The technique has been developed to evaluate the safest conditions of epidural anesthesia depending on the level of paracentesis, access and needle size. The technique is offered for calculation of the safe area allowing evaluating the chances of adverse events depending on the applied access.

The purpose of this study is to assess changes in the rates of acid-base balance in adult cardiac surgery patients with acquired cardiac defects who were operated using hypo- and normothermic cardiopulmonary bypass. Materials and Methods: 140 patients who had surgical treatment of acquired cardiac defects with the use of cardiopulmonary bypass were randomly divided into two similar groups with the use of hypothermic and normothermic cardiopulmonary(31-32˚С and > 36˚С). The rates of acid-base balance were evaluated during peri-operation and post-surgery stages as well as morbidity and mortality during the hospital stage. Results. The patients who had surgery with the use of hypothermic cardiopulmonary bypass, had the level of РаO2 statistically lower one day after surgery compared to the patients who had surgery with normothermic cardiopulmonary bypass. When analyzing the post surgery period with the use of hypothermic cardiopulmonary bypass the duration of artificial pulmonary ventilation was significantly lower compared to the group who had normothermic cardiopulmonary bypass. However it made no impact on duration of stay in the wards for post-surgery follow-up, general duration of hospital stay, frequency of complications and hospital mortality. Conclusion. The results of study demonstrated no statistically significant differences in the rate of acid-base balance in patients who had surgery with normothermic and hypothermic cardiopulmonary bypass. Moreover the changes in acid-base balance in both groups during surgery and post-surgery periods did not go beyond the normal values which indicates the adequate protection of the host from surgery aggression factors.

The quality rates of neuromuscular block with various ways of dosing were compared for the patients with body weight index exceeding 40kg*m-2 who had laparoscopic surgery for gallstone disease. It has been found that dosing per actual body weight did not cause the danger of excessive duration and depths of neuromuscular block, the lowest doses were noted by dosing for ideal weight. The muscle relaxant dose did not define the development rate and the duration time of the block. The most close direct correlation has been found between the dose and area of body surface therefore the dosing of a muscle relaxant basing on calculation as per 23-33 mg/m2 is more preferable compared to traditional dosing per body weight in case of normal or high body weight index. 

The randomized prospective study presents the comparative evaluation of efficiency of unilateral and traditional epidural analgesia after total knee joint replacement. The administration of traditional and unilateral epidural analgesia through continuous infusion of ropivacainum was characterized by the adequate post-surgery pain relief. The targeted lateral catheterization towards the surgery side provided preferable development of the sensor and motor block on the surgery side with bigger analgesic effect at rest and lower consumption of local anesthetic compared to traditional administration of epidural catheter.

The abstract describes the prospective randomized study which included 60 patients with severe traumatic brain injuries divided into two groups. In the group under the study (n = 30) the distant ischemic preconditioning has been applied which is commonly used for planned surgeries and it allowed achieving statically significant decrease in the time of coming out from coma, the duration of stay in the intensive care ward and increase the rate of 28 day survival.

Goal: optimization of methods for prevention of acute post-surgery pancreatitis in endoscopic trans-papilliferous operations. Materials and methods. Parallel non-blind randomized trial has been performed. The 1st group included patients (n = 98) who had chest epidural analgesia while performing ERCP, and the 2nd group of patients (n = 97) had narcotic analgesics (intramuscular) and indomethacin (per rectum). Results. It has been found that in the 1st group the acute pancreatitis was statistically significant less diagnosed compared to the patients from the 2nd group (ES 0.22 [CI 95%, 0.06-0.83]). The acute pancreatitis was verified in 3.1% (3/98) of patients in the 1st group, and in 12.4% (12/97) of patients in the second group. When chest epidural analgesia was used for the patients with the high risk of post ERCP pancreatitis, its frequency decreased from 23.3% (10/43) to 4.3% (2/46) of cases. (ES 015 [CI 95%, 0.03-0.75]). Conclusion. The use of chest epidural analgesia is the effective and proved preventive tool for the patients with the high risk of development of post ERCP pancreatitis. Indomethacin (per rectum) can be used for the patients with the low risk of this complication: the chest epidural analgesia is not recommended due to the invasiveness of this technique.

Respiratory distress syndrome of the newborns is one of the most common critical states of the neonatal period, the cause of this complication is the primary deficiency of surfactant with the consequent progress of hypoxia, syndrome of fetal systemic inflammatory response and hypermetabolism. Goal of the trial: the evaluation of blood amino-acid metabolism in the newborns with respiratory distress syndrome depending on the duration of artificial pulmonary ventilation. Materials and methods: prospective controlled non-randomized one-centered trials with 48 newborns included. The main group (n = 22) included newborns to whom surfactant was administered one, and the control group (n = 26) included children who required the repeated administration of surfactant and continuous (72 hours and more) artificial pulmonary ventilation. Results of the trial. It has been found out that the children from the control group had higher concentration of citrulline in blood plasma (21.0 ± 0.7 versus 14.4 ± 1.2, p < 0.05) and lower concentration of the total protein in blood plasma (49.10 ± 0.87 versus 64.8 ± 1.8; p < 0.05). The negative correlation dependency was found between hypoproteinemia and content of alanine (r = -0.99; p < 0.05), arginine (r = -0.97; p < 0.005), citrulline (r = -0.93; p < 0.05) and tyrosine (r = -0.66; p < 0.05). Conclusion. Severe course of respiratory distress syndrome in the newborns is accompanied by obvious disorders in amino acid metabolism, which requires timely management.

In order to investigate the structure of medical errors in the intensive care the clinical cases of 660 patients in the age from 15 to 99 years old have been studied as well as expert conclusions describing treatment in the intensive care departments. Inadequate examination has been found in 42% of cases, inadequate diagnostics of the main disease and its complications in 34% of cases and inadequate intensive therapy in 46% of cases. Inadequate intensive care decreases the survival of patients of the intensive care departments from 83 to 74.5%.

There is  a  need to  conduct big randomized clinical trials of  efficiency of  medical interventions in the peri-operative period in order to identify the end points with the use of universal classification of potential complications and unfavorable outcomes. In order to achieve that under umbrella of European Society of Anaesthesiology (ESA) and European Society of Intensive Care Medicine (ESICM) Standards of defining and using of criteria of the severity degree for investigation of clinical efficiency in the peri-operation period have been developed. These standards allow more accurate comparative analysis of data, provide researchers and clinical specialists with standard definitions and promote integration of the Russian institutes into international research activities.