Objective: to study the specific features of sevoflurane and desflurane-based anesthetic maintenance and awakening periods in outpatient surgery. Subjects and methods. The course of intraoperative and immediate postoperative periods was analyzed in 125 patients. By using the envelope method, the patients were randomized to one of two study groups according to the mode of anesthesia: 1) desflurane-based anesthesia (n = 62); 2) sevoflurane-based anesthesia (n = 63). Results. During surgery, all group 1 patients needed mechanical ventilation to maintain adequate gas exchange. This is probably associated with the use of the fairly high dose of fentanyl, which is required to ensure adequate analgesia. With equal fresh gas streams, the consumption of desflurane doubled that of sevoflurane. The postanesthetic awakening period turned out to be equal in both groups. The length of awakening unit stay after anesthesia with desflurane proved to be shorter than after that with sevoflurane. Conclusion. Desflurane-based anesthesia is attractive when it is important to reduce the length of postoperative unit stay as far as possible. If 10–12 more minutes are uncritical to do this, sevoflurance-based anesthesia is preferable.

Objective: to evaluate the impact of preoperative use of angiotensin-converting enzyme inhibitors on hemodynamics in elderly patients. The use of enalapril on the day of surgery in patients lowly tolerant to transient hypoxia and hypercapnia was accompanied by hemodynamic instability during anesthesia and by the higher frequency of vasopressor usage. The hemodynamics of patients moderately tolerant to transient hypoxia and hypercapnia did not depend on the intake of enalapril.

A randomized trial was conducted in 22 patients with a body mass index of 44.9 ± 1.6 kg/m2 and morbid obesity who underwent endoscopic sleeve gastroplasty. According to the mode of anesthesia, the patients were divided into two groups: 1) concomitant anesthesia based on low-flow sevoflurane inhalation in combination with continuous epidural 0.2% ropivacaine analgesia (n = 12); 2) concomitant anesthesia based on low-flow desflurane inhalation in combination with continuous epidural 0.2% ropivacaine analgesia (n = 10). The indicators of central and peripheral hemodynamics and external respiratory function were examined; neuromuscular conduction was monitored; and the efficiency of postoperative rehabilitation was evaluated. Surgery under low-flow inhalational anesthesia with desflurane was established to contribute to prompter postanesthetic rehabilitation.

The paper presents the results of using sugammadex and an antireflux endotracheal tube during surgical treatment for stenotic lesions of the extracranial internal carotid artery. It shows the results of examining a group of patients with carotid atherosclerotic lesion at high surgical/anesthetic risk in whom the anesthetic regimen used neuromuscular blockade reversal and an antireflux endotracheal tube. The paper emphasizes the importance of the proposed procedure that may positively affect the entire early postoperative period, restores muscle tone rapidly and adequately, statistically significantly shows a 1.4-fold reduction in the time of awakening, tracheal extubation and activation, and leads to hemodynamic stabilization.

Under spinal anesthesia, different types of nerve fibers forming spinal nerve roots are unequally blocked. Objective: to estimate differences in the development of temperature, sensory, and motor blockades when performing different procedures of spinal anesthesia. This prospective study covered 70 patients undergoing different operations. In accordance with the procedure of spinal anesthesia, the patients were divided into classical (n = 35) and unilateral spinal anesthesia (n = 35) groups. The performed study has indicated that blockade of temperature fibers occurs, and first, next is that of sensory neurons, and at last motor ones. The latent period of temperature blockade is about 1 min and that is an early predictor of evolving sensory block. At all stages and under traditional and unilateral spinal anesthesias, the width of temperature blockade was 1–2 segments higher than that of sensory blockade. The lower bupivacaine dosage used with the unilateral procedure gave rise to even greater block differentiation. Sensory anesthesia developed more slowly, but motor blockage did fully in not all cases.

Objective: to compare the degree of sympathetic blockade caused by thoracic epidural or bilateral paravertebral anesthesia. Superior mesenteric artery blood flow was measured calculating the coefficient of flow resistance (resistance index) as an indicator of the degree of sympathetic block in patients undergoing high-traumaticity operations on the upper abdominal organs under thoracic epidural or bilateral paravertebral anesthesia. The patients of both groups were noted to develop sympathetic blockade with a statistically significant reduction in vascular resistance (resistance index) of the superior mesenteric artery and with an increase in blood flow in the visceral bed. The degree of sympathetic blockade was statistically significantly higher in patients under epidural anesthesia. Conclusion. Bilateral thoracic paravertebral blockade decreases sympathetic nervous system activation and may be used during high-traumaticity surgery if there are existing or predictable contraindications to epidural anesthesia.

A retrospective cohort study was conducted, which included 1,274 patients after coloproctological operations. Bacteremia was diagnosed in 28% of the patients; in 17% of them, it manifested itself as the clinical presentation of sepsis (74%) or severe sepsis (26%). Bacteremia was proven to significantly increase the risk of death and to reduce 28-day survival rate.

Mortality due to pyoseptic complications after severe mechanical injury is rather high. Some hopes for its reduction are associated with the timely detection of infectious complications. In this case an important role is, in terms of early diagnosis, attached to the calcitonin prohormone procalcitonin that is positioned itself as a marker for the progression of a bacterial infectious process. At the same time, there is evidence for elevated PCT levels after extensive surgical interventions and in massive injuries directly unassociated with the development of an infectious process. Objective: to estimate the significance of its changes early after injury. A prospective investigation was conducted, which enrolled 76 victims of severe concomitant mechanical injury (patients with severe brain injury and victims whose death had occurred within the following few days were excluded from the study). The time course of changes in the blood levels of PCT, C-reactive protein, activated monocytes expressing receptors for lipopolysaccharide and other bacterial antigens (CD14+ and HLA-R+), cytokines (IL-6, IL-10), glucose, and lactate was studied on admission, at 12 and 24 hours, 3, 7, and 10 days. The diagnosis of bacteremia involved blood microbiology tests for sterility and polymerase chain reaction to detect antigens of blood opportunistic microorganisms. The findings were analyzed in view of injury severity scores (ISS), the development of infectious complications, and an outcome. PCT concentrations were shown to rise significantly within the first 24 hours after injury in the absence of clinical manifestations of infectious complications. The increase in PCT levels was preceded by the highest rise of HLA-DR+ within the first 24 hours and CD14+ just 12 hours after injury, which could not preclude the bacterial translocation inducing, along with other factors, the development of a systemic inflammatory response. At the same time, the findings could suggest that the role of this indicator must not boil down exclusively to the function of that of infectious complications.

This was a prospective observational study covering 463 surgical intensive care patients. Independent poor predictors, such as abdominal perfusion pressure, APACHE II scores, positive fluid balance, and no defecations during treatment in intensive care patients, were found.

The paper analyses the literature, the results of which suggest that there are currently no unified scientifically grounded guidelines for the diagnosis of malnutrition in children with blood cancer. Analysis of global experience demonstrates the need for comprehensive nutritional screening and elaboration of an individualized nutrition support program to enhance the efficiency of treatment.