The endothelial glycocalyx (EG) system is an important protective regulator of vascular integrity and permeability, provides cellular interaction and serves as a component of hemostasis. Damage of EG in septic shock, cardiopulmonary bypass (CPB), trauma, ischemia and in a number of other critical states leads to capillary leakage, hemodynamic and metabolic disorders.

The aim of the study was to evaluate the interaction of EG components with hemodynamic and metabolic response in patients with septic shock and in cardiosurgical interventions using CPB.

Materials and methods. The study included 21 patients with septic shock and 26 patients undergoing cardiac surgery with CPB. The plasma concentrations of EG components, including heparin-sulfate proteoglycan (HSPG) and syndecan 1 (S1), were determined in the group of patients with septic shock at baseline, 2 and 24 hours after the fluid load test, and in the group of cardiosurgical patients – after induction of anesthesia, at 6 and 24 hours after the end of CPB.

Results. In septic shock, the concentration of S1 in blood plasma tended to increase at 2 hours after the fluid load test. In cardiosurgical patients, at 6 hours after the end of CPB, the plasma concentration of HSPG reduced from 6.13 (4.20–9.04) to 5.08 (4.18–7.21) ng/ml (p <0.01), whereas S1 increased from 0.80 (0.56–1.13) to 1.25 (1.04–1.41) ng/ml (p <0.001). At 24 hours, HSPG and S1 returned to values close to baseline. In both groups, we established the relationship of the EG components with the parameters of pre- and afterload, as well as with the concentration of lactate.

Conclusion. The damage of EG in septic shock and in cardiosurgical interventions using CPB is related with disorders of hemodynamics and metabolism.

The objective of the study: to assess the impact of the agonist of vasopressin receptor V-1 (terlipressin) in the operative delivery of obstetric patients with a high risk of hemorrhage during cesarean section.

Subjects and methods. 60 women were examined, all of them had planned cesarean section; the median age made 32.7 years and gestation time made 38 weeks. Group 1 (n =30) included patients who underwent surgery without terlipressin; Group 2 (n =30) included women who had 0.4 mg of terlipressin intra-operatively introduced endometrially (into the place of the uterus incision) immediately after omphalotomy. The volume of the blood loss was measured intra-operativelly. The arterial tension and hemodynamic rates were assessed during the surgery and in 24 hours after it in the morning.

Results. It was found out that there was a statistically significant difference in the volume of intra-operative blood loss and need for blood transfusion. Using terlipressin resulted in the reduction of blood loss by 37–50% which was due to its pharmacological effects, i.e. vasoconstrictive and antihemorrhagic ones.

Conclusions. Using terlipressin within comprehensive intensive care during cesarean section in the patient facing the high risk of hemorrhage allows reducing the intra-operative blood loss to a significant extent and reducing transfusion of donor blood components.

The article presents the results of a prospective randomized double-blind study which was investigating the efficacy of intra-operative transcutaneous stimulation of median nerve on the wrist aimed to prevent post-operative nausea and vomiting after planned resection of brain tumors located in posterior fossa.

Methods. 40 patients were included into the study: 20 patients were enrolled into the stimulation group and 20 of them were enrolled into the control group, where the prevention of emetogenic reactions was limited by the use of dexamethasone and ondansetron.

Results. The demographic and clinical parameters were compatible in the both groups. During the first 12 hours after recovery, the risk to develop symptoms was significantly lower in the stimulation group (p <0.05): 7 cases versus 14 ones in the control group (RR =0.5; 95% CI 0.26−0.97) and 4 versus 10 cases of vomiting in the control group (RR =0.4; 95% CI 0.15−1.07). No side effects were observed.

Conclusion. It was confirmed that this method was effective to prevent postoperative nausea and vomiting in the patients who underwent infratentorial craniotomy.

From the safety point of view, procedural sedation results in fairly frequent complications, typical of the anesthetics being used.

The objective: to study the hemodynamics, gas exchange and the character of complications (respiratory disorders, agitation) when using thiopental sodium, ketamine and propofol during procedural sedation in the children with CNS disorders undergoing computed tomography.

Subjects and methods. 90 patients at the age from 8 months to 10 years with the risk degree of II–III as per ASA who underwent computed tomography were enrolled in the study. The patients were divided into three groups depending on the anesthetic being used. Changes in hemodynamics, gas exchange and frequency of complications were analyzed.

Results. Hypercapnia and reduced saturation were documented in the propofol group, which were the consequences of hypoventilation and they required the respiratory support in the form of oxygen insufflation through the face mask in 46.7% of cases or artificial pulmonary ventilation (30% of cases). In ketamine group, agitation was documented in 6% of cases.

Conclusions. For procedural sedation in children with CNS disorders, thiopental sodium is the drug of choice, since it provides the least significant impact on hemodynamics, gas exchange and causes no complications.

Resuscitation during pregnancy is a rare event (one case per 20,000 pregnancies) with a high mortality rate in mothers (about 45%). It is difficult to perform cardiopulmonary resuscitation effectively not only due to specific physiological features of the pregnant but due to difficulties in the development of clinical recommendations which is related to these situations being rare and lacking evidence. The above circumstances make the detail description of each case of cardiopulmonary resuscitation in the pregnant highly valuable.

The objective of the study: to analyze the number of clinical cases of cardiac arrest with advanced cardiopulmonary resuscitation in the pregnant in one of special perinatal centers from the position of modern international and national recommendations.

Subjects and methods. A retrospective descriptive study of cardiopulmonary resuscitation in the pregnant was performed in the Special Perinatal Center of Almazov National Medical Research Center.

Results. From 2010 to 2017, there were 5 cases of cardiac arrest in the pregnant; the risk of development made 1:3,650. The median gestation time made 39 (37; 40) weeks. All patients had cesarean section during resuscitation in 4 minutes (1; 10) after cardiac arrest developed. The median duration of resuscitation made 12 (2; 19) minutes. Maternal and neonatal survival made 100%. All patients were discharged from the unit with no severe neurologic impairment.

Conclusion. Compliance with modern international clinical recommendations significantly improves the prognosis for the pregnant who experienced cardiac arrest. Since the risk of such situations is much higher in the patients of special perinatal centers versus the general population, these centers should develop and adopt local protocols on cardiopulmonary resuscitation.

The object of research in the field of anesthesiology and intensive care is the functional systems of the host; this research includes original tasks, elaboration and making certain decisions especially for critically ill patients where as a rule the outcome of anesthesia and intensive care depends not only on the special professional skills but moral and ethic features of the doctor. The main feature of biomedical systems is that the human body is the system which is complex, open and stochastic, and if the man is ill it is especially complex. And the major part of information about the patient is non-verbal; so the classification is an important component providing an impact on the treatment outcome. If the principles of information classification are properly used, the doctor is fully armed for analyzing, comprehending, adopting, assessing and solving the task. It also facilitates the dissemination of acquired knowledge and experience among other specialists.

The practical part of the state final certification implies an assessment of skills.

The objective of our study was the approbation of the Station of Subarachnoid Space Puncture as a part of the objective structured clinical examination.

Subjects and methods. 26 students of the second year of the clinical residency were included in the study; they all were taking the practical part of the final exam in Anesthesiology and Reanimatology. A phantom-simulator was used for the manipulation, which allowed authentic simulating of a lumbar puncture. Two trainers evaluated the manual skills, independently of each other.

Results. 25 (96%) residents passed the station successfully. The total time required to pass the station made 3.1 (2.58, 3.45) min. In 1 (4%) case, the student failed to gain the required number of points for the successful passage of this station. The most common mistakes during the manipulation were associated with improper control of the patient's state after the drug administration into subarachnoid space, there were 14 (54%) such cases; and in 10 (38%) cases, several attempts were required to obtain cerebrospinal fluid. The monitoring of the check-list filling incompletion demonstrated that different trainers at the station could use it. The difference in the filled check-lists was less than 5%.

Conclusions. The developed check-list allows performing an objective assessment of the practical skills of graduates from the clinical residency. 

The article describes the topicality of simulation-based technologies as a part of the practical training of anesthesiologists and emergency physicians. It validates the theoretical and practical background for inclusion of simulation-based technologies into the training in order to decrease the number of medical errors in one of the most highly technical fields of modern medicine. The authors share the experience of staged simulation-based training of anesthesiologists and emergency physicians in the Simulation Center of Altai State Medical University by the Russian Ministry of Health.

This clinical case demonstrates specific features of anesthetic management during radiosurgery in pediatric patients considering the limited access to them during continuous manipulations with pharmacological sedation. Considering the age of the child, dexmedetomidine, the drug from the group of agonists of α₂-adrenergic receptors, was used as the main agent. It was used since it could be administred by the noninvasive way for premedication and intravenously in a form of infusion to provide the necessary depth of sedation with preservation of spontaneous breathing and minimization of uncontrolled motions of the patient.