There are certain debates regarding epidural anesthesia (EA) and analgesia in cardiac surgery.

The objective: to evaluate functions of left ventricle (LV) and right ventricle (RV) function with echocardiography after off-pump coronary artery bypass grafting (OPCAB) using combined inhalation and epidural anesthesia.

Subjects and methods: 68 patients were randomized into 2 groups, differed by anesthesia techniques. In Group 1 (GA, n = 34), we used general anesthesia with sevoflurane and fentanyl, while in Group 2 (CA, n = 34) – its combination with epidural anesthesia by 0.5% ropivacaine followed by infusion of 0.2% ropivacaine after OPCAB. Parameters of cardiac performance and ventricular function were assessed by echocardiography.

Results. There were no differences in systolic function of LV, RV, diastolic function of LV between the groups. The difference in the left atrial strain was revealed before hospital discharge and made 18.0 (14.5‒21.5) % in CA Group and 24.0 (18.0–26.0)% in GA Group (p = 0.028).

Conclusions. The use of epidural anesthesia and analgesia is not associated with clinically significant changes in inotropic and lusitropic functions of LV as well as RV systolic function after OPCAB.

The objective: to assess the impact of total intravenous and combined anesthesia (consisting of regional block and inhalation anesthesia with sevoflurane) on higher mental functions, frequency and nature of postoperative complications in carotid endarterectomy.

Subjects and methods. A total of 190 patients with ipsilateral carotid stenosis exceeding 70%, or with the unstable atheromatous plaque were examined. CE was performed in 140 (73.6%) patients, while 50 (26.4%) patients underwent plasty with the autovenous patch. 60 patients had total intravenous anesthesia. The other 60 patients had combination anesthesia (cervical plexus block as per A. Yu. Paschuk + non-inhalation anesthesia with thiopental sodium). In 70 patients, low-flow inhalation anesthesia with sevoran and potentiation of the analgesic effect by bolus administration of fentanyl was performed. The parameters of central hemodynamics, cerebral blood flow, markers of cerebral damage, and state of higher mental functions were assessed.

Results. Inhalation anesthesia with sevoflurane was characterized by decrease of total peripheral resistance index by 20% (p = 0.002) and SBP by 13% (p = 0.004) compared to baseline values. Moderate reduction of afterload was accompanied by normalization of cardiac and stroke indices. Optimization of the central hemodynamic parameters led to high levels of the linear velocity of cerebral blood flow and cerebral perfusion pressure which at the main stages of the operation did not differ from the control values. At the end of the operation, a statistically significant insignificant increase in intracranial pressure was noted (on average, by 4 mm Hg exceeded values at the previous stages, p = 0.014) and levels of markers of ischemic neuronal damage: the levels of antibodies to protein S-100 increased by 14% (p = 0.043), and NSE – by 2.8 μg/L. During inhalation anesthesia with sevoflurane, the lowest number of postoperative neurological and cardiac complications was recorded; they developed only in 6 (8.6%) patients and distributed equally. However, more pronounced postoperative cognitive dysfunction was noted when this method of anesthesia was used.

Conclusion. Each method of anesthesia provided an unequal level of cerebral protection from ischemic damage which was manifested by a difference in the severity of disorders of higher mental functions, the number and nature of postoperative neurological complications.

Detailed psychological testing is needed to identify cognitive impairments after anesthesia and surgery. This problem can be solved by development of the program of combination psychological tests with their assessment based on the Z-score, also known as the standard deviation test.

The objective: to determine reference values of psychological tests to assess the results of Z-score.

Subjects and methods. The study was included 30 healthy volunteers and 43 patients who underwent surgery. The panel of psychological tests consisted of the clock drawing test, oral counting test, assessment of short-term memory, sequence set, Digit Symbol Substitution Test, and the classic Stroop test. The mean values and standard deviations were calculated for each of the groups to evaluate the test results by Z-score.

Results. It was found that using standard deviations obtained in the group of healthy volunteers as reference values for Z-score resulted in a higher percentage of deterioration in the result of repeated tests compared to using reference values obtained in group of patients.

Conclusion: When using Z-score for cognitive tests, it is better to use the means and SD obtained in a group of healthy volunteers taking into account the possibility of finding differences where there are none (type I error).

Methadone poisoning is one of the most common causes of unfavorable outcomes in children.

The objective is to identify specific parameters of the course and intensive care for methadone poisoning in children.

Subjects and methods. 30 children were examined. The average age made 16 (15‒17) years. The duration of treatment in ICU was 3 (1.5‒4.0) days.

Results. The most frequent clinical manifestations of methadone poisoning included coma (40%), acute respiratory failure (70%), low body temperature (57%), and myosis (100%). By the admission, the oxygenation index was 4.5 r.u. 37% of patients had pronounced lactate acidosis. On day 1, the volemic support made 143 (124‒165)% of the estimated fluid demand. 21 (70%) children needed artificial pulmonary ventilation. The negative correlation was established between treatment duration in ICU, Glasgow coma scale (R = -0.41; p < 0.05), Glasgow-Pittsburgh coma scale (R = -0.52; p < 0.05) and urea concentration in blood within the first 24 hours (R = 0.44; p < 0.05).

Conclusion. The main criteria determining the severity of the state of patients with acute methadone poisoning include the level of depression of consciousness, the presence of acute respiratory and renal failure.

Coagulopathy associated with traumatic brain injury (TBI) is recognized as one of the risk factors for poor outcome in patients with TBI, however, the safety of using fresh frozen plasma (FFP) is not fully understood.

The objective of the study: to identify the indications for FFP transfusion in the acute period of TBI.

Subjects and methods: a retrospective-prospective observational study included 160 patients aged 18-59 years with isolated TBI in the first 48 hours after injury. Patients were assessed by Glasgow Coma Scale (GCS); patients were divided into two study groups: Group 1 – GCS ≤ 8 points, Group 2 – GCS ≥ 9 points. All patients underwent hemostatic assessment with standard clotting tests (activated partial thromboplastin time, prothrombin ratio, fibrinogen blood level). In 42 patients, additional thromboelastometry was performed. Specific parameters of FFP transfusion and trauma outcomes were assessed.

Results: according to clotting tests, hypocoagulation was detected in 50.6% of patients; according to thromboelastometry – in 22.7%. FFP was used more often in severe TBI (83%) with a decrease in prothrombin ratio (PR). However, FFP transfusion is associated with an unfavorable outcome: in the case of transfusion, a greater number of deaths and vegetative states were recorded in patients with severe TBI.

Conclusion: in patients in the acute period of isolated TBI, it is preferable to minimize the use of FFP; an isolated decrease in PR should not be a trigger for FFP transfusion.

The prophylaxis of ventilator-associated lung injury (VALI) and postoperative pulmonary complications (PPC) is of utmost importance to reduce complications both in the perioperative period of major surgery and in the intensive care unit (ICU).

Protective approach to mechanical ventilation comprises a wide range of measures reducing the damage of the lung tissue associated with the stress and strain phenomena. The implementation of the strategy of high positive end-expiratory pressure (PEEP) in combination with alveolar recruitment maneuver has numerous limitations and requires further personalized approaches.

When lung injury is self-induced by a patient, it becomes an important contributor to VALI and should be timely diagnosed and prevented both before initiation of mechanical support and during the restoration of spontaneous breathing. This review highlights the key mechanisms of VALI and current understanding of protective ventilation. The concept of damaging energy as well as approaches to the personalized optimization of respiratory settings are discussed in detail. Particular attention is paid to the prognostication of the risk factors of VALI and PPC.

According to the recommendations of the Surviving Sepsis Campaign (SSC), antibiotics should be administered within 1 hour after the onset of sepsis, and the centers for Medicare & Medicaid Services prescribe their administration within 3 hours.

The objective of this publication is to analyze the literature data on the start time of ABT when a patient with sepsis is admitted to the ICU.

Results. Currently, basing on literature analysis, it is impossible to conclude about advantages of administering an antibiotic within an hour after the patient with sepsis is admitted to a medical unit. In the vast majority of cases, an antibiotic should be administered up to three hours of the early IT complex (bundle). The change in the time algorithm for drug administration is due to the heterogeneity of the clinical situation, the lack of the unified "scenario" of interaction between the infection and host, and the need for more detail diagnostics.

Conclusion. It is preferable to approach each case individually when deciding about the time to start ABT, considering the history, clinical and laboratory characteristics by the admission to the ICU. However, ABT should be started within 3 hours in any case.

The article analyzes literature data on modern methods of non-invasive respiratory support for premature newborns with respiratory distress syndrome. The article describes positive and negative aspects of the contemporary methods and devices of non-invasive lung ventilation widely used as a starting method of respiratory therapy in obstetrics units of any level, including children with extremely and very low birth weight. The choice of the device and management tactics often depends on the facilities and financial situation of medical units as well as on the experience of medical professionals using specialized equipment.

The objective: to present information about potential mechanisms of development of sepsis-associated encephalopathy, and its potential role in sepsis outcome.

Neurohumoral regulation is the most important system that integrates many functions of variable values to achieve the final result that is beneficial for the host. The central nervous system (CNS) is the switch and control mechanism responsible for the functioning of this system. The increasing number of studies indicating the relationship between the development of sepsis and occurrence of qualitative and quantitative changes in the central nervous system suggests that it is the degree of damage to neurohumoral regulation mechanisms at the very beginning of the disease can significantly determine the severity of the course and prognosis of the outcome of multiple organ failure syndrome in sepsis.

The objective: to assess the potential use of the personalized telemedical system (PTS) of Obereg to ensure monitoring and constant medical control over the state of vital systems of the patient's body in the hospital, during transportation, and in out-of-hospital conditions.

Subjects and methods. The Obereg system was tested in leading Russian clinics through simultaneous measurement of vital activity parameters with other standard patient monitoring systems. Comparative evaluation criteria were the following: functionality, measurement accuracy in comparison with stationary systems, reliability of operation, the impact on the operation of PTS of other equipment in the intensive care unit and possible interference, user friendliness for personnel and patients, and verification of communication capabilities based on field experiments. Additional parameters of the system were also evaluated. The need for it by medical units of the Ministry of Health of Russia was estimated.

Results. The operability of the system has been confirmed in clinical conditions for patients of various profiles, including the most severe cases; it was found that the functionality of the system and accuracy of measurement met relevant requirements. It was estimated that the total demand for such systems in Russia might amount to 4,250,000 units.

Conclusion. The device can be used for individual and group monitoring in intensive care units, in in-patient settings after transfer from intensive care, during rehabilitation for remote monitoring at home, and during patients' transportation to monitor their condition in case of emergency.

The article describes a clinical case - the resection of the hormone- active tumor of the carotid glomus. The hormonal activity of the tumor was suspected based on data of the patient's history, (malignant arterial hypertension with sharp rises in arterial tension, episodes of the increased arterial tension during mechanical impact on the tumor) and hemodynamic parameters during surgery (heart rhythm disturbances after induction of anesthesia and pronounced hypertensive reactions when manipulating the tumor tissue). The article reviews publications on anesthetic support during the resection of hormone-active chemodectomas.

Detection of typical clinical signs such as hypertension, tachycardia, fever, headaches, etc. in the history of patients with chemodectoma may suggest hormonal activity of the tumor. Biochemical tests that determine the level of catecholamines and their breakdown products can confirm the diagnosis. When planning surgery, the anesthesiologist should be prepared for the development of the relevant complications. Hypertension, as the most frequent complication, should be prevented by preoperative adrenergic blockers and treated intraoperatively with short-acting antihypertensive drugs. After exclusion of the tumor from the bloodstream, it is necessary to prepare for the development of hypotension.