The review is devoted to pharmacology of the general anesthesia in the light of current understanding of this event and as a medical technique. The discussion covers the classification of medications used for general anesthesia basing on action mechanisms of these substances including specific and nonspecific actions on the central nervous system functions and evolution of their presentation.

The correlation between the age and wakefulness level evaluated as per the value of constant potential and  frequency of critical incidence occurrence has been investigated in 160 patients who had planned surgery with combined anesthesia due to the colon tumor. The latter depended on the age, it was the lowest in the high level of wakefulness and it was high in the low level of wakefulness regardless of the age.

The trail was conducted with the purpose to compare two heating devices in the groups of patients who had surgery due to varicose veins of the lower extremities with spinal anesthesia with intravenous sedation in the  intra- and post-operative periods. It was found out that warming with the help of blankets with active self-heating technology is more efficient for prevention and treatment of intra-operative hypothermia compared to resistive mattresses. The article includes discussion of mechanisms of intra-operative hypothermia development, its negative effects and measures for its prevention and treatment. Recommendations on the use of this equipment are given.

The concentration of N-terminal fragment of pro-BNP in the blood plasma is significantly higher than the normal rates during the first week from the moment of development of acute respiratory distress syndrome (ARDS). ARDS patients with medium and severe degree manifest higher rates of this biomarker compared to patients with mild ARDS. However the rate of NT-proBNP is only of the limited value for diagnosis of pulmonary edema in such patients.

The  article describes the  emergency care in  massive injury during the  military conflict (230 patients, of them 220 are civilian population, of them 7 are children; 348 cases of urgent anesthesia). Special attention is paid to organizational activities. Specifics of peri-operative provisions, intensive care are defined and given special emphasis.

The article presents the description of successful tracheostomy in the patient suffering from severe pneumonia and disseminated intravascular coagulation. In order to prevent peri-operative hemorrhage complications one can use endoscopic dilatational technique of tracheostomy, ultrasound examination of the neck prior to the surgery, intra-operative lining of the stoma with hemostatic material.

The approaches to intra-operative infusion therapy have been developed for patients with low and medium risk of complications. The evolution of understanding of inter-sectorial fluid transfer is presented. The special emphasis is put on the review of Straling equation, which does not consider endothelial glycocalyx. The chances of iatrogenic damage of this vulnerable structure due to excessive loading are highlighted.

The article presents the results of comparative analysis of the 13 mixtures for sipping (oral) enteral feeding, most commonly used in RF, which are prescribed during the transfer from tube feeding to regular diet, and also when it is impossible to take regular food, in case of hypercatabolism (in traumas, burns, severe sepsis), anorexia nervosa, cachexy. The special emphasis is put onto the inexpediency of enteral tube administration of highly osmolar sipping mixtures if there is risk of osmotic diarrhea.

The review includes clinical opportunities of the new technique for evaluation balance of nociception/anti-nociception with help of medication of ANI-Monitor (MetroDoloris®, France), used abroad, with the calculation of original index of analgesia/nociception of ANI (Analgesia Nociception Index). Objective and non-invasive technique is based on the evaluation of changes in variability of cardiac rhythm under nociception effect. Basing on literature the further investigation is required to identify specificity and sensitivity of ANI index in various clinical situations.

The statistic rates describing the accuracy of diagnostic techniques and their combination have been analyzed including sensitivity, specificity, positive and negative prognostic value, plausibility relation. The best evaluation technique for diagnostic test accuracy at present has been studied, i.e. building up ROC-curve and evaluation of the area under it (Area Under Curve). Advantages and deficiencies of each test have been presented, and their use in the clinical practice has been described.

Translators and editors of the first Russian edition of Miller’s Anesthesia analyze one of the biggest publication projects for anesthesiology and intesive care in RF, implemented by 109 specialists from 11 countries all over the world without involvement of professional translators. In order to support future similar translations special attention is paid to organizational details and errors.