[OPTIMIZATION OF PRECLINICAL TRAINING OF ANAESTHESIOLOGISTS BASED ON THE FORMATION OF PATHOGENIC SIMULATION LEARNING ENVIRONMENTS].

Simulation training has become an important component of the postgraduate training of anaesthesiologists for several reasons: organizational difficulties in obtaining primary professional skills in a clinical setting, the opportunity to study in a hospital existing pathology only and not planned in accordance with the curriculum. This increases the risk of medical malpractice of young specialist and study may be accompanied by complications and increasing the cost of treatment. In our work, we have studied the factors of continuity of preclinical and clinical stages of anaesthesiologists training in inhalation anaesthesia based on the use of modern simulation technologies. We compared the training programs and the results of traditional and simulation techniques, defined the concept of quasi physiology and propedeutics of robots and simulators, the role of clinical scenarios and reliability of robots of 6th level of realism in the formation of pathogenic environment for simulation training. In formulating the concept of pathogenetic simulation environment, we evaluated its impact on the motivation of the trainees of studied category. The study included 23 interns, divided approximately in half into 2 groups, the 1st of which at the preclinical stage of training was trained at the real operating theater gradually studying the technique of inhalation anaesthesia with an experienced curator The 2nd group studied the same anaesthesia in clinical scenarios of a simulator robot in a simulation operating theater Other components of the curriculum in the groups did not differ. According to the results of pre-clinical training interns started prforming an anaesthesia their self under the control of supervisor (i.e. to the clinical stage). In the 1st group, a supervisor made the verdict of readiness for clinical stage, and in the 2nd trainees were tested by the performing a robotic anaesthesia maintaining targeted qualitative and quantitative parameters. The evaluation was conducted according to the quality and stability criteria of five consecutive "independent" anaesthesia, where the highest scores were 100 points, confered by a supervisor. We found that for interns' admission to the clinical stage in the 1st group, it took significantly more educational anaesthesia than in 2nd group. It was also indirectly proved expectedly greater regularity and predictability of anesthesia simulation workshops. Based on the example of the clinical scenario of inhalation anesthesia we showed a possibility of formation of pathogenic simulation environment without excessive dramatization of studing environment, while maintaining the motivation of trainees. Thus, simulation training is more efficient than traditional schemes, in terms of providing the rational use of robotic systems of 6th level of realism.

[Optimization of infusion therapy in large abdominal operations].

Volume and consist of infusion therapy determine in many respects postoperative period in patients who underwent large abdominal operations. Purposeful infusion therapy controlled according to monitoring of stroke volume variability is perspective. It was proved that evaluation of this parameter allows to optimize consist and volume of transfused solutions intraoperatively. Use of purposeful infusion therapy was accompanied by decreasing of number of postoperative complications and duration of intensive care unit stay after large abdominal operations.

[Accelerated postoperative rehabilitation: multidisciplinary issue. Part 2]. / Uskorennoe vosstanovlenie posle khirurgicheskikh operatsii: mul'tidistsiplinarnaya problema. Chast' 2.

AIM: To discuss the main aspects of multimodal method of accelerated postoperative rehabilitation (fast track surgery). MATERIAL AND METHODS: The program of accelerated rehabilitation consists of minimization of surgical treatment's stressful influence on patient's organism in all stages of perioperative period. The method implies use of efficient preoperative management, minimally invasive operations, regional anesthesia and short-acting anesthetics, early postoperative rehabilitation. RESULTS: The program improves the results of surgical treatment, reduces number of complications and cost of treatment, improves the "quality" of hospital stay and satisfaction of meeting with doctors.

[Importance of surgery of quick recovery program for surgical treatment of bladder tumors].

The article presents an analytical review of literature outlining the prospects for the use of the program "Surgery of quick recovery" in the surgical treatment of the bladder malignant tumors. The multi-modal program "Surgery of quick recovery" was found to reduce the number of postoperative complications and shorten recovery of patients with bladder cancer.

[Accelerated postoperative rehabilitation: multidisciplinary issue (Part 1)].

AIM: To discuss the main aspects of multimodal method of accelerated postoperative rehabilitation (fast track surgery). MATERIAL AND METHODS: The program of accelerated rehabilitation consists of minimization of surgical treatment's stressful influence on patient's organism in perioperative period. The method implies use of efficient preoperative management, minimally invasive operations, regional anesthesia and short-acting anesthetics, early postoperative rehabilitation. RESULTS: The program improves the results of surgical treatment, reduces number of complications and cost of treatment, improves the "quality" of hospital stay.