This article analyzes compliance with basic current international and national recommendations for managing sepsis patients and infection prevention in the critical care departments of medical units located on the territory of Russia. The study was conducted by means of interactive polling during special training sessions devoted to sepsis ("Sepsis Schools") during 2013–2014 run in 45 large cities of Russia covering almost all regions of the country. The total number of responding doctors made 2,915 persons. The obtained data have proven that the main problems are inadequate provision with modern equipment and technologies for microbiological diagnostics and the absence of laboratory service available for 24 hours. There is significant lack of knowledge about role of biomarkers for sepsis diagnostics. Dopamine and hetastarch are unnecessary widely used to treat septic shock. More than half of specialists can not start empiric antimicrobal therapy with the optimal agent within the first hour after the diagnosis is clear.

Multicenter, retrospective, cohort study was conducted enrolling 727 patients suffering from septic shock as a complication of extensive peritonitis (abdominal sepsis). Patients were treated in eight intensive care departments of eight medical units. Outcomes were compared depending on the applied tactics (using algorithm of early targeted therapy of septic shock in accordance with international recommendations and local approaches typical for a certain unit). It has been found out that the algorithm of early targeted therapy was used unreasonably rearly (in 27% of patients in the study subpopulation). However its application allowed reducing the mortality by 12% and increasing 28-day survival period.

The purpose of the trial is to assess the informative value of procalcitonin level in blood when diagnosing infectious complications of lower respiratory tract during lung ventilation in newborns with respiratory distress syndrome. The trial was designed as retrospective, observatory, one-center historical monitoring. 134 newborns were included into the trial. Ventilator-associated pneumonia was diagnosed basing on CDC/NNIS criteria. Ventilator-associated tracheobronchitis was identified basing on Code LRI-BRON criteria. Sensitivity, specificity and area under operating characteristics curve were set up for patients with different concentration of procalcitonin in order to assess the threshold diagnostic value of procalcitonin level in blood. Procalcitonin level ≥ 2.1 ng/ml in a newborn with respiratory distress syndrome by the 6th day of life proves that the patient has ventilator-associated pneumonia or tracheobronchitis.

Goal: to study the rates of central hemodynamics and clinical progress and to evaluate the activity of biomarkers of myocarditis overload and damage in patients with isolated reduction of systolic function of right or left ventricle in early period after aortocoronary bypass. 25 patients were enrolled into the study (14 men, 11 women, average age 58 ± 7 years), admitted to the intensive care department after aortocoronary bypass with artificial circulation and in need of inotropic therapy. Rates of central hemodymanics were monitored with the help of PiCCO system and VoLEF additional module. Blood was collected to assess the NT-proBNP level in 1 and 24 hours from the admission to the intensive care department, and tropinin I level - in 24 hours. It has been found out that the acute heart failure in early period after aortoconorary bypass was associated with isolated systolic dysfunction of right ventricle in 40% of cases, with left ventricle in 32% and in 28% it was of bi-ventricular nature. Failure of right ventricle requires a continuous rehabilitation period and bigger activity pf NT-proBNR compared to the left ventricle failure while the troponin I level does not confidently differ for these groups.

Every year more than a million of patients undergo cardiac surgery which is characterized by a significant mortality. The purpose of this article is to familiarize our readers with the results of the 1st International Consensus Conference published in Acta Anaesthesiol. Scand. in 2011, devoted to detection of interventions/manipulations increasing or reducing perioperative mortality basing on randomized evidences. Of the 17 major topics with mortality effect, seven were subsequently excluded after further evaluation. The following was recognized as reducing mortality: administration of insulin, levosimendan, volatile anesthetics, statins, chronic β-blockade, early aspirin therapy, the use of pre-operative intra-aortic balloon counterpulsation, and referral to high-volume centers. The following are documented as increasing mortality: administration of aprotinin and aged red blood cell transfusion. These interventions were classified according to the level of evidence. Conclusions: The further study is required for the investigation and evaluation of the above interventions.

The purpose of the study is to compare two techniques of neuromuscular transmission (acceleromyography and kinemyography) during multicomponent anesthesia during abdominal laparoscopic surgery. The average value of the difference between methods during the block start makes 9.6% (95% CI 7.2–12.1), lower agreement limit makes 24.1%, upper agreement level makes +43.3%. The average value of the difference between methods regarding restoration of neuromuscular transmission makes 3.1% (95% CI 3.1-7.5), lower agreement limit makes 24.1%, and upper limit makes 24.0%. The both above techniques are accurate, confident, simple and can be used for evaluation of neuromuscular transmission.

A prospective, randomized, controlled study included investigation of data of 45 oncology patients who had total endoprosthesis replacement of the knee joint. The control group (n=23) had the continuous block of peripheral nerves for pain relief, and the trial group (n=22) had continuous epidural anesthesia. With the help of mechanic dynamometer the strength of maximum voluntary isometric muscle contraction by flexion and extension of healthy leg in the knee joint was measured in the early postoperative period. Given the continuous epidural analgesia compared with the control group the maximum difference in the muscle strength of lower extremity was observed in the evening on the day of surgery and it made 37% by the knee joint flexion (7.3 ± 6.1 against 11.6 ± 3.2 kgs ∙ m, p = 0.0065, 95% CI 1.2–7.4) and 41% by extension (9.9 ± 8.8 against 16.9 ± 4.9 kgs ∙ m, p = 0.0023, 95% CI 2.6–11.4). On the 1st and 3rd days after the surgery the muscle strength was not statistically different compared to the control group, but it was lower that the preferred level by 14-8%, p < 0.05; in 5–27 patients the reduction of muscle strength was more than 20% of the one in the preoperative period.

A prospective randomized study was conducted in order to evaluate the quality of anesthesia for patients with hip fracture when using various methods of regional analgesia. It has been proved that continuous administration of local anesthetic to the femoral nerve is the most efficient one among the peripheral regional methods of pain syndrome management by hip shaft fracture.

Goal of the trial: to evaluate efficiency interpleural administration of local anesthetics for pain management after surgery on the thoracic spine. Materials and methods. Tuberculosis spondylitis patients after the surgery on the thoracic spine were divided into two groups depending on the way of postoperative anesthesia. Interpleural administration of local anesthetic was used for the 1st group, and drug therapy was used for the 2nd group. Every 4 hours of the postoperative period the pain intensiveness, non-invasive hemodynamic monitoring, the quantity of used analgesics, activeness of patients and side effects such as nausea and vomit were evaluated as per the visual analogous score. Results. Interpleural block after thoracic spine surgery in tuberculosis spondylitis patients statistically significantly reduces the pain intensiveness, quantity of taken analgesics and their side effects, increases the activity of patients comparing to the patients who had analgesics administered parenterally. Conclusion. The trial proves the efficiency and safety of interpleural analgesia for postoperative pain management after surgery on the thoracic spine.

Intercellular potentials changes of identifiable intact neurons ini solated CNS of great ramshorn (Planorbarius corneus) have been investigated with the help of intercellular microelectrodes and ion currents of isolated neurons of great ramshorns and pond snails (Lymnaea stagnalis) with the fixation of potential influenced by desflurane in concentrations of 1 and 10 mM (1.2 и 12 MAC) and sevoflurane in concentrations of 1 and 5 mM (2.27 and 11.36 MAC). In 3-5 minutes after the start of anesthetics' action some neurons developed insignificant hyperpolarization (for 2-5 mV), and some other developed depolarization (up to 10 mV). When anesthetics were being washed out for 5-10 minutes the reversible depolarization appeared. Changes in ion currents under the influence of anesthetics were more homogeneous compared to changes in biopotentials. Desflurane and sevoflurane in 1 mM concentrations suppressed amplitudes of sodium, calcium and potassium currents by 40%, and inactivation of potassium low currents was speed up. Anesthetics in the concentration of 5-10 mM suppressed currents by 70-80%. It developed fast (for 20-30 seconds) and after this action the amplitudes restored slowly (for 5-15 minutes) and it failed to reach the initial values in all the times. Intercellular activity of sevoflurane did not suppress ion currents, i.e. it was ineffective.