[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.

[Role and place of albumin dialysis in the treatment of patients with hepatic insufficiency].

The term "hepatic insufficiency" (HI) unites various hepatic dysfunctions that may be further completely compensated and that may progress until coma develops. Comprehensive examination and treatment were performed in 96 patients (64 males and 32 females) with HI. Irrespective of an etiological factor and a HI form, all the patients were divided into three groups. All the three groups received drug therapy; plasmapheresis was additionally carried out in Group 2 while in Group 3 hepatic function was maintained by therapy involving the combination removal of both albumin-bound (hydrophobic) and water-soluble toxins via the mechanism of transportation of these substances across the membrane without eliminating the substances that are important and useful for the body (MARS). The findings have indicated that combination treatment using MARS makes it possible to restore hepatic synthetic function, to alleviate the signs of cytolysis and cholestasis, and to reduce the degree of encephalopathy. In addition, MARS provides hemodynamic stabilization that allows the inotropic support to be lowered.

[The oxidant-antioxidant system and cognitive functions in patients undergoing elective abdominal operations under various general anesthesia modes].

The impact of various general anesthesia modes on the oxidant-antioxidant system (OAS) and cognitive function in the perioperative period was studied in 88 patients (4 groups, each comprising 22 patients according to the mode of general anesthesia who had undergone elective surgery for chronic calculous cholecystitis (out of an exacerbation) and inguinal, umbilical, and postoperative hernias. Oxidative protein and lipid damages with the lower activity of antioxidant defense enzymes were found in the surgical patients exposed to various modes of general anesthesia. The findings suggest that the pattern of changes in OAS parameters depends on the method of anesthetic maintenance. Oxidative protein modification is much more frequently recorded that lipid peroxidation. Propofol-based balanced anesthesia has a minimal impact on OAS parameters as compared to neuroleptic analgesia, ataralgesia, and sevoflurane anesthesia. After elective abdominal surgery, decreased free radical oxidation under propofol-anesthesia is concurrent with lower postoperative cognitive dysfunction.

[State of the kinin-regulating function of the lungs in the perioperative period in patients undergoing thoracic surgery]. / Sostoiania kininreguliruiushchei funktsii legkikh v perioperatsionnom periode u bol'nykh, operirovannykh na organakh grudnoi polosti.

Kallikrein-kinin system (prekallikrein and kallikrein) has been studied in arterial and mixed venous blood of 22 patients operated on the lungs and mediastinum for suppurative processes and tumors and in 15 patients operated on for ischemic heart disease (aortocoronary bypass surgery). The study was conducted before surgery, immediately after the operation was over, and 8 to 10 hours after surgery. It has been observed that the lungs do not play an essential part in the regulation of background plasma kallikrein activity. Metabolic function as regards kallikrein manifests only with the activation of kallikrein synthesis in systemic circulation. Pathologically changed pulmonary tissue is itself a source of elevated kinin formation, whose products, in their turn, are destroyed in the organs and tissues of systemic circulation, while surgical interventions on the lungs are also accompanied by short-term enhancement of kinin release into the arterial blood.

[Lipid peroxidation processes in the blood of patients during thoracic surgery]. / Sostoianie protsessov perekisnogo okisleniia lipidov v krovi bol'nykh pri torakal'nykh operatsiiakh.

Lipid peroxidation processes (malonic dialdehyde, parameters of induced Fe(2+)-chemiluminescence) have been studied in 22 patients operated on for diseases of the lungs and mediastinum and 15 patients subjected to heart surgery for ischemic disease. It has been shown that the severity of the disease depends on the activity of lipid peroxidation and the presence of a toxic product, malonic dialdehyde, in the blood plasma. The incidence and severity of postoperative complications were also higher in patients with intensive lipid peroxidation. The necessity of preventive therapy with antioxidants both in the pre- and postoperative periods has been substantiated.