Postoperative cognitive dysfunction is a cognitive impairment developing in the postoperative period and confirmed by the data of neuropsychological testing. The article presents the results of a survey among practicing anesthesiologists-resuscitators in the Russian Federation on the problem of postoperative cognitive dysfunction.

Methods. From January 21, 2019 to April 26, 2019, the survey was conducted among practicing anesthesiology and resuscitation physicians from 20 different regions of the Russian Federation, both in the online format and on paper. 340 questionnaires were analyzed, including 11 questions about the problem of cognitive impairment in the postoperative period. Microsoft Excel, Survio, Statistica 8.0 were used for statistical processing of the results.

Results. It was revealed that 74.7% of respondents were aware of the problem of postoperative cognitive impairment. At the same time, doctors ranked second in terms of the frequency of clinical manifestations, symptoms that were more characteristic of postoperative delirium. 18.5% had difficulty in describing the clinical manifestations of postoperative cognitive disorders. Analysis of the answers on the diagnosis of postoperative cognitive dysfunction showed that 45.3% of specialists considered neuropsychological testing mandatory in all patients undergoing surgery, 40% noted the need for mandatory testing of the cognitive functions in patients at risk, but 37.6% of doctors were not able to name a single method, and 34% answered that doctors of other specialties were engaged in neuropsychological testing. The survey results also showed the absence of a single treatment strategy for cognitive dysfunction.

Сonclusions. The analysis of respondents' answers revealed insufficient awareness of specialists about clinical manifestations, diagnosis and treatment of postoperative cognitive dysfunction. 

The purpose of the study was to examine the damaging activity of Lidocaine and Ropivacaine on the sciatic nerve and biceps muscle of rats. A double blind randomized study was conducted. The control group received injectiona of 0.9% NaCl. The following concentrations of Lidocaine were examined – 0.5, 1, 1.5, and 2. For Ropivacaine, these concentrations were 0.25, 0.5, 0.75, and 1. Under the US control, 0.2 ml were injected along the perineural sciatic nerve and 0.2 ml into the two-headed muscle. The drugs were taken out in 1 hour after their injection. When injecting 0.9% NaCl no cell necrosis or apoptosis in the muscle and nerve were found, only single cells of inflammatory type were found. The administration of all concentrations of local anesthetics caused inflammatory filtration and damage to muscle tissue and nerve stems compared to 0.9% NaCl. Increased expression of damage and inflammatory infiltration depended on the concentration of the local anesthetic. The higher the concentration of Lidocaine or Ropivacaine was, the greater were the damage and inflammatory changes. The study demonstrated neurotoxic and miotoxic activity of all concentrations of Lidocaine and Ropivacaine compared to 0.9% NaCl. The dependence of damage strengthening and the growth of inflammatory filtration in the muscle and peripheral nerve on the increased concentration of the local anesthetic was revealed.

The aim was to determine the risk factors for severe respiratory failure in newborns of 37-week gestational age.

Methods. The study was designed as retrospective, controlled, non-randomized, and single-center. 640 patients corresponded the criteria of inclusion and exclusion. 7 (1.1%) children died. Depending on the gestational age (GA), patients were divided into two groups. The main group (n = 279) included newborns with GA of 37 weeks. The comparison group (n = 361) consisted of newborns with GA of 34‒36 weeks. Both groups of children received comparable critical care and had similar settings of initial artificial pulmonary ventilation. The software of BioStat was used for statistical processing.

Results. Patients of the main group had initially higher pressure in the right ventricle, they were in need of noninvasive ventilator more often (χ² = 4.23; p = 0.05), and pulmonary hemorrhage were also more frequent in them (χ² = 9.608; p = 0.02). It was mostly newborns delivered by cesarean section who developed respiratory problems. A uterine scar in a pregnant woman made a significant risk factor for severe respiratory failure in patients of the main group (OR ‒ 1.99).

Conclusion. Severe respiratory failure in newborns with gestational age at 37 weeks develops with intrauterine growth retardation, the main risk factor of which is the presence of a scar on the uterus. 

The article analyzes domestic and foreign publications from 2009 to 2019, found in the MEDLINE, PubMed, Embase, Web of Science database on the topic: multiple pregnancy, complications, outcomes, and anesthesia for cesarean section. The data on the prevalence, complications and outcomes of multiple pregnancies are presented. Optimal timing and methods of delivery for multiple pregnancy, their influence on perinatal outcomes have been determined. The review examines different methods of anesthesia and their influence on the mother, the intrauterine condition of the fetus and newborn undergoing a cesarean section. Currently, the main methods of anesthesia for cesarean section are regional ones. Among the methods of neuroaxial anesthesia, spinal anesthesia is preferred. Given the limited data on the impact of regional anesthesia methods on the mother and fetus/fetus during multiple pregnancies, additional research is needed.

The review was carried out using the medical databases PubMed, Scopus, The Cochrane Library, CyberLeninka.

The objective: evaluate the range of methods used for anesthesia in dentistry in children.

Results. Inhalation anesthesia is most commonly used with halogenated volatile anesthetics, in combination with local or intravenous anesthesia. Xenon is a perspective inhalation anesthetic for general anesthesia in dentistry. However, information its use in children is limited.

The review analyzes the results of modern clinical and experimental studies on the search and informative value of biomarkers for acute respiratory distress syndrome (ARDS). It describes ARDS biomarkers of the main morphological changes in the lungs and severity of the systemic inflammatory response syndrome. Biomarkers of injury of bronchial epithelium, alveolar epithelium, vascular endothelium and pulmonary extracellular matrix were analyzed to determine the most informative indicators of ARDS of different etiology. It was found that for diagnosis and prognosis of the course of ARDS, the following biomarkers were the most informative: interleukin-6, a soluble form of the receptor for advanced glycation end products (sRAGE), surfactant protein D, protein KL-6, vascular endothelial growth factor, and angiopoietin-2. Using a multimarker panel for simultaneous determination of these indicators can promote rapid diagnostics of ARDS.

The article presents the literature review devoted to the method of continuous administration of local anesthetic solutions in wound after various types of surgeries and its efficacy and safety compared to other methods of post-operative analgesia. It has been concluded that continuous infusion of local anesthetics into the post-operative wound is a safe and effective method allowing reducing consumption of opioid and non-narcotic systemic analgesics, minimizing the risk of post-operative nausea, vomit, skit itch, urine retention and other adverse events, thus providing favorable conditions for early activation of patients. Technical aspects are of critical value since the efficacy of this method depends on the place of catheterization, anesthetics concentration and rate of infusion. It is promising to investigate the efficacy of administration of various concentrations of solution and use of adjuvants. 

Hypoalbuminemia and hypovolemia are independent risk factors for the development of multiple organ dysfunction, the main cause of death in critically ill patients. The use of a human albumin (HA) solution in complex of the fluid therapy affects both of these risk factors. However, more than 75 years of experience of HA use by the medical community and numerous clinical studies have proved its safety but did not lead to a consensus on the clinical effectiveness of its use. Thus, questions remain, and in which patients the use of HA is most appropriate. The authors of this review attempted to summarize the knowledge accumulated by the medical community on the use of HA in the practice of intensive care.

Atypical hemolytic uremic syndrome (aHUS) is an orphan disease, representing one of thrombotic microangiopathies, the natural course of which leads to an unfavorable outcome often accompanied by multiple organ failure in the onset of the disease. Anesthesiologists and emergency physicians play an important role in the multi-disciplinary team of specialists managing such patients. However, this disease is rare and its symptoms are similar to the ones of some other disorders including sepsis and disseminated intravascular coagulation syndrome, thus often aHUS is diagnosed late and specific treatment is not started in time. This article aims to present main notions related to thrombotic microangiopathies and discuss topical issues of differential diagnostics of aHUS in the intensive care units giving two clinical cases as an example. 

The article presents a clinical case of a 14-year-old patient with viral meningoencephalitis complicated with cerebral edema and a brain coma caused by herpes simplex viruses. Comprehensive etiopathogenetic therapy was not sufficiently effective due to the late referral for medical help and the late start of treatment. It has been shown that the use of the L-lysine escinate preparation up to 10 intravenous injections in a single dose of 0.15 mg/kg twice a day, even in the later stages of encephalitis, which has an extremely severe course due to cerebral edema development, is highly effective due to its multifactorial actions.

Acute ischemic stroke is a common cause of disability and mortality. In some rare cases, it can result from the structural changes in the major extracranial arteries, including vascular dissection. Due to the low incidence, the management of the acute period of dissection-associated stroke is not completely understood.

In the clinical case presented, we describe the medical history of a forty years old patient in the acute period of cerebral infarction related to the dissection of the internal carotid artery, including the techniques and possible results of endovascular therapy. In this clinical scenario of acute stroke period, emergency angioplasty and stenting of carotid artery have been shown to be a highly effective approach.