[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.

[New approach to postoperative delirium treatment].

The efficiency of different drugs for sedation was studied in 51 patients after large abdominal operations complicated by postoperative delirium. Diagnosis of postoperative delirium was established according to CAM-ICU criteria. Dexmedetomidine has demonstrated significantly decreased duration of delirium and hospital stay in intensive care unit in comparison with haloperidol. Besides, patients which received dexmedetomidine preserved opportunity for verbal contact. Also these patients interacted better with department's stuff.

[Abdominal sepsis and oxidative stress].

INTRODUCTION: Oxidative stress deserves special attention in the pathogenesis of sepsis. MATERIAL AND METHODS: The study included 96 patients with abdominal sepsis caused by advanced suppurative peritonitis and destructive pancreatitis. All patients were divided into 3 groups depending on the severity of sepsis. Level of malondialdehyde (MDA) was determined to evaluate the intensity of lipid peroxidation (LPO). Proteins oxidative modification was assessed according to level of sulfhydryl groups (SH-groups) and carbonyls in proteins. State of anti-oxidant system (AOS) was defined based on activity of catalase, peroxidase, superoxide dismutase and glutathione peroxidase in erythrocytes. RESULTS AND DISCUSSION: There was no relationship between severity of multiple organ failure, MDA concentration, SH-groups and anti-oxidant enzymes levels. At the same time positive correlation between severity of multiple organ failure and carbonyls content in proteins was revealed. CONCLUSION: In surgical patients sepsis develops on background of oxidative stress. Significant reduction of SH-groups in proteins by the moment of sepsis diagnosis is an unfavorable factor for outcome. The degree of multiple organ failure in patients with abdominal sepsis correlates with oxidative injury of proteinic structures.

[Glutamatergic neurotransmitter system in regulation of the gastrointestinal tract motor activity].

The review include actual facts, demonstrating high probability of glutamatergic neurotransmitter system role in the regulation of the gastrointestinal tract motor activity. These facts suggest significant role of the glutamatergic neurotransmitter system dysfunction in forming motor activity disorders of the digestive tract, including in patients in critical condition. The analysis is based on results of multiple experimental and clinical researches of glutamic acid and other components of the glutamatergic neurotransmitter system in central nervous system and autonomic nervous system (with the accent on the enteral nervous system) in normal conditions and with functioning changes of the glutamatergic neurotransmitter system in case of inflammation, hupoxia, stress and in critical condition.

[Glutamine, glutamate and citrulline concentration in blood plasma in patients in critical condition (pilot study results)].

UNLABELLED: Study objective was to evaluate and to compare glutamine, glutamate and citrulline plasma levels (Glu-p, Gl-p, Cit-p) with electrical activity indicators (EA) from the proximal small intestine in patients in critical condition (CC). MATERIALS AND METHODS: 27 patients in CC (15 women, 12 men, 70 +/- 14 years, from them "therapeutic profile" patients--12, "surgical"--15) have been surveyed and treated. At admission to reanimatology department (RD) Glu-p, Gl-p, Cit-p (by highly effective liquid chromatography), relative duodenal and jejunum EA--by peripheral electrogastrography--have been measured. Patients' 1st day general condition and 28-day survival rates in the RD were assessed by various scales. Glutamine preparations have not been administered. RESULTS: Relatively to norm Glu-p, Gl-p, Cit-p increase has not been observed. By Gl-p and Cit-p maintenance patients were classified into 2 clusters, nominally named accordingly to decreased or normal Gl-p level as glutamatergic system hypofunction condition (HCS) and glutamatergic system normofunction (NGS). HGS condition is associated with more expressed proximal small intestine EA and less 28-day RD survival (p < 0.05), the worst prognosis was observed in case of combination of more signified proximal small intestine relative EA depression with subnormal Gl-p or Cit-p less than 10 mcmol/l. CONCLUSION: HCS or NGS condition is characteristic for patients in extremely critical condition (with APACHE II 30 (24; 38)). Conjunction of glutamate (Gl) and its' biochemical metabolism indicators maintenance alterations in peripheral blood, small intestine EA parameters and 28-day survival rates in RD shows the participation of glutamatergic system in pathogenesis of functional gastrointestinal tract motor activity disorders in patients in CC, possible diagnostics courses and rationality of its hypofunction correction.

[Comparative effectiveness of different treatment methods of liver failure].

It was analyzed the results of treatment of 217 patients (139 men, 78 women) with chronic liver failure in case of liver cirrhosis of various etiology for study of degree of hepatic encephalopathyregression. All patients were divided into 3 groups. In the first group the drug therapy was used. In the second group additionallyplasma exchange was performed, in the third group - alsomolecular absorbent recirculating system was used (effectiveness of MARS-therapy).The results showed that the use of extracorporeal treatment techniques can effectively reduce the severity of hepatic encephalopathy in patients with liver cirrhosis. MARS-therapy improved the neurological status of patientsmore significantly in this case. It is considered that the inclusion of MARS-therapy in the combined treatment of patients leads to a significant reduction of hepatic encephalopathyseverity (1-2 points), in comparison with other methods of treatment.

[Simulation technologies in anesthesiology, resuscitation and intensive care: state of the problem].

The foundation of simulation technologies application in educational process is presented in the article. It is described difficulties during anesthesiologists-resuscitators training and education of physicians of not intensive care specialty in intensive care methods. It was emphasized that new innovative educational stage is formed at present time. It is simulation stage between preclinical and clinical stages. Theoretical foundation and practical evidence of efficiency of simulation training are expressed in detail.

[A comparative evaluation of "cerebral oximetry" during anesthesia with xenon and other anesthetics]. / Sravnitel'naia otsenka "tserebral'noi oksimetrii" pri anesezii ksenonom i drugimi anestetikami.

The oxygen status dynamics during the general anesthesia is one of the most important issues of anesthetic monitoring. The set target was to study the cerebral oximetry (rSO2) in anesthesia with xenon as compared with other anesthetics. A total of 80 patients (class ASA I-II) were examined in the venectomy surgery. According to an anaesthetic used in induction and anesthesia management, the patients were divided into 3 groups. Group 1--40 patients with xenon mono-anesthesia; group 2--20 patients with propofol + N2O + neurolpangesia; and group 3--20 patients with N2O + ftorotan. At xenon induction, rSO2 went up by 6.4%. At propofol induction, there were no changes in rSO2. A biggest increase in the cerebral blood circulation was noted, at the anesthesia management stage, in the patients' group, who received ftorotan; a lesser increase was registered in xenon anesthesia. An increased rSO2 level was higher, during the wakening stage, in case of ftorotan administration than in the group, which received xenon; the process of recovering the initial parameters was slower in the former group. Xenon and ftorotan were shown to contribute to a higher oxygen status and an increased volume of the cerebral blood circulation. In case of xenon mono-anesthesia, there was a smaller increase in the cerebral blood circulation as compared to N2O + ftoratan anesthesia. Further special investigations are needed to give a final answer to the question on whether it is possible to use xenon in neuroanesthesiology and in intensive care of patients with a neuroresuscitation-type pathology of the brain.

[Surgical treatment of abdominal aortic aneurysm in a patient with a horseshoe kidney (a case report)]. / Khirurgicheskoe lechenie anevrizmy briushnoi aorty u bol'nogo s podkovoobraznoi pochkoi (klinicheskii sluchai)..

This paper describes a clinical case of the treatment of a patient with associated abdominal aortic aneurysm and a horseshoe kidney. Examination revealed type II blood supply of the horseshoe kidney according to Crawford. The operation was performed from thoraco-phreno-lumbotomy on the left. During operation, we ligated the accessory renal artery with a good retrograde blood flow, branching out just from the aneurysmal sac. Examination carried out in the early and long-term postoperative period did not discover renal malfunction as shown by laboratory and radionuclide research methods.

[Electrophysiological features of xenon anesthesia]. / Nekotorye élektrofiziologicheskie osobennosti ksenonovoi anestezii.

One of the central problems of zenon anesthesia is evaluation of its adequacy. The bispectral index (BIS) is estimated empirically on the basis of electroencephalograms of patients treated with vapor-forming anesthetics. We investigated clinical and electrophysiological parallels of xenon monoanesthesia by using the EEG bispectral index. The study was carried out in 40 patients (ASA I-II) during venectomy under Xe anesthesia. Electrophysiological parameters were stable during maintenance and corresponded to the depth of anesthesia. Hence, monitoring of BIS and SEF-95 provides for an adequate control of anesthesia, while during induction and awakening the values of these indices are doubtful. The incorrectness of EEG BIS at these stages of Xe anesthesia is due to specific electrophysiological mechanisms of Xe, affecting mainly HMDA and H-cholinergic receptors of the CNS.