyzed, all those patients developed myocardial infarction after surgeries (non-cardiac) in the post-operative period. Clinical and electrocardiogram parameters, outcomes of peri-operative myocardial infarction and its intra-operative risk factors were analyzed. The comparison group included 80 patients who had surgeries with the favorable course of the post-operative period.

Results: 72.9% of cases developed myocardial infection in the post-operative period with the 1st day after surgery and had blurring clinical signs of it: it was not accompanied by pain syndrome in 23.5% of cases, and there was no ST elevation on ECG in 69.4% of cases. Risk factors of myocardial infection in the post-operative period were the following: duration of surgery for more than 90 minutes, intra-operative hypotension (systolic arterial pressure < 100 mm Hg.) for more than 10 minutes, anemia with hemoglobin level less than 70 g/l, cardiac rhythm in the peri-operative period more than 90 bpm. Results of the logistic multi-factorial analysis showed that reduction of systolic arterial pressure less than 100 mm Hg., OR 4.24 (1.181–15.20), p = 0.026, was the only independent risk factor of myocardial infarction.

The frequency of difficult laryngoscopy and tracheal intubation in obese patients is higher compared to non-obese patients. Therefore it is important to perform an adequate assessment of airway before surgery with general anesthesia and tracheal intubation in such patients. This retrospective study evaluated the predictive value of El-Ganzouri score in the patients with body weight index exceeding 30 kg/sq. m.

Subjects and methods. 116 patients were enrolled into the study, general anesthesia with tracheal intubation was planned in all those patients. The airway of all patients was assessed by El-Ganzouri score prior to surgery. Regardless of the number of scores in a patient, a video laryngoscope was always used, however by the first intubation attempt it was used as a regular one.

Results. The score sensitivity made 0.81, specificity – 0.66, positive predictability – 0.4, negative predictability – 0.93. The area under ROC-curve made 0.82.

Conclusions. We recommend El-Ganzouri score for evaluation of airway in the patients with BMI exceeding 30 kg/sq. m. since it possesses good modeling properties (AUC = 0.85) and allows selecting the safest way of intubation.

Nowadays, the effectiveness of inhalation drug therapy during non-invasive ventilation (NIV) has been proved. The delivery of aerosol drugs during non-invasive ventilation depends on numerous factors, such as the choice of inhalation equipment and a mask, position of the leak port and position of the device in the respirator settings. Innovations in the field of inhalation therapy resulted in the development new devices able to optimize pulmonary deposition and reduce the time of inhalation therapy. Compared to standard jet nebulizers, mesh nebulizers can deliver the 4 fold higher dose of the drug to the patient's airways. Further research is needed in order to investigate the opportunities of aerosol therapy during high-flow oxygen therapy by means of nasal cannulae.

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.

Dexmedetomidine is a high-selective α2-agonist, which is used as an anesthetic component, and it is expected to induce polyuria. Initially, it was mainly used for sedation in emergency wards, and further this medicine got widespread use in anesthesiology. The major positive effect of dexmedetomidine is related to its central sympatholytic action and suppression of the activity of sympathetic nervous system. This medicine also provides a favorable hemodynamic profile. However, it has a number of certain disadvantages. The present clinical study reports development of acute polyuria syndrome due to the administration of dexmedetomidine during spinal neurosurgery.

Recommendations on peri-operative infusion-transfusion therapy in children have been developed by the members of Association of Children Anesthesiologists and Emergency Physicians of Russia, possessing significant experience of anaesthesiologic and intensive care provided to children. These recommendations are aimed to provide clear instructions on compilation of peri-operative infusion program in order to reduce the risk of complications related to this in children of various age groups, to enhance efficiency and safety of anaesthesiologic support in general. Recommendations do not include some specific issues of infusion therapy in specialized medical fields.